Italian Journal of Pediatrics最新文献

Background: This study aimed to analyze the clinical characteristics and identify predictive factors associated with small segment molded sputum plugs in pediatric patients with Mycoplasma pneumoniae pneumonia (MPP).

Methods: A retrospective analysis was performed on the clinical data of pediatric patients diagnosed with MPP who underwent bronchoscopy at our hospital between December 2021 and April 2024. Multivariate logistic regression was employed to determine independent predictors of small segment molded sputum plug formation.

Results: Among 116 pediatric patients with MPP who met the study criteria, 48 (41.38%) were found to have small segment molded sputum plugs, while 68 (58.62%) did not. Patients with a history of recurrent respiratory infections, diminished breath sounds, and radiological evidence of atelectasis were significantly more likely to develop molded sputum plugs (P < 0.05). Furthermore, the group with small segment molded sputum plugs exhibited a longer duration of fever (P = 0.025) and elevated levels of procalcitonin (PCT; P = 0.024), alanine aminotransferase (ALT; P = 0.048) and prothrombin time (PT; P = 0.021). Multivariate logistic regression analysis identified a history of recurrent respiratory infections and diminished breath sounds as independent predictors for the development of small segment molded sputum plugs.

Conclusions: A history of recurrent respiratory infections and diminished breath sounds emerged as independent predictors of small segment molded sputum plugs in pediatric MPP. These findings highlight the importance of considering these clinical features during the evaluation of MPP patients to inform diagnostic and therapeutic decision-making. Future studies are warranted to investigate the potential benefits of early detection and intervention on clinical outcomes in pediatric MPP.

Background: Congenital Pulmonary Airway Malformation (CPAM) is a rare lung anomaly in pediatric patients, often diagnosed prenatally or postnatally. Although typically asymptomatic, CPAM can present with severe complications such as recurrent infections or lung abscesses. Thoracic ultrasound (LUS) is emerging as a valuable diagnostic tool, offering a non-invasive and radiation-free alternative to traditional imaging.

Case presentation: We present the case of a 2-year-old girl with persistent fever, cervical lymphadenopathy, and elevated inflammatory markers, initially raising suspicion for incomplete Kawasaki disease (KD). Despite the administration of intravenous immunoglobulin (IVIG), the fever persisted, prompting further investigations. Lung ultrasound revealed a 5.5 cm lesion with hyperechoic spots and vascularization, suggestive of a lung abscess associated with CPAM. Diagnosis was confirmed by chest CT, and the patient was successfully treated with targeted antibiotic therapy.

Conclusions: This case highlights the importance of considering CPAM as a differential diagnosis in pediatric patients with persistent fever of unknown origin. It also underscores the potential of lung ultrasound as a non-invasive diagnostic tool, complementing traditional imaging methods, in the management of complex pediatric conditions.

Background: This study aimed to investigate the differences in anterior fontanelle closure time and size between children with non-syndromic craniosynostosis and controls on CT imaging.

Methods: A retrospective cross-sectional study was conducted involving 182 children with non-syndromic craniosynostosis and 2,777 age-matched controls (≤ 36 months). The status, size, and timing of anterior fontanelle closure were compared between the two groups. Receiver Operating Characteristic (ROC) curve analysis was utilized to assess the diagnostic value of anterior fontanelle measurements. Additionally, correlation analysis was performed to determine the relationship between age and fontanelle size.

Results: Patients with craniosynostosis exhibited higher closure rates under 24 months, particularly at 7-9 months (22.7% vs. 3.2%, P < 0.0001) and 10-12 months (50.0% vs. 6.9%, P < 0.0001), but lower closure rates at 25-36 months (80.0% vs. 94.0%, P < 0.01). ROC curve analysis identified an optimal cut-off age for fontanelle closure of 9.5 months in craniosynostosis patients (AUC = 0.85) and 17.5 months in controls (AUC = 0.93). Spearman correlation analysis revealed weaker relationships between age and fontanelle size in craniosynostosis patients compared to controls.

