Italian Journal of Pediatrics最新文献

Background: Infection is a common complication of idiopathic nephrotic syndrome (INS), and early identification of severe infection can improve patient outcome.

Methods: This multicenter retrospective study developed and validated machine learning (ML) models that predict severe infection in children with INS. The derivation cohort (n = 2357) consisted of INS patients at one institution, and was separated into a training set and testing set. The external validation set (n = 372) consisted of INS patients from three other hospitals. Data were collected for 41 variables, and ten of them were then selected by univariate analysis and Least Absolute Shrinkage and Selection Operator (LASSO) regression. Ten ML models were compared, and the best one was identified using receiver operating characteristic (ROC) analysis and other methods.

Results: The incidence rate of severe infection was 6.8% in the derivation cohort. The Light Gradient Boosting Machine (LightGBM) model had the best predictive performance (accuracy: 0.843, precision: 0.843, recall: 0.842, F1: 0.843, sensitivity: 0.842, specificity: 0.844, AUROC:0.912, AUPRC:0.915). The ten predictors were C-reactive protein, hemoglobin, white blood cells, activated partial thromboplastin time, creatinine, high-density lipoprotein, corrected serum calcium, complement 3, and number of immunosuppressants, and incidence of SRNS. This model had an AUROC of 0.979 and AUPRC of 0.842 in the external validation cohort.

Conclusion: A LightGBM model for predicting severe infection in patients with INS had excellent performance. Future applications of this model may provide an effective, convenient, and cost-effective approach for early identification of severe infection in children with INS.

Background: Metabolic-associated fatty liver disease (MAFLD) has emerged as a critical pediatric health concern, particularly among children with obesity. However, its diagnosis poses substantial challenges, especially in the use of non-invasive methods. Our goal was to construct an online nomogram for screening MAFLD in obese children.

Methods: We designed a retrospective cross-sectional study involving 2,512 obese children. Detailed anthropometric data and laboratory parameters were collected. The study dataset was randomly allocated into training (n = 1758) and validation (n = 754) sets at a 7:3 ratio. To identify MAFLD risk factors, we conducted logistic regression analyses, from which a web-based predictive nomogram was constructed. Using receiver operating characteristic (ROC) curves and area under the curve (AUC), the nomogram's performance was assessed and contrasted with the triglyceride glucose (TyG) index, Zhejiang University (ZJU) index, and Korean NAFLD (K-NAFLD) score. The goodness-of-fit of the nomogram was evaluated using calibration plots, and the nomogram's clinical value was assessed using decision curve analysis (DCA).

Results: A total of 1,344 participants (53.50%) were diagnosed with MAFLD by ultrasound. Age, gender, BMI Z-score, waist circumference (WC), homeostatic model assessment of insulin resistance (HOMA-IR), and alanine aminotransferase (ALT) were identified as independent factors influencing MAFLD in obese children. These six variables were selected for the construction of the nomogram. ROC analysis revealed that the nomogram had superior diagnostic performance for MAFLD detection compared to the other three models, with AUC values of 0.874 (95% confidence interval [CI]: 0.858-0.890) in the training set and 0.870 (95% CI: 0.845-0.895) in the validation set. Calibration plots indicated a good fit of the nomogram in both datasets. Furthermore, DCA demonstrated its strong clinical applicability.

Conclusions: This study developed an online nomogram that demonstrates robust diagnostic accuracy and clinical utility for assessing obese children's MAFLD risk.

