Italian Journal of Pediatrics最新文献

{"title":"Multidisciplinary treatment of severe spinal deformity complicated with severe cardiopulmonary dysfunction: a case report.","authors":"Beiyu Xu, Chao Li, Longtao Qi, Yao Zhao, Wence Wu, Chengxian Yang, Ranlv Zhu, Zhengrong Yu, Chunde Li","doi":"10.1186/s13052-025-01925-9","DOIUrl":"10.1186/s13052-025-01925-9","url":null,"abstract":"<p><strong>Background: </strong>Severe spinal deformity (Cobb angle > 90°) often leads to cardiopulmonary dysfunction, posing significant surgical risks. We report a rare case of severe kyphoscoliosis with cardiopulmonary failure treated with non-invasive ventilation, anti-shock treatment, Halo-pelvic traction (HPT), and orthopedic surgery, emphasizing the importance of multidisciplinary cooperation.</p><p><strong>Case presentation: </strong>A 13-year-old Boy with genetic suspicion of distal arthrogryposis (Type 5D) presented with Cobb angles of 94° (scoliosis) and 69° (kyphosis), respiratory failure (PO₂ 36.3 mmHg), and pre-shock status. A multidisciplinary team stabilized the patient using non-invasive ventilation, nutritional optimization and HPT. Post-traction correction rates reached 46.8% (coronal) and 53.6% (sagittal). Subsequent posterior spinal fusion (T1-L5) achieved 69% correction, resolving cardiopulmonary dysfunction and resulting in a highly satisfactory therapeutic outcome.</p><p><strong>Conclusions: </strong>This case illustrates a case with severe spinal deformity combined with extremely severe cardiopulmonary dysfunction and highlights the importance of multidisciplinary cooperation in high-risk pediatric patients.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"92"},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characterization of necrotizing enterocolitis in neonates with or without congenital heart disease: a case-control study.","authors":"Kaiyishaer Balati, Zhuoming Xu, Limin Zhu, Xiaolei Gong","doi":"10.1186/s13052-025-01928-6","DOIUrl":"10.1186/s13052-025-01928-6","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to analyze the clinical characteristics and differences between neonates with congenital heart disease (CHD)-related neonatal necrotizing enterocolitis (NEC) and those with non-CHD-related neonatal NEC.</p><p><strong>Method: </strong>This retrospective study included patients with CHD who met Bell's staging diagnostic criteria and were hospitalized between 2014 and 2023 in the Cardiac Intensive Care Unit of Cardiothoracic Surgery, Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine. These patients comprised the CHD-related NEC group (CHD-NEC group). Meanwhile, the control group included randomly matched non-CHD-related NEC children (nCHD-NEC group) admitted to the neonatal department of the Second People's Hospital in Kashi Prefecture according to the 1:2 matching principle. Patients' basic information, adverse clinical events before NEC onset as well as NEC severity and treatment were recorded.</p><p><strong>Results: </strong>The CHD-NEC group comprised 60 cases, whereas the nCHD-NEC group comprised 120 cases. Compared with the nCHD-NEC group, the CHD-NEC group had an older gestational age (38.71 [37.89, 39.67] weeks vs. 30.65 [29.68, 32.29] weeks, p < 0.001); a heavier birth weight (3.2 [2.69, 3.67] kg vs. 1.39 [1.1, 1.59] kg, p < 0.001); and higher proportions of patent ductus arteriosus (73.3% vs. 26.7%, p < 0.001), shock (81.7% vs. 36.7%, p < 0.001), and mechanical ventilation requirement (91.7% vs. 51.7%, p < 0.001). At disease onset, the CHD-NEC group had a higher vasoactive drug score (16.75 [7.26, 23.63] vs. 0 [0, 10], p < 0.001) but lower values for the proportion of infants who were small for gestational age (15% vs. 33.3%, p = 0.045), incidence of premature rupture of membranes (3.3% vs. 26.7%, p = 0.002), incidence of early onset sepsis (6.7% vs. 23.3%, p = 0.038), and incidence of late onset sepsis (46.7% vs. 70%, p = 0.036) than the nCHD-NEC group. Among children who required abdominal surgery, the CHD-NEC group tended to have more colon involvement (6.6% vs. 0.8%, p = 0.063), but no significant difference in mortality was noted between the two groups.