Conclusions: Anterior fontanelle measurements, particularly closure timing and size, have potential as assistant markers for the early identification of craniosynostosis. However, definitive diagnosis requires clinical evaluation and imaging confirmation. These findings underscore the importance of early recognition and intervention in craniosynostosis to prevent complications.

Allergic rhinitis (AR) and recurrent respiratory infections (RRIs) are common conditions that significantly impact quality of life and healthcare systems. Thermal water inhalation therapies have emerged as a potential non-pharmacological option due to their immunomodulatory and anti-inflammatory properties. This narrative review aimed to evaluate the efficacy and safety of thermal water inhalations in managing patients with AR and RRIs. The inclusion criteria were pertinent articles written in English and published in journals listed in PubMed. Six studies conducted in Italy, involving 548 participants (most of whom were children and adolescents), met the inclusion criteria. Significant improvements were observed in nasal mucociliary transport time, with reductions ranging from 2 to 8 min across treatment groups. Total Symptom Scores decreased significantly (one study reported a > 50% reduction). The frequency and duration of upper respiratory tract infections were reduced considerably in the treatment groups compared to the controls. However, results for nasal cytology were inconsistent, and heterogeneity in study designs limited comparability. The reviewed studies highlighted the potential of thermal water therapies to enhance mucociliary clearance, alleviate symptoms, and reduce reliance on other pharmacological treatments. On the other hand, these studies have a regional limitation and this review was not systematic. In conclusion, this narrative review may suggest that thermal water inhalations could be a promising option for managing patients with AR and RRIs, providing an alternative therapy with significant clinical benefits. Nevertheless, further high-quality, standardized, and international studies are necessary to confirm these findings and facilitate meta-analyses. These treatments could play a valuable role in reducing the burden of respiratory and allergic conditions.

Beckwith-Wiedemann spectrum (BWSp) is a congenital imprinting disorder characterized by overgrowth, cancer predisposition, and diverse clinical manifestations, resulting from epigenetic and genetic alterations at chromosome 11p15.5. BWSp represents the most common imprinting disorder, with a prevalence exceeding 1:10,000. The disorder is primarily associated with loss or gain of methylation at imprinting control regions IC2 and IC1, paternal uniparental disomy of 11p15, or pathogenic variants in CDKN1C. Advances in molecular diagnostics have refined genotype-phenotype correlations, improving both clinical management and tumor screening protocols. This review, produced by the Scientific Committee of the Italian BWSp Association (AIBWS), builds upon the 2018 international consensus, incorporating updated scientific evidence up to 2024. The committee critically assessed post-2017 literature using PRISMA and Delphi methodologies to revise ten key topics, including diagnosis and criteria, prenatal testing, molecular testing strategies, tumor surveillance, macroglossia surgery, growth monitoring, limb-length discrepancy, cognitive and psychosocial outcomes, and MLID (multi-locus imprinting disturbances). A major focus is optimizing diagnosis in cases with negative methylation tests on DNA from blood, where somatic mosaicism often necessitates alternative tissue testing. The review emphasizes prenatal diagnosis challenges, recommends including ART-related pregnancies in diagnostic criteria, and proposes a prenatal scoring system. Updated tumor surveillance strategies are presented, including universal α-fetoprotein screening for hepatoblastoma up to 3 years and genotype-based protocols for Wilms tumor. CDKN1C-related neuroblastoma surveillance is also addressed. MLID, often co-occurring with IC2-LoM, is discussed regarding clinical relevance, testing strategies, and implications for recurrence risk, particularly involving maternal-effect gene variants. Orthopedic and surgical management of limb-length discrepancy (LLD) and macroglossia is reviewed, alongside growth chart development and their role in personalized interventions. New findings on cognitive, behavioral, and psychosocial aspects highlight the need for routine screening and supportive care. The transition to adult care remains underexplored, though recommendations include attention to residual pediatric complications, fertility, and potential long-term risks. This review reinforces the importance of a multidisciplinary and personalized approach to BWSp across the lifespan, calling for further research to refine diagnostics, long-term outcomes, and transition models.

