Italian Journal of Pediatrics

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ISSN / EISSN : 1824-7288 / 1824-7288
Published by: Springer Nature (10.1186)
Total articles ≅ 1,748
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, Giuseppina Mansi, Carmine V. Lambiase, Marta Barone, Valeria Piro, Marcella Pesce, Giovanni Sarnelli, Francesco Raimondi, Letizia Capasso
Published: 24 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-9; https://doi.org/10.1186/s13052-022-01202-z

Abstract:
Backgorund: Parents after Neonatal Intensive Care Unit (NICU) hospitalization of preterm infant may develop psychopathological symptoms. The aim of the study was to determine how parental stress and psychophysical wellbeing affect posttraumatic symptoms (PTTS) in parents during the first year after NICU discharge. Moreover, this study aimed to explore any gender-specific difference in psychological distress among mothers and fathers. Methods: Prospective study design from September 2018 to September 2019. 20 pairs of parents of preterm infants admitted to a tertiary-level NICU were enrolled. Primary outcome was evaluation of PTTS in parents of preterm infants at one year after NICU discharge through Impact of Event Scale- Revised. Secondary outcomes were: impact of parental stress, psychophysical wellbeing, anxiety and depression respectively through Parental Stressor Scale: NICU, Short Form Health Survey-36(SF-36), Self-rating Anxiety Scale and Self-rating Depression Scale. Results: Mothers experienced higher rates of PTTS than fathers across the first year after NICU discharge (55% vs 20%). Maternal avoidance symptoms were associated with perception of their own infant look. Emotional aspects linked to maternal role predicted 36,8% of their hyperarousal symptoms. Maternal PTTS severity was predicted by their social functioning. Paternal mental health was associated both with maternal and paternal intrusive symptoms.. Maternal stress was associated with paternal avoidance symptoms. Paternal mental health predicted their hyperarousal symptoms (40%) and PTSD severity (52%). Conclusions: Parents who experienced NICU hospitalization of their own infant are at heightened risk to develop psychopathological symptoms. According to our initial hypothesis, investigating parental psychophysical wellbeing, through SF-36, originally provides a valuable support to detect parents at higher risk to develop posttraumatic outcomes across the first year after NICU discharge. In addition, paternal depression deserves to be taken into account since hospitalization as it could impact paternal PTSD development. Finally, these findings provide an initial evidence of gender-related patterns in PTSD development and psychological distress among mothers and fathers across the first year of their infant.
Noemi Graziano, , Francesca Chiaraviglio, Céline Betti, Arianna Piffer, Mario G. Bianchetti, Gregorio P. Milani
Published: 24 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-4; https://doi.org/10.1186/s13052-022-01203-y

Abstract:
Background: The biochemical hallmarks of transient pseudo-hypoaldosteronism associated with a pyelonephritis include hyponatremia, hyperkalemia, and acidosis. We tested if the kidney-urinary tract ultrasound helps in predicting the diagnosis of overt pseudo-hypoaldosteronism in infants with a pyelonephritis. Cases presentation: Between 2013 and 2020, we managed 71 previously healthy infants 4 weeks to 24 months of age with a pyelonephritis (42 males and 29 females) and made the biochemical diagnosis of pseudo-hypoaldosteronism in 17 (24%). Infants with and without pseudo-hypoaldosteronism did not significantly differ with respect to the prevalence of kidney-urinary tract ultrasound abnormalities, graded by means of the UTD classification system of urinary tract abnormalities. Conclusions: Kidney-urinary tract ultrasound is almost routinely obtained in children with a febrile urinary tract infection. Our experience does not support the hypothesis that ultrasound might be relevant for the diagnosis of overt transient pseudo-hypoaldosteronism in babies affected by a urinary tract infection. Our data confirm the assumption that negative studies may be important for advancing clinical practice.
, Amare Belachew, Sileshi Mulatu, Tigabu Desie Emiru, Nigusie Selomon Tibebu, Moges Wubneh Abate, Adane Birhanu Nigat, Amsalu Belete, Belete Gelaw Walle
Published: 21 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-8; https://doi.org/10.1186/s13052-022-01204-x

