Italian Journal of Pediatrics最新文献

{"title":"Changes in intestinal bacterial characteristics during hospitalization in the NICU in very low birth weight infants.","authors":"Junhua Wu, Ting Wang, Beirong Yu","doi":"10.1186/s13052-025-02095-4","DOIUrl":"https://doi.org/10.1186/s13052-025-02095-4","url":null,"abstract":"<p><strong>Background: </strong>The gut microbiota plays a crucial role in neonatal defense against pathogens, immune training, nutrient absorption, and postnatal disease development.</p><p><strong>Methods: </strong>We prospectively collected fecal samples from 58 very low birth weight infants and 34 preterm infants with birth weights > 1500 g during their first two postnatal months. Using 16SrRNA sequencing, we characterize the compositional dynamics of gut microbiota in very low birth weight infants during early postnatal development, and evaluate potential associations with clinical factors.</p><p><strong>Results: </strong>In the very low birth weight infants group (experimental group), a total of 45 bacterial phyla and 1,327 genera were identified. The top two dominant phyla were Proteobacteria (65.64%) and Firmicutes (29.64%), accounting for 95.28% collectively. Among the dominant phyla, the experimental group showed significantly higher levels of Bacteroidetes (P < 0.001) and Firmicutes (P = 0.018) compared to the control group, whereas Acidobacteria (P < 0.001), Proteobacteria (P < 0.001), Fusobacteria (P = 0.001), Chloroflexi (P = 0.018), and Patescibacteria (P = 0.006) were significantly lower. The top 10 dominant genera represented 91.9% of the total. At the genus level, the experimental group had significantly higher abundances of Klebsiella (P = 0.016), Streptococcus (P < 0.001), Corynebacterium_1 (P < 0.001), Clostridium_sensu_stricto_1 (P = 0.018), Clostridioides (P = 0.013), Staphylococcus (P < 0.001), and Lactobacillus (P = 0.001), while Escherichia_Shigella, Sphingomonas (P = 0.013), Veillonella (P = 0.037), Methylobacterium (P = 0.021), and Enterobacter (P = 0.029) were significantly lower compared to controls. Additionally, during the first 28 days after birth, the control group exhibited higher relative abundance of Bifidobacterium than the experimental group. Compared to preterm infants with birth weight > 1500 g, very low birth weight infants demonstrated more active intestinal metabolism. Within the very low birth weight infants, probiotic use, delivery mode, and premature rupture of membranes significantly influenced the relative abundances of Streptococcus, Clostridium_sensu_stricto_1, and Pseudomonas, respectively.</p><p><strong>Conclusions: </strong>Very low birth weight infants exhibit distinct gut microbiota characteristics during their first two months of life. Factors including probiotic using, delivery mode, and premature rupture of membranes significantly influence specific bacterial populations. The gut microbiome represents a crucial influencing the health outcomes of very low birth weight infants.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"263"},"PeriodicalIF":3.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954189","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":"An uncommon case of neonatal asphyxia associated with infantile-onset Pompe disease.","authors":"Francesco Leo, Luca Barchi, Giulia Russo, Eleonora Balestri, Elena Chesi, Francesco Di Dio, Livia Garavelli, Lorenzo Iughetti, Giancarlo Gargano","doi":"10.1186/s13052-025-02088-3","DOIUrl":"https://doi.org/10.1186/s13052-025-02088-3","url":null,"abstract":"<p><strong>Background: </strong>Pompe disease, also known as glycogenosis type II or acid maltase deficiency, is an autosomal recessive disease caused by a deficiency of alpha-glucosidase. The severity depends mainly on the type of mutation, which in turn determines early or late onset; therapy modifies the outcome but does not alter the severity of the disease at presentation.</p><p><strong>Case presentation: </strong>We present a case report of a male infant, inborn and delivered at a gestational age of 39 weeks. Medical history reveals consanguineous parents with no invasive screening tests performed during pregnancy. They chose not to undergo prenatal screening even though they were aware of the risks associated with their consanguinity. At birth, the newborn was atonic and pale, with a heart rate of 70 bpm. During resuscitation, an umbilical venous catheter was placed, and three doses of adrenaline and one dose of bicarbonate were administered. At the Neonatal Intensive Care Unit, he underwent therapeutic hypothermia. Echocardiography, performed a few hours later, revealed severe biventricular and septal hypertrophy consistent with non-obstructive hypertrophic cardiomyopathy. During recovery, even after the discontinuation of hypothermia, the newborn exhibited abnormal neurological signs, including axial hypotonia and a tendency to keep his mouth open with tongue protrusion. Given the clinical picture and the early detection of septal and biventricular hypertrophy, genetic testing was performed, revealing a homozygous c.2560 C > T variant in the acid alpha-glucosidase gene (both parents were carriers), described in scientific literature as a class 5 pathogenic variant associated with glycogenosis type II (Pompe disease).