</p><p><strong>Conclusion: </strong>Children with CHD-NEC and nCHD-NEC have significantly different clinical characteristics. CHD-NEC is mainly observed in full-term infants with appropriate weight for gestational age, and perioperative intestinal ischemia may be the main pathophysiology. Conversely, nCHD-NEC is mainly noted in preterm infants, possibly related to immature intestinal development and infection. Large prospective clinical research is warranted to explore the pathogenesis, pathophysiology, indicator monitoring, and treatment plan for children with NEC.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"93"},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of decision tree model in diagnosis of mycoplasma pneumoniae pneumonia with plastic bronchitis.","authors":"Lin Li, Dong Wang, Rongrong Yang, Xing Liao, Ling Wu","doi":"10.1186/s13052-025-01934-8","DOIUrl":"10.1186/s13052-025-01934-8","url":null,"abstract":"<p><strong>Background: </strong>To establish a decision tree model of Mycoplasma pneumoniae pneumonia(MPP) complicated with plastic bronchitis(PB) in children, and to explore the application value of decision tree model in the auxiliary diagnosis of children.</p><p><strong>Methods: </strong>A retrospective study was conducted to collect the clinical data of 214 children who met the admission criteria in Fujian Children's Hospital from June 2022 to June 2024, and they were divided into plastic bronchitis group (n = 66) and non-plastic bronchitis group (n = 148). Using R language, 70% of the data from each group of patients was randomly selected for training the model using decision tree algorithm analysis, thus generating a clinical diagnostic decision tree for Mycoplasma pneumoniae (MP) combined with PB. The generated decision tree model was validated on the validation sample dataset and the detection effect value of the model was calculated.</p><p><strong>Result: </strong>In this study, a total of 22 indicators were employed to build the decision tree diagnostic model. Univariate statistical analysis was carried out prior to the model construction, and it was discovered that the differences of 13 indicators between the molded group and the non-molded group were statistically significant. A decision tree model with D-dimer ≥ 1.7ug/mL, C-reactive protein ≥ 15 mg/L, drug resistance or not, and serum ferritin<137 mg/L was constructed in the training sample dataset of the molded group and the non-molded group. The sensitivity of the decision tree model was 0.884, which was verified in the dataset of the remolded group and the non-molded group. The specificity was 0.727, and the area under the receiver operating characteristic curve was 0.831.</p><p><strong>Conclusion: </strong>Decision tree model can provide reference for the application of auxiliary diagnosis in children with mycoplasma pneumoniae pneumonia complicated with plastic bronchitis. The model has good discriminative ability in general, and is worthy of clinical application and further study.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"95"},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Nickel-induced labial angioedema in a pediatric patient with orthodontic braces: a case report.","authors":"Fabrizio Leone, Alessandra Gori, Bianca Laura Cinicola, Giorgio Colletti, Elia Pignataro, Martina Capponi, Giulia Brindisi, Caterina Anania, Anna Maria Zicari","doi":"10.1186/s13052-025-01923-x","DOIUrl":"10.1186/s13052-025-01923-x","url":null,"abstract":"","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"89"},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A long-lasting low oxygen saturation hiding Titusville hemoglobin diagnosis in a premature 14-month-old child - case report.","authors":"Maria Francesca Patria, Marta Piotto, Cristina Curcio, Silvana Gangi, Youssra Belhaj, Mara Lelii, Barbara Madini, Alessia Rocchi","doi":"10.1186/s13052-025-01900-4","DOIUrl":"10.1186/s13052-025-01900-4","url":null,"abstract":"<p><strong>Background: </strong>There are some clinical conditions that can impact the accuracy of spO₂ measurements, leading to an incorrect diagnosis of hypoxemia. Low oxygen affinity hemoglobinopathy can present with low spO₂ and discordance with PaO₂ and general clinical conditions.