Copeptin, a stable surrogate marker of arginine vasopressin, has been implicated in blood pressure regulation, but its role in pediatric hypertension remains unclear. This systematic review evaluates the association between copeptin levels and hypertension in children and adolescents. A comprehensive search was conducted in PubMed, Scopus, Web of Science, Embase, and Cochrane Library up to February 21, 2025. Additional sources, including Google Scholar and reference lists of relevant articles, were screened to ensure literature saturation. Observational studies (cohort, case-control, and cross-sectional) assessing copeptin levels in relation to blood pressure in pediatric populations (< 18 years) were included. Copeptin levels were assessed using validated biochemical methods, including enzyme-linked immunosorbent assay. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Due to heterogeneity in study designs and outcome measurements, a narrative synthesis was performed. Twelve studies met the inclusion criteria, with sample sizes ranging from 25 to 351 participants. Some studies reported a significant association between higher copeptin levels and hypertension, particularly in children with obesity or metabolic disorders. However, other studies found no significant correlation. Differences in study design, sample characteristics, copeptin measurement methods, and confounding factors contributed to the heterogeneity of findings. The evidence on the association between copeptin and hypertension in children is inconclusive. While some studies support its potential role as a biomarker, inconsistencies highlight the need for standardized methodologies and longitudinal studies. Future research should explore copeptin's clinical utility in pediatric hypertension risk stratification.Systematic review registration number PROSPERO: CRD420251003190.

Background: Birth weight (BW) is an indicator for the assessment of neonatal health. No recent studies have specifically evaluated the distribution of BW in infants born in Lombardy and no updated regional neonatal charts are available. The aim of this study is to trace region-specific BW charts (CedAP charts) for neonates born in Lombardy and to compare them with the INeS charts, specific for Italian neonates, and with the Intergrowth21st (IG21) international neonatal charts.

Methods: Data of 361,105 singleton live births were extracted from the certificate of assistance in childbirth (CedAP) registry. The Extended Mechanistic Growth Function method was used to trace CedAP charts. The comparison with the INeS and the IG21 charts was performed by centiles shape, computing z-scores means and standard deviation, and by the proportion of small-for-gestational-age (SGA), appropriate-for-gestational-age (AGA), and large-for-gestational-age (LGA) detected with each chart.

Results: The CedAP charts are similar to the INeS charts, particularly at lower centiles, while at higher centiles the CedAP charts tend to show slightly higher values. Comparisons with the IG21 charts show more differences. According to INeS charts, the mean BW z-score is close to expected, with minor deviations observed across gestational ages (GA). According to IG21 z-scores, the mean values were negative for preterm classes and positive for term neonates. The SDs are comparable in all the three charts. The proportion of neonates classified as SGA is overestimated in IG21 charts at GA < 33 weeks and underestimated at term. In contrast, the INeS and CedAP classifications are more consistent, with CedAP showing a slight underestimation of SGA at term. The IG21 charts tend to classify fewer preterm neonates as LGA.

Conclusion: While IG21 represent a useful tool for studies of populations comparison, CedAP and INeS charts may be more appropriate for assessing neonates in Lombardy and throughout all Italy. These findings suggest that the INeS charts remain relevant for clinical practice, CedAP charts providing complementary, region-specific charts. Further studies are needed to assess the clinical predictive performance of different neonatal charts in identifying neonates at risk for adverse outcomes.

Background: The transient Headache and Neurological Deficit with cerebrospinal fluid Lymphocytosis (HaNDL) Syndrome is a rare form of primary headache, with few cases reported in children.

Case presentation and review: We report the case of a 15-year-old female with HaNDL syndrome showing paresthesia to the right side of her face and upper limbs, asthenia, dysarthria and aphasia, followed by left periorbital pulsating headache with moderate nausea, lasting about four hours. Forty-four cases of pediatric HaNDL syndrome are reported in literature (ours included), but only 25 fulfilled all diagnostic criteria according to ICHD-3. Overall, 59.1% were females. Sensory symptoms affected 71.4% of patients, followed by impaired speech (69.0%) and motor symptoms (52.4%). At CSF analysis, the mean value of white blood cells was 201.1/µl; proteinorrhachia was reported in 31 patients (70.5%). When asked, neuroimaging was negative. Symptomatic treatment was reported only in 14 patients (31.8%).