</p><p><strong>Conclusion: </strong>Pompe disease is a rare genetic disorder and may be difficult to diagnose at birth. Suspicion should arise in the presence of hypertrophic cardiomyopathy, especially when associated with a history of neonatal asphyxia and abnormal neurological signs. An accurate diagnosis and early treatment are essential to improving the patient's survival and quality of life.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"260"},"PeriodicalIF":3.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954230","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":"Long-term cardiometabolic and bone health consequences of ketogenic diet in children with refractory epilepsy.","authors":"Wael A Bahbah, Ali M El-Shafie, Heba M S El Zefzaf, Doaa M Hosny, Shymaa A Elshafey, Aya A A Hegazy","doi":"10.1186/s13052-025-02109-1","DOIUrl":"https://doi.org/10.1186/s13052-025-02109-1","url":null,"abstract":"<p><strong>Background: </strong>Ketogenic diet (KD) is a well-tolerated and efficacious therapy for refractory epilepsy (RE). While numerous mild short-term side effects have been reported, long-term cardiometabolic and bone heath consequences of KD need more advanced work-up and were not fully evaluated especially in children. So, we aimed to evaluate cardiac, vascular, metabolic, bone health and growth consequences in children with RE receiving KD for more than 2 years compared to those receiving antiepileptic drugs (AEDs ) without any dietary interference.</p><p><strong>Methodes: </strong>Fifty-six children following KD for at least 2 years, 27 classic KD and 29 modified atkins diet (MAD), were recruited in addition to 40 children with RE maintained on multiple AEDs. Lipid profile values, atherogenic indices, serum selenium binding protein 1, and anthropometric measurements were measured for all participants. Additionally, echocardiography, electrocardiography, carotid ultrasonography and DEXA scan were performed.</p><p><strong>Results: </strong>Atherogenic index of plasma (AIP) was high in all groups with no significant correlation with carotid intima-media thickness. Although no cardiac complications were documented, Bone mineral density (BMD) was significantly reduced in all groups. Castelli risk index II and ambulation were the significant predictors for reduced BMD in KD groups in contrast to AIP in AEDs group. Stunted growth was most prevalent in MAD group 44.8% while wasting was highest in AEDs group 40%.</p><p><strong>Conclusions: </strong>KD did not show additional risk regarding metabolic, cardiovascular, BMD and growth side effects compared to AEDs only. Therefore, KD remains a relatively safe dietary therapy for RE, yet close monitoring is still recommended.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"261"},"PeriodicalIF":3.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954207","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":"Primary care pediatricians' involvement in influenza vaccination campaign in Italy.","authors":"Rosaria Indaco, Francesca Leoni, Costantino Panza, Paolo Giorgi Rossi","doi":"10.1186/s13052-025-02093-6","DOIUrl":"https://doi.org/10.1186/s13052-025-02093-6","url":null,"abstract":"<p><strong>Background: </strong>In 2022, the Italian Ministry of Health extended free annual influenza vaccination to all children aged 6 months to 6 years. Since coverage remained low, the Emilia-Romagna region authorized primary care pediatricians (PCPs) to vaccinate both healthy and chronically ill children in 2023, with the aim of increasing vaccine uptake. This study aims to investigate factors influencing PCPs' participation in the 2023/24 influenza vaccination campaign in Emilia-Romagna, including perceived barriers and satisfaction among participant pediatricians.</p><p><strong>Methods: </strong>An anonymous online survey was distributed between January 13-28, 2024, to all PCPs in Emilia-Romagna (N = 557), to evaluate participation in the 2023/24 pediatric influenza vaccination campaign. The survey explored demographic and professional information, vaccination practices and training, and perceived campaign impact and satisfaction. Outcome variables included campaign participation, perceived problems and satisfaction levels. Logistic regression models to assess determinants of participation and Cochran-Armitage test to explore trends in satisfaction levels were used.