</p><p><strong>Case presentation: </strong>We report the case of a 14-month-old male, born extremely premature, with severe bronchopulmonary dysplasia (BPD). He required continuous high-flow nasal cannula (HFNC) oxygen therapy and was hospitalized due to a viral respiratory infection causing dyspnea and desaturation. Once the child clinically recovered, all attempts to wean him off oxygen resulted in rapid drops in SpO2. This occurred despite the absence of increased work of breathing, cyanosis, or abnormal PaO2.</p><p><strong>Conclusions: </strong>Severe BPD and recurrent respiratory issues could have per se justified the persistently low spO2. Incongruence between low spO₂ values, normal PaO₂ levels and good clinical condition, once the child was recovered, raised suspicion of low oxygen affinity hemoglobin (Hb) variants. Abnormal Hb peak detected through high-performance liquid chromatography allowed rare diagnosis of Hb Titusville, confirmed by molecular analysis. In conclusion, the case matched a rare low oxygen affinity hemoglobinopathy (Hb Titusville), highlighting its relevance in unexplained hypoxemia. Diagnosis challenges necessitate a systematic approach to prevent misinterpretations.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"88"},"PeriodicalIF":3.2,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of two nutritional risk screening tools in hospitalized children with Japanese encephalitis: a causal inference of clinical outcomes and implications for optimized management.","authors":"Yilei Shen, Lijuan Xu, Tian Tan, Wei Cao, Yong Zhao, Yue Feng, Xia Li, Yongfang Liu, Yingting Luo, Lin Kong","doi":"10.1186/s13052-025-01922-y","DOIUrl":"10.1186/s13052-025-01922-y","url":null,"abstract":"<p><strong>Background: </strong>This study used two nutritional risk screening (NRS) tools to explore the causal relationship between nutritional risk and clinical outcomes (length of hospital stay and cost), as well as clinical results (incidence of sequelae), in hospitalized children with Japanese encephalitis (JE). The goal is to screen for a more suitable nutrition risk tool for JE reveal the underlying mechanisms, accurately quantify the impact, and provide a reliable basis for optimizing clinical management and reducing the burden of the disease in affected children.</p><p><strong>Methods: </strong>The classical Screening Tool for Risk of Nutrition in Growth Kids (STRONGkids) and Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP) were utilized to evaluate the nutritional risk of the children. A heatmap analysis was conducted to investigate the correlation between variables influencing the STRONGkids score and STAMP score. Subsequently, a decision tree was employed to identify the main factors influencing the STRONGkids score and STAMP score. Finally, causal inference was employed to calculate the causal effects between the NRS score, clinical outcomes, and clinical results.</p><p><strong>Results: </strong>Dysphagia was the most significant factors affecting STRONGKids scores, and the weight and height was the most significant factors affecting STAMP scores. Causal analysis revealed that for every unit increase in the severity of JE type, the STRONGkids score increased by 0.515 units, and 1.339 units for STAMP. Moreover, the presence of dysphagia led to a 1.944-unit increase in the STRONGkids score, and 1.497-unit for STAMP. Additionally, for every unit increase in the STRONGkids score, the length of hospital stay increased by 2.541 days, and hospitalization costs increased by $612.507. Similarly, for every unit increase in the STAMP score, the length of hospital stay increased by 1.571 days, and hospitalization costs increased by $425.595.</p><p><strong>Conclusions: </strong>Based on decision tree, causal analysis and the actual situation of SNI, the internal structural setup of the STAMP tool is more suitable for screening pediatric patients with JE, making it a more reasonable choice for this purpose when compared to STRONGkids.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"87"},"PeriodicalIF":3.