Abstract:
S: Background: Burn is one of the leading causes of preventable death and disability every year in low and middle-income countries, which mainly affects those aged less than 15 years. Death from burn injuries carries the most significant losses, which often have grave consequences for the countries. Even though data from different settings are necessary to tackle it, pieces of evidence in this area are limited. Thus, this study was aimed to answer the question, what is the Magnitude of Mortality? And what are the factors associated with mortality among burn victim children admitted to South Gondar Zone Government Hospitals, Ethiopia, from 2015 to 2019? Methods: Institutional-based cross-sectional study design was used to study 348 hospitalized burn victim pediatrics’, from 2015 to 2019. A simple random sampling method was used. Data were exported from Epidata to SPSS version 23 for analysis. Significant of the variables were declared when a p-value is < 0.05. Result: The mortality rate of burn victim children in this study was 8.5% (95% CI = 5.5–11.4). Medical insurance none users burn victim children were more likely (AOR 3.700; 95% CI =1.2–11.5) to die as compared with medical insurance users, burn victim children with malnutrition were more risk (AOR 3.9; 95% CI = 1.3–12.2) of mortality as compared with well-nourished child. Moreover, electrical (AOR 7.7; 95% CI = 1.8–32.5.2) and flame burn (AOR 3.3; 95% CI = 1.2–9.0), total body surface area greater than 20% of burn were more likely (AOR 4.6; 95% CI 1.8–11.8) to die compared to less than 20% burn area and burn victim children admitted with poor clinical condition at admission were four times (AOR 4.1, 95% CI = 1.3–12.0) of mortality compared to a good clinical condition. Conclusion: The mortality among burn victim children was higher than most of the studies conducted all over the world. Medical insurance none users, being malnourished, burned by electrical and flame burn, having total body surface area burnt greater than 20%, and having poor clinical condition at addition were significantly associated with mortality of burn victim pediatrics. Therefore, timely identification and monitoring of burn injury should be necessary to prevent mortality of burn victim pediatrics.
, Cristiana Indolfi, Giulio Dinardo, Fabio Decimo, Michele Miraglia Del Giudice
Published: 18 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-6; https://doi.org/10.1186/s13052-022-01199-5

Abstract:
In the last year, many countries adopted a plan to contain hospital infections by Sars-Cov-2 also limiting pulmonary function tests (PFTs), exclusively to indispensable cases. All the recommendations of the major scientific societies regarding the use of PFTs, in particular spirometry, in the Covid era were formulated in the initial period of the pandemic. Currently, the new scientific knowledge about Sars-Cov-2 and the vaccination among healthcare workers, shown new insight to start doing PFTs again to help the investigation and monitoring of patients with respiratory pathology. In this article, we sum up the recommendations of major International Respiratory Societies, and we shared our experience about PFTs in a Pediatric Respiratory Disease Unit during the pandemic.
, Bianca Nardin, Valentina Taucar, Egidio Barbi, Lucia De Zen
Published: 18 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-6; https://doi.org/10.1186/s13052-022-01206-9

Abstract:
Background: Italy was the first European country to experience a massive outbreak of Sars-coV-2 in March 2020. Severe measures were introduced to face the pandemic, significantly impacting all healthcare services, including pediatric palliative care (PPC) networks. We investigated how the Covid-19 pandemic modified the provision of PPC services in Friuli Venezia Giulia, Italy. Both the acute and long-term impacts on the families were addressed. Methods: We administered a retrospective three-sections online questionnaire to the eligible families assisted by our regional PPC network. Inclusion criteria were: child needing specialistic PPC, adequate knowledge of the Italian language, being in charge of the PPC regional network of Friuli Venezia Giulia from February 1, 2020. The three sections examined the same issues in different periods: the pre-covid period (until February 29, 2020), the lockdown period (March 1, 2020, to April 30, 2020), and the post-lockdown period (May 2021). Results: Twelve patients were included. During the lockdown period, 54.6% of children had to stop physiotherapy sessions, while, among those who continued, 80.0% experienced a reduction in the sessions’ frequency. In the post-lockdown period, 45.5% of children did not have physiotherapy as often as before the pandemic onset. Overall, the access to medical visits during the lockdown and after its end was significantly reduced (p = 0.01). The level of support perceived by the families descended from grade 3 (intermediate) in the pre-covid period to 2 (low) during the lockdown (p< 0.05) and returned to grade 3 in the post-lockdown period. Conclusion: The COVID-19 pandemic and the related restrictions impacted the families and caused a transitory contraction of the perceived support. The most significant change was reduced access to medical visits and physiotherapy, which lasted over a year after the start of the pandemic.
Marcello Lanari, Elisabetta Venturini, Luca Pierantoni, Giacomo Stera, Guido Castelli Gattinara, Susanna Maria Roberta Esposito, Silvia Favilli, Emilio Franzoni, Eleonora Fusco, Paolo Lionetti, et al.
Published: 12 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-10; https://doi.org/10.1186/s13052-021-01187-1

