Italian Journal of Pediatrics最新文献

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.

Background: Infant colic is a common functional gastrointestinal disorder characterized by excessive crying with no effective treatment available. We aimed to evaluate the efficacy of a mixture of Tyndallized Bacillus Coagulans and Simethicone in reducing the crying time in colicky infants and improving quality of sleep and infants' and parents' quality of life.

Methods: A pilot study was conducted on a group of 41 infants with diagnosis of Infant Colic according to Rome IV criteria. We administered to all the enrolled infants a mixture of Tyndallized bacillus coagulans and Simethicone for 28 days. The primary outcome was the mean infant crying duration at 28th day. The secondary outcome was the improvement in the quality of sleep and infants' and parents' quality of life.

Results: Forty-one infants were enrolled, two didn't complete the study. In 89% of patients, we observed at least a 50% reduction in crying time at 28 days post-intervention. This success rate was significantly higher (p < 0.001) compared to a physiological reduction in newborn/infant crying, estimated at 39%. We observed that the mean daily crying time at the end of the treatment was significantly lower (p < 0.001). Regarding the sleep duration we found a significantly longer diurnal and nocturnal sleep at 28th day (p < 0.001 and p < 0.001, respectively). In addition, a significant improvement of mothers' and fathers' quality of life and severity perception of IC was detected at 28th day (p < 0.001 and p < 0.001, respectively). No relevant adverse events were observed.

Conclusions: Tyndallized bacillus coagulans and Simethicone seems to be promising in the management of infants with colic. Nevertheless, further studies are needed to confirm this preliminary data.

Trial registration: ClinicalTrial.gov, NCT06458881. Registered 11 June 2024-Retrospectively registered.

Background: The 2021 updated guidelines revised the bronchodilator responsiveness (BDR) positivity criteria to an increase in FEV₁ or FVC of > 10% of the predicted value. This new standard aims to reduce the impact of baseline lung function variability in determining BDR. However, it should be noted that supporting evidence for children and young adults is limited and thus cannot provide fully substantiated recommendations. The study systematically compare the test results of the BDR diagnostic criteria in the 2005 and 2021 versions of the ERS/ATS guidelines in a clinical setting in children of different age groups with asthma and to explore the reasons for the differences.

Methods: This was a single-center, retrospective, cross-sectional study. The applications of the 2005 and 2021 versions of BDR standards in different age groups(4-5 years, 6-11 years, 12-18 years) with asthma was compared, the lung-function characteristics of children with inconsistent results were analyzed, and the trend of the proportion of BDR + changing with the degree of airflow obstruction was analyzed.

Results: A total of 1,525 children with asthma were included in this study. There is a significant difference in the number of inconsistent group between the two methods (P < 0.01). In each age group, the number of people in the 2005 + 2021- group was higher than that in the 2005-2021 + group. The kappa consistency test revealed the kappa values of all age groups to be > 0.80 (P < 0.01) and consistent. The inconsistent group had lower lung-function values than the consistent group. The 2005BDR-2021BDR + group of lung-function values were higher than 2005BDR + 2021BDR- group. The analysis revealed that only Z-FEV1 (OR = 0.773, 95% CI: 0.650 to 0.919, p = 0.004) was an independent factor of Inconsistent results.The trends of 2005BDR + and 2021BDR + were consistent with the degree of airflow obstruction, indicating a weak positive correlation.

Conclusions: The kappa test showed that the results of 2005BDR and 2021BDR were consistent, but there were differences between the inconsistent groups. Z-FEV1 is an independent factor affecting the inconsistent results, so baseline data is the main reason for the inconsistent results of the two methods. The 2021BDR standard may reduce the influence of baseline lung function when determining the results. The positive rate obtained based on the two evaluation criteria maintained the same trend with the degree of airflow obstruction. All showed a weak positive correlation.

Background: This study investigated the differences in clinical features of acute lower respiratory tract infection in children caused by suspected Omicron, respiratory syncytial virus (RSV), and influenza virus A (Flu A).

Methods: A retrospective analysis was conducted on the clinical data of 241 hospitalized children with lower respiratory tract infections due to suspected Omicron, RSV, or Flu A at Chengdu Women and Children's Central Hospital from December 9, 2022 to August 1, 2023. Differences in age, sex, clinical characteristics, laboratory results, imaging findings, and fractional exhaled nitric oxide (FENO) results between the three viral infections were analyzed.

Results: Patients infected with suspected Omicron were predominantly infants and toddlers; in contrast, those infected with Flu A were mostly preschool children. Fever was most common in Flu A-infected patients, followed by RSV-infected and Omicron-infected patients. Inspiratory crackles in the lungs were most frequently observed in suspected Omicron-infected patients, whereas wheezing was more common in RSV-infected patients. No wheezing was observed in the lungs of any suspected Omicron-infected patients. Patients with both suspected Omicron and RSV infections had longer hospital stays. Notably, Flu A infection significantly decreased white blood cell count and increased neutrophil percentage (Neu%) compared with the other two infections. Furthermore, patients with suspected Omicron infection exhibited a pronounced reduction in Neu%; however, the decrease in lymphocyte percentage (Lym%) was considerable in all groups, with the Flu A-infected group showing the greatest decline. C-reactive protein levels were markedly higher in the RSV- and Flu A-infected groups. Liver function was significantly affected in suspected Omicron-infected patients, who were also more likely to have Mycoplasma pneumoniae or bacterial infections. Pulmonary consolidation was more common in suspected Omicron-infected patients, and they had the highest positive rate of FENO.