Conclusions: HaNDL is a rare self-limiting syndrome affecting both adults and children. The etiology is unknown, but autoimmune mechanisms have been proposed. HaNDL is a diagnosis of exclusion: differential diagnoses include stroke, tumors, epilepsia, neuro-infective disorders, autoimmune encephalitis, vasculitis, hemiplegic migraine and migraine with aura. Usually, HaNDL episodes last less than 3 months; therapy is symptomatic. The diagnostic work out includes CSF analysis, neuroimaging and EEG. The treatment is symptomatic, and the course is self-limiting, usually resolving within 3 months.

Background: E-cigarettes and Heated Tobacco Products (HTPs), which emerged as "safer" alternatives to traditional cigarettes, remain easily accessible and widely misperceived as harmless, especially among adolescents. Our study aimed to assess the prevalence of e-cigarette and HTP use among Italian adolescents, and investigate underlying motivations, risk perceptions, and social influences.

Methods: We conducted a cross-sectional survey among 200 adolescents aged 11-18 years. Participants completed a 50-item anonymous questionnaire exploring sociodemographic characteristics, smoking behaviors, reasons for use, risk awareness, and social influence.

Results: Among participants, 23% reported using e-cigarettes and 16% HTPs. Disposable, flavored and nicotine-containing products were highly prevalent. Among vapers, use was significantly more frequent in those aged > 14 years, and in individuals reporting social influence, stress, or sadness/apathy. Similar patterns were observed among HTP users. Risk perception was low: 85% of participants believed e-smoking was less harmful than conventional smoking, and only 5% recognized e-cigarettes as significantly harmful. Only 20% of all participants had been asked about smoking during medical visits, with significantly lower rates among those < 14 years. A comprehensive analysis of usage patterns, psychosocial correlates, and risk perception is provided in the full manuscript.

Conclusion: The underestimation of health risks associated with electronic smoking devices pose a serious Public Health challenge. Findings highlight the urgent need for targeted interventions combining stricter access control, enhanced risk communication, and integration of tobacco prevention into school and clinical settings. Greater attention should be paid to the psychological dimension of adolescent smoking and the evolving landscape of nicotine delivery systems.

Background: This study aims to inform the enhancement of prevention and control strategies for Kawasaki disease (KD) by conducting a retrospective analysis of its clinical features in the context of the Omicron pandemic.

Methods: KD cases from the three years preceding the Omicron pandemic were categorized as the control group, while cases occurring during the Omicron pandemic were designated as the observation group. Comparative analyses were performed between these groups, focusing on demographic characteristics such as the proportion of hospitalizations for KD, age, gender, and place of residence, as well as clinical data encompassing symptoms, laboratory findings, imaging results, diagnosis and treatment, and prognosis.

Results: A total of 407 children participated in the study, with 180 allocated to the observation group and 227 to the control group. During the Omicron outbreak, the proportion of KD among hospitalized children gradually declined, with a more pronounced decrease observed in rural areas compared to urban areas. No significant differences were noted in age, sex, or season between the two groups. Compared to the control group, the observation group demonstrated a lower incidence of conjunctival congestion, extremity changes, mucosal alterations, and joint and urinary system damage (P < 0.05). Furthermore, our study identified significantly elevated levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), increased rates of valve regurgitation and pericardial effusion, and prolonged recovery time for inflammatory markers in the observation group (P < 0.05). Additionally, no statistically significant differences were observed in coronary lesions during the one-year follow-up period.

Conclusion: Because of the Omicron pandemic, the proportion of children hospitalized for KD decreased. Meanwhile, the incidence of clinical symptoms was low, and the inflammatory reaction was heavy. Moreover, there was a trend towards increased IKD and IVIGR and no difference in coronary lesions at 1 year of follow-up. This might indicate that we should pay attention to early diagnosis of IKD and treatment of IVIGR to prevent and treat KD.

Trial registration: Retrospectively registered.