Ceftriaxone is commonly used in pediatric infections, but its association with cholelithiasis poses potential health concerns. To determine the pooled frequency of ceftriaxone-induced cholelithiasis in pediatric patients and identify factors commonly associated with its occurrence. Web of Science, PubMed, Google Scholar, and Scopus were systematically searched until March 2024.Studies reporting ceftriaxone-induced cholelithiasis in pediatric patients (0-18 years) were included. Randomized controlled trials (RCTs) and prospective and retrospective cohort studies published in English were eligible. PRISMA guidelines were followed. The Newcastle‒Ottawa Scale and CASP tools were used to assess risk of bias. A random-effects meta-analysis estimated the pooled frequency. Sensitivity analysis was conducted to explore heterogeneity. The primary outcome was the pooled frequency of ceftriaxone-induced cholelithiasis. Secondary outcomes included identification of factors commonly associated with its occurrence and their impact on symptom burden. Eleven studies (1 RCT, 10 cohort studies) met the inclusion criteria. The pooled frequency of cholelithiasis was 15% (95% CI: 9-23%), with significant heterogeneity (I² = 81.76%). Commonly associated factors included high ceftriaxone doses (> 2 g/day), prolonged use (> 5 days), short bolus injections, and dehydration. Most cases resolved upon discontinuation, but symptomatic patients experienced nausea, vomiting, and abdominal pain. Ceftriaxone-induced cholelithiasis is relatively common in pediatric patients, particularly those with associated risk factors. Clinicians should monitor for biliary complications and consider alternative treatments when feasible. PROSPERO REGISTRATION: CRD42024503807.

Antimicrobial Stewardship Programs (ASPs) and Diagnostic Stewardship Programs (DSPs) are essential for optimizing infectious disease management and addressing antimicrobial resistance (AMR). However, the implementation of pediatric ASPs presents distinct challenges that set them apart from adult-focused initiatives. Additionally, many existing ASP guidelines are primarily tailored to the U.S. healthcare system, requiring significant adaptation to fit the diverse healthcare infrastructures, resources, and prescribing practices across different countries. These factors highlight the need for context-specific strategies to ensure the effective implementation of pediatric ASPs worldwide. To develop a national, intersociety consensus on pediatric ASPs in Italy, an ASP steering committee was established, bringing together a multidisciplinary group of experts. A systematic scoping review was conducted to identify relevant literature on ASPs and DSPs published between 2007 and August 2024, retrieving 260 articles. Based on this evidence, 33 recommendations were formulated, covering general ASP and DSP principles (10 recommendations), ASP interventions (14), DSP interventions (3), and monitoring strategies (6). Consensus on the importance and feasibility of each recommendation was reached using the Delphi method, with two rounds of anonymous questionnaires. The steering group defined a priori criteria for recommendation acceptance, requiring at least 80% agreement on the importance of each item. This consensus highlights the critical role of a multidisciplinary approach in ASP implementation, supported by institutional leadership. Given the variability in healthcare systems, ASP interventions must be tailored to specific settings, considering factors such as hospital resources, patient complexity, and the parent-child dynamic. Standardized metrics for assessing the impact of ASPs are essential for benchmarking and ensuring sustainability, although data collection remains a significant challenge. While there was strong agreement on the importance of the recommendations, feasibility assessments identified key areas requiring further refinement, particularly in settings with limited pediatric-specific expertise and diagnostic tools. This national consensus provides a structured framework for the implementation of pediatric ASPs in Italy, equipping clinicians with essential tools to optimize antibiotic use in both inpatient and outpatient settings. It represents a foundational step toward improving pediatric ASP, fostering national and international collaboration, and guiding future research to address implementation barriers.