Conclusions: The clinical manifestations of suspected Omicron infection in patients with acute lower respiratory tract infections are similar to those of Flu A and RSV infections. However, these infections exhibit more severe liver function damage, lung consolidation, and airway inflammation. Paying attention to respiratory tract infections caused by the suspected Omicron virus in children is imperative to ensure timely and appropriate diagnosis and treatment. Promoting child vaccination remains crucial for safeguarding susceptible populations and protecting children's health.

Acetaminophen and ibuprofen are among the most commonly used over-the-counter (OTC) medications for managing fever and pain in children. Although their safety profiles are well established, there has been a progressive increase in reports of suspected adverse drug reactions (ADRs) in pediatric populations in recent years. This trend may be partly attributable to improved reporting systems, but also to increased consumption. For example, the proportion of pediatric ibuprofen packages purchased without a prescription rose from 28% in 2008 to 70% in 2015. From 2020 to 2024, pediatric ibuprofen use grew by over 60%, and accordingly, the number of reported ADRs also increased. This rise may be due to specific pharmacovigilance programs targeting pediatric populations and the fact that, since 2009, ibuprofen in Italy no longer requires a prescription, making it more accessible and widely perceived as safe.To provide a narrative review of suspected ADRs related to Acetaminophen and ibuprofen use in children.A literature search was conducted using PubMed and Embase databases, employing the following terms: (Children OR Pediatrics) AND (Acetaminophen OR Ibuprofen OR NSAID OR Nonsteroidal Anti-Inflammatory Drugs) AND (Adverse Events OR ADRs).A total of 337 records were identified, of which 15 studies were eligible for inclusion. According to Italian consumption data from the last five years, acetaminophen use declined from 68.8% in 2019 to 63.5% in 2024, while ibuprofen use increased from 31.2% to 36.7% (2). Additionally, the number of pediatric ibuprofen packages purchased increased by 61% between 2019 and 2024. Data from the European spontaneous reporting database (EudraVigilance) also showed a significant rise in reported ADRs in children receiving either drug. However, for comparable levels of use, ibuprofen appears to be associated with a higher rate of potentially serious adverse events.Our analysis shows a marked increase in reported ADRs related to antipyretic use in children, likely linked to the rising use of ibuprofen in recent years. These findings emphasize the need for better parental education and healthcare provider guidance on the safe and appropriate use of antipyretics in pediatric patients.

Background: GNAO1-related disorders (GNAO1-RD) encompass a wide phenotypic spectrum, including muscular hypotonia, movement disorders (MD), epilepsy, developmental delay, and intellectual disability. MD often presents with dystonia and choreoathetosis, and dyskinetic crises can lead to life-threatening conditions. Despite increasing reports, limited information exists on the impact of upper airway dysfunction in GNAO1-RD patients. This study examines the implications of muscular hypotonia on upper airway function and subsequent clinical outcomes.

Methods: This study includes four patients, three from the GNAO1 registry in Germany, with data collected from medical records including neurological examinations, EEG recordings, genetics, imaging studies, and video documentation of dyskinetic movements and respiratory symptoms. Treatment interventions and clinical outcomes were documented.

Results: The study involved four patients (three males and one female) aged between 15 months and 12 years, all of whom were within the severe spectrum of GNAO1-RD. All patients exhibited severe hypotonia and hyperkinetic MD, leading to recurrent dyskinetic crises. Respiratory complications included an inspiratory stridor and airway obstructions. All patients died at young age (2.4, 2.8, 7.8 and 12 years) due to respiratory complications. Despite interventions such as DBS and tracheostomy, clinical outcomes remained poor.

Conclusions: Upper airway dysfunction significantly contributes to the high morbidity and mortality in GNAO1-RD patients. Current therapeutic options are limited; while DBS can be life-saving during acute crises, it does not address swallowing or airway dysfunction effectively. Multimodal approaches and larger, multicenter trials are needed to improve outcomes for these patients.

Pediatric stroke is a life-threatening emergency condition characterized by a wide range of presentations, which frequently delays the diagnosis and intervention. This study aimed to evaluate the clinical presentation, diagnostic approaches, and outcomes of pediatric patients presenting with suspected stroke in emergency settings. A systematic search was conducted in PubMed, Embase, Cochrane Library, Scopus, and Web of Science for studies published up to May 2024. Nineteen peer-reviewed studies investigating pediatric stroke in emergency settings were included. A qualitative synthesis was performed, and meta-analysis was conducted when appropriate. The risk of bias was assessed using the NIH Quality Assessment Tool for Observational Cohort and Case Series Studies. Out of 2,958 identified records, 19 studies (13 cohort studies and 6 case series) met the inclusion criteria, with 8 eligible for meta-analysis. The pooled mortality rate was 19.2% (95% CI: 8.1%-30.4%), while intubation and ICU admission were required in 21.6% (95% CI: 10.9%-32.3%) and 37.6% (95% CI: 18%-57.2%) of cases, respectively. The average hospital stay was 11.12 days (95% CI: 8.58-13.65). CT was more frequently used (80.71%) than MRI (35.86%) for neuroimaging. The mean time from symptom onset to diagnosis was 9.95 h. Variability in prehospital management and diagnostic accuracy was noted across studies. Migraines (19.39%) and seizures (12.75%) were the most common non-stroke diagnoses reported. Pediatric stroke remains underrecognized and frequently misdiagnosed in emergency settings. Delays in diagnosis, reliance on CT over MRI, and inconsistent triage practices contribute to suboptimal outcomes. Standardized, pediatric-specific stroke protocols emphasizing early recognition, appropriate imaging, and timely intervention are urgently needed to improve patient care and outcomes.