Background: In this Debate, based on our clinical data from the "pre-nirsevimab" and "first year of nirsevimab implementation" bronchiolitis seasons, we challenge the validity of policy decisions that led to partial immunization coverage of eligible newborns and infants during the 2024-25 season in Italy.

Main body: Starting with a pre-nirsevimab prospective cohort of 780 newborns, we documented that 84 (9.2%) were diagnosed with acute bronchiolitis (45 of them (5.8% of the cohort) were RSV positive. 44 patients (5.6%) were hospitalized due to bronchiolitis, of which 7 (0.9%) patients were admitted to the Pediatric Intensive Care Unit. Among hospitalized, 31 infants (70%) had RSV infection. Secondly, we evaluated the impact on bronchiolitis admissions during the first year of nirsevimab use in our region, showing a negligible effect on the most severe cases, probably due to the fact that a low coverage will risk to miss the relatively small number of infants (about 10%) that will develop RSV bronchiolitis in the first year of life. These findings inspired our clinical insights and reflections arguing that without a long-term, cost-conscious approach to implementation, even major scientific breakthroughs like nirsevimab risk becoming public health failures.

Conclusions: Our clinical insights and reflections aim to inspire deeper engagement among policymakers, health agencies, and clinicians to better adapt and integrate RSV preventive strategies-maximizing benefit not only for susceptible infants, but for society at large. In a world of finite healthcare resources, optimizing both the reach and the value of such essential interventions is imperative, given the multitude and diversity of health needs our society is facing.

Background: To investigate the characteristics of co-infection pathogen profiles in children with adenovirus pneumonia and provide guidance for clinical diagnosis and rational treatment.

Methods: A retrospective analysis was conducted on the etiological results of co-infections in children hospitalized with adenovirus pneumonia in the Respiratory Department of Hebei Children's Hospital from January 1, 2024, to December 31, 2024. Differences in co-infections across genders, age groups, and seasons were analyzed.

Results: Among 5,373 children hospitalized with community-acquired pneumonia, 330 cases (6.1%) were diagnosed with adenovirus pneumonia, of which 310 (93.9%) exhibited co-infections. Bacterial co-infections predominated (70.0%, 231/330), with Streptococcus pneumoniae (45.2%), Haemophilus influenzae (40.9%), and Moraxella catarrhalis (2.7%) being among the most frequently detected, followed by Staphylococcus aureus (2.4%), Bordetella pertussis (2.1%), Pseudomonas aeruginosa, Enterobacter cloacae, and Streptococcus pyogenes. Viral co-infections were identified in 45.5% (150/330), primarily rhinovirus (26.4%), influenza A/B (7.3%), parainfluenza virus (5.8%), respiratory syncytial virus (RSV, 4.8%), metapneumovirus (4.5%), coronavirus (1.5%), and bocavirus (0.3%). Additionally, Mycoplasma pneumoniae co-infections accounted for 44.5% (147/330). Gender-specific analysis revealed significantly higher RSV co-infection rates in girls than boys (P < 0.05), with no notable gender disparities for other pathogens. Age-related differences showed higher bacterial co-infection rates in infants/toddlers compared to preschool/school-age groups (P < 0.05), where Streptococcus pneumoniae peaked in infants/toddlers, parainfluenza virus was most frequent in infants/toddlers, and Mycoplasma pneumoniae predominated in school-age children. Seasonally, co-infection rates remained consistent year-round, though RSV and influenza A/B peaked in winter, parainfluenza virus in summer, metapneumovirus was least detected in summer, and Mycoplasma pneumoniae exhibited the highest positivity in autumn and the lowest in spring.

Conclusion: Adenovirus pneumonia in children in this region exhibits a high rate of co-infections, predominantly bacterial (especially Streptococcus pneumoniae and Haemophilus influenzae), followed by viral (rhinovirus, influenza, parainfluenza, RSV) and Mycoplasma pneumoniae. Co-infection profiles vary by gender, age, and season. Timely identification of co-pathogens is critical for guiding rational antimicrobial use and improving prognosis.