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activin-A urine levels correlate with radiological patterns in preterm infants complicated by intraventricular hemorrhage.","authors":"Giuseppe Lapergola, Giorgia Gasparroni, Alessandro Graziosi, Darek Gruzfeld, Bashir Moataza, Hanna Aboulgar, Hala Mufeed, Iman Iskander, Giovanni Livolti, Fabio Galvano, Gabriella Levantini, Ebe D'Adamo, Adele Patrizia Primavera, Elisabetta Barbante, Rita Salomone, Claudia D'Egidio, Chiara Strozzi, Antonio Maconi, Danilo A W Gavilanes, Ali Saber Abdelhameed, Diego Gazzolo","doi":"10.1186/s13052-025-01938-4","DOIUrl":"10.1186/s13052-025-01938-4","url":null,"abstract":"<p><strong>Background: </strong>To validate the role of Activin A in the early diagnosis and prognosis of preterm newborns at risk for intraventricular hemorrhage and neurological sequelae by means of cerebral ultrasound and magnetic resonance imaging (MRI), currently considered standard of care procedures.</p><p><strong>Methods: </strong>We conducted an observational case-control study in 46 preterm newborns, 23 with intraventricular hemorrhage (IVH group) and 23 controls matched for gestational age. Standard clinical, laboratory, cerebral ultrasound monitoring procedures and Activin A urine measurement were performed at four time-points (first void, 24, 48, 96 h) after birth. Cerebral MRI was performed at 40-42 weeks of corrected gestational age.</p><p><strong>Results: </strong>Elevated (P < 0.001, for all) Activin A levels were observed in the IVH group at all monitoring time-point. Activin A correlated (P < 0.05, for all) with intraventricular hemorrhage grade on cerebral ultrasound. At the cut-off of 0.08 pg/mL Activin A at 48-h achieved the best sensitivity, specificity, positive/negative predictive values as early predictor of an abnormal MRI pattern (area under the curve: 0.93).</p><p><strong>Conclusions: </strong>The present data showing a correlation among Activin A, cerebral ultrasound and MRI provide further support to Activin A inclusion in clinical daily management of cases at risk for intraventricular hemorrhage and adverse neurological outcome.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"85"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of long term asfotase alfa treatment in childhood hypophosphatasia.","authors":"Debora Mariarita d'Angelo, Federico Lauriola, Luisa Silvestrini, Luigia Cinque, Marco Castori, Giulia Di Donato, Armando Di Ludovico, Saverio La Bella, Francesco Chiarelli, Cosimo Giannini, Luciana Breda","doi":"10.1186/s13052-025-01883-2","DOIUrl":"10.1186/s13052-025-01883-2","url":null,"abstract":"<p><strong>Background: </strong>Hypophosphatasia (HPP) is a rare inherited disorder characterized by a deficiency of tissue-non-specific alkaline phosphatase (TNSALP) due to loss-of-function variants of the ALPL gene. HPP is characterized by an extremely variable age of onset and clinical presentation, largely depending on the type of genetic disruption. Childhood HPP commonly presents with skeletal deformities, bone fragility, precocious tooth loss, muscle weakness and sometimes neurological implications. Laboratory tests usually document low levels of alkaline phosphatase (ALP), and radiologic investigations show peculiar bone abnormalities. Treatment with human recombinant TNSALP (asfotase alpha, Strensiq^®), available since 2015, is associated with a sudden improvement and a good safety profile.</p><p><strong>Case presentation: </strong>A previously healthy 15-month-old girl presented with progressive \"genu valgus\" and sudden limping. The patient was diagnosed with childhood HPP due to the presence of two ALPL variants, never described in compound heterozygosity: a missense variant c.571G > A, p.(Glu191Lys), and a frameshift deletion c.963delG; p.(Lys322Argfs*44), both classified as pathogenetic. The child was promptly treated with asfotase alpha, and good improvement was quickly obtained. Efficacy, safety, and good tolerance persisted after a long-term follow-up of 6 years.</p><p><strong>Conclusions: </strong>Pediatricians should consider HPP in children presenting with a suggestive clinical phenotype. Calcium-phosphorus metabolism, ALP, and vitamin B6 should always be investigated in suspected cases. Moreover, asfotase alfa represents a safe, well-tolerated, and effective drug in children with HPP.