Abstract:
The fast diffusion of the SARS-CoV-2 pandemic have called for an equally rapid evolution of the therapeutic options.The Human recombinant monoclonal antibodies (mAbs) have recently been approved by the Food and Drug Administration (FDA) and by the Italian Medicines Agency (AIFA) in subjects aged ≥12 with SARS-CoV-2 infection and specific risk factors.Currently the indications are specific for the use of two different mAbs combination: Bamlanivimab+Etesevimab (produced by Eli Lilly) and Casirivimab+Imdevimab (produced by Regeneron).These drugs have shown favorable effects in adult patients in the initial phase of infection, whereas to date few data are available on their use in children.AIFA criteria derived from the existing literature which reports an increased risk of severe COVID-19 in children with comorbidities. However, the studies analyzing the determinants for progression to severe disease are mainly monocentric, with limited numbers and reporting mostly generic risk categories.Thus, the Italian Society of Pediatrics invited its affiliated Scientific Societies to produce a Consensus document based on the revision of the criteria proposed by AIFA in light of the most recent literature and experts’ agreement.This Consensus tries to detail which patients actually have the risk to develop severe disease, analyzing the most common comorbidities in children, in order to detail the indications for mAbs administration and to guide the clinicians in identifying eligible patients.
Nicola Principi,
Published: 10 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-5; https://doi.org/10.1186/s13052-021-01192-4

Abstract:
Background: Despite the growing evidence of the extreme efficacy of COVID-19 vaccines in adults and the elderly, the administration of the same prophylactic measures to pediatric subjects is debated by some parents and by a number of researchers. The aim of this manuscript is to explain the reasons for overcoming hesitancy towards COVID-19 vaccination in children and adolescents and to highlight the importance of universal COVID-19 vaccination in the pediatric population. Main findings: Recent epidemiological data suggest that the risk that a child with COVID-19 is hospitalized or admitted to the pediatric intensive care unit is greater than initially thought. Children may also suffer from long COVID and school closure because of COVID-19 can cause relevant mental health problems in the pediatric population. Placebo-controlled, observer-blinded, clinical trials showed appropriate efficacy, safety and tolerability of authorized mRNA COVID-19 vaccines in children and adolescents 12–17 years old. Vaccination in children younger than 12 years of age will allow further benefits . Conclusions: COVID-19 vaccine administration seems mandatory in all the children and adolescents because of COVID-19 related complications as well as the efficacy, safety and tolerability of COVID-19 vaccines in this population. Due to the recent approval of COVID-9 vaccines for children 5–10 years old, it is desirable that vaccine opponents can understand how important is the universal immunization against COVID-19 for the pediatric subjects.
Francesco Del Monte, Laura Bucchino, Antonia Versace, Irene Tardivo, Emanuele Castagno, Giovanni Pieri, Giulia Pilloni, Enrico Felici, Antonio Francesco Urbino
Published: 10 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-5; https://doi.org/10.1186/s13052-021-01191-5