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"86"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and factors associated with hypertension among children attending pre-schools in Dar es Salaam, Tanzania.","authors":"Jida Said, Nahya Salim, Peter P Kunambi, Francis Furia","doi":"10.1186/s13052-025-01841-y","DOIUrl":"10.1186/s13052-025-01841-y","url":null,"abstract":"<p><strong>Background: </strong>Childhood hypertension has become a public health problem due to its increasing prevalence and complications; the high prevalence is noted to mirror an increase in obesity among children. Hypertension in children is frequently undiagnosed due to challenges in getting appropriate cuff sizes and interpretation of the readings. Several studies have been carried out among children however; most of available information is focused on hypertension among older children and adolescents.</p><p><strong>Methods: </strong>A cross sectional study was conducted in 2 districts of Dar es Salaam region namely Ilala and Kinondoni from October to November 2020. Children aged 2-5 years attending pre-schools in these districts meeting the inclusion criteria and whose parent/guardian signed informed consent were included. Questionnaires were used to collect socio-demographic characteristics; anthropometric and three oscillometric single- occasion blood pressure measurements were taken. The average blood pressure was compared to the standard charts for age and sex provided by the American Academy of Pediatrics 2017 to determine the blood pressure category of the child.</p><p><strong>Results: </strong>A total of 1083 children fulfilled the eligibility criteria and were enrolled into the study, 51.3% (556/1083) of participants were males and the median age was 4 years (IQR 3-5). Blood pressures for 252 (23.3%) participants were in the high blood pressure range (19.8% with elevated blood pressure and 3.5% with hypertension). No significant gender difference was observed among those with high blood pressure. Factors that were noted to be significantly associated with elevated blood pressure included low birth weight (p = 0.036), increasing age (p = 0.032) and body mass index (p < 0.001).</p><p><strong>Conclusion: </strong>High prevalence of elevated blood pressure in this population of pre-school aged children is alarming. Low birth weight, increasing age and body mass index were significantly associated with elevated blood pressure.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"84"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and impact of exchange transfusion in infant pertussis with extreme leukocytosis.","authors":"Yuanyuan Wu, Chuan Gan","doi":"10.1186/s13052-025-01933-9","DOIUrl":"10.1186/s13052-025-01933-9","url":null,"abstract":"<p><strong>Background: </strong>Extreme leukocytosis in pertussis is a rare condition, and without effective interventions to reduce white blood cell counts, the mortality rate can approach 100%. The clinical characteristics of these patients and the application of exchange transfusion (ET) in their management are not yet clear.</p><p><strong>Methods: </strong>This retrospective study examines the clinical characteristics and impact of ET in infant pertussis with extreme leukocytosis.</p><p><strong>Results: </strong>We have included six infant pertussis patients with extreme leukocytosis, all of whom were female and underwent ET. Two patients survived, while four died. The surviving patients were relatively older at disease onset compared to those who died, and all three unvaccinated patients died. All patients required admission to the pediatric intensive care unit, presenting with fever, whooping cough, cyanosis, severe pneumonia, and respiratory failure. Pulmonary consolidation, cardiovascular failure, and pulmonary hypertension (PH) were also common, especially among those who died. Hypoglycemia and seizures were rare. Acute-phase proteins, such as C-reactive protein and procalcitonin, were elevated to varying degrees. ET effectively reduced peripheral blood leukocytes; however, a significant increase in leukocytes was observed 1-2 days after the first ET in the deceased patients.</p><p><strong>Conclusion: </strong>Extreme hyperleukocytosis is more commonly observed in young female children with pertussis. Younger age, unvaccinated status, and the presence of concurrent heart failure and PH may be associated with a poor prognosis. ET can effectively reduce peripheral blood leukocytes, but a rapid leukocyte rebound post-ET may be indicative of impending death.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"82"},"PeriodicalIF":3.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}