Abstract:
Background: Idiopathic intracranial hypertension is an infrequent condition of childhood, and is extremely rare in infants, with only 26 cases described. The etiology is still unknown. Typical clinical manifestations change with age, and symptoms are atypical in infants, thus the diagnosis could be late. This is based on increased opening pressure at lumbar puncture, papilloedema and normal cerebral MRI. The measurement of cerebrospinal fluid opening pressure in infants is an issue because many factors may affect it, and data about normal values are scanty. The mainstay of treatment is acetazolamide, which allows to relieve symptoms and to avoid permanent visual loss if promptly administered. Case presentation: We report the case of an 8-month-old infant admitted because of vomit, loss of appetite and irritability; later, also bulging anterior fontanel was observed. Cerebral MRI and cerebrospinal fluid analysis resulted negative and after two lumbar punctures he experienced initial symptom relief. Once the diagnosis of idiopathic intracranial hypertension was made, he received oral acetazolamide, and corticosteroids, with progressive symptom resolution. Conclusions: Infantile idiopathic intracranial hypertension is extremely rare, and not well described yet. Bulging anterior fontanel in otherwise healthy infants with normal neuroimaging should be always considered suggestive, but can be a late sign, while irritability and anorexia, especially if associated with vomiting, may represent an early sign. In such cases, lumbar puncture should be always done, hopefully with cerebrospinal fluid opening pressure measurement, which is among coded diagnostic criteria, but whose threshold is controversial in infants. Early diagnosis, timely treatment and strict follow-up help to prevent vision loss or death of affected infants.
Francesca Cossovel, , Augusto Ramondo, Guglielmo Riccio, Luca Ronfani, Alessia Saccari, Giorgio Cozzi, Egidio Barbi
Published: 10 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-5; https://doi.org/10.1186/s13052-021-01196-0

Abstract:
Background: Non-painful diagnostic procedures require an inactive state for a prolonged time, so that sedation is often needed in younger children to perform the procedures. Our standard of care in this setting consists of the association between oral midazolam (0.5 mg/kg) and intranasal dexmedetomidine (4 mcg/kg). One of the limits of this approach is that the onset of action is quite delayed (up to 55 min) and poorly predictable. We chose to compare this association with intranasal-ketamine and intranasal-dexmedetomidine. Methods: This is a “pre-post” study. The study population included the first forty children receiving sedation with the “new” combination intranasal ketamine (3 mg/kg) and intranasal dexmedetomidine (4 mcg/kg) compared to a historical cohort including the last forty children receiving sedation with our standard of care combination of intranasal dexmedetomidine (4mcg/kg) and oral midazolam (0,5 mg/kg). Results: The association intranasal dexmedetomidine and intranasal ketamine allowed for a significantly shorter sedation induction time than the combination intranasal dexmedetomidine and oral midazolam (13,5 min versus 35 min). Both group’s cumulative data showed a correlation between age and sedation effectiveness, with younger children presenting a higher success rate and shorter induction time (p 0,001). Conclusions: This study suggests that the ketamine and dexmedetomidine intranasal association may have a shorter onset of action when compared to intranasal dexmedetomidine and oral midazolam.
Jong Ho Cha, Jung-Sun Lim, Yong Hun Jang, Jae Kyoon Hwang, Jae Yoon Na, Jong-Min Lee, Hyun Ju Lee, Ja-Hye Ahn
Published: 10 January 2022
Italian Journal of Pediatrics, Volume 48, pp 1-10; https://doi.org/10.1186/s13052-021-01197-z

Abstract:
Background: Necrotizing enterocolitis (NEC) is a devastating disease in preterm infants with significant morbidities, including neurodevelopmental impairment (NDI). This study aimed to investigate whether NEC is associated with (1) brain volume expansion and white matter maturation using diffusion tensor imaging analysis and (2) NDI compared with preterm infants without NEC. Methods: We included 86 preterm infants (20 with NEC and 66 without NEC) with no evidence of brain abnormalities on trans-fontanelle ultrasonography and magnetic resonance imaging at term-equivalent age (TEA). Regional brain volume analysis and white matter tractography were performed to study brain microstructure alterations. NDI was assessed using the Bayley Scales of Infant and Toddler Development-III (BSID-III) at 18 months of corrected age (CA). Results: Preterm infants with NEC showed significantly high risk of motor impairment (odds ratio 58.26, 95% confidence interval 7.80–435.12, p< 0.001). We found significantly increased mean diffusivity (MD) in the splenium of corpus callosum (sCC) (p = 0.001) and the left corticospinal tract (p = 0.001) in preterm infants with NEC. The sCC with increased MD showed a negative association with the BSID-III language (p = 0.025) and motor scores (p = 0.002) at 18 months of CA, implying the relevance of sCC integrity with later NDI. Conclusion: The white matter microstructure differed between preterm infants with and without NEC. The prognostic value of network parameters of sCC at TEA may provide better information for the early detection of NDI in preterm infants.
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