</p><p><strong>Results: </strong>319 PCPs (57.2% of total) responded to the survey, of which 223 (70.8%) joined the campaign. The number of patients in care, working in group clinic vs. single PCP clinic (OR 2.45), experience as vaccinator (OR 3.12) and PCP's anti-flu vaccination (OR 1.94) were positively associated with participation; age, training at post-graduate school (OR 0.54) and self-reported competence in vaccination (OR 0.62) were negatively associated with participation. Among non-participants, only 25% reported at least one difficulty, mainly lack of fridge or emergency kit and fear of managing adverse reactions; among participants, 85% reported at least one problem, mostly related to limited communication campaigns, organization and fear of managing adverse reactions. Satisfaction levels were higher among male PCPs, those with experience as vaccinators, who vaccinated more children, and those with shorter administration times. The main reasons for dissatisfaction were related to the organization time, and lack of information for parents and economic advantage.</p><p><strong>Conclusions: </strong>This study highlights the barriers that must be removed to achieve effective PCPs' involvement in the vaccination campaign. Future strategies should focus on strengthening logistical support, tailored training and parent communication, and promoting shared models of care to enhance effectiveness and sustainability of vaccination programs.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"259"},"PeriodicalIF":3.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954307","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":"Glucose-6-phosphate dehydrogenase deficiency induced hemolytic anemia and methemoglobinemia: a case report in a 7 -year-old female patient.","authors":"Adalgisa Fastuca, Antonio Vergori, Giuseppe Robustelli, Chiara Piccolo, Maria Ragazzo, Maddalena Marinoni, Massimo Agosti","doi":"10.1186/s13052-025-02051-2","DOIUrl":"https://doi.org/10.1186/s13052-025-02051-2","url":null,"abstract":"<p><strong>Background: </strong>Patients affected by glucose-6-phosphate dehydrogenase (G6PDH) deficiency are often asymptomatic until an oxidative stress occurs, causing acute hemolytic anemia. The coexistence of hemolytic crisis secondary to G6PDH deficiency and methemoglobinemia is an already known phenomenon, especially after the ingestion of fava beans. While past literature described this association primarily in adult patients, it remains an unusual finding in pediatric population. Our patient's age, as long as her gender, and a negative family history represent, indeed, the peculiarity of what we described.</p><p><strong>Case presentation: </strong>We present the case of a 7-year-old female patient with a clinical history of hyperpyrexia, several episodes of yellowish vomit, hypercromic urine, loose stools, asthenia with jaundice. At home paracetamol and a single dose of ibuprofen were administered. No recent history of fava bean ingestion or relevant events were reported in physiological and pathological anamnesis. Family history was negative for hematological comorbidities. Blood tests performed at the emergency room showed a picture of severe anemia with negative direct and indirect Coombs tests, mild acute renal failure, increased inflammation markers and a methemoglobin level equal to 13.7% on blood gas analysis. The detection of vital parameters showed O2-Sat equal to 75% without signs of respiratory distress. A broad-spectrum antibiotic therapy with ceftriaxone and oxygen-therapy were administered, hospitalization was then arranged. Immune-mediated anemia and lymphoproliferative diseases were excluded. G6PDH dosage was requested, resulting indicative of deficiency. Fecal virus testing revealed a positivity for Norovirus. Transfusions of red cell concentrates (RCC) were performed, and the methemoglobin value gradually decreased with stabilization of the hemoglobin, so that methylene blue therapy was not administrated. The patient's clinical conditions improved in almost 5 days.</p><p><strong>Conclusions: </strong>When G6PDH deficiency and methemoglobinemia coexist, a prompt diagnosis is essential. The administration of methylene blue, therapy of choice for the treatment of methemoglobinemia, in fact, may cause a worsening of hemolytic crises in patients affected by G6PDH deficiency. Considering our patient's clinical features, not clearly evocative of G6PDH deficiency, this case represented a challenge for both diagnosis and treatment, reminding to always consider G6PDH deficiency in case of hemolytic anemia associated with methemoglobinemia.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"258"},"PeriodicalIF":3.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12369025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954246","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 prognosis of patients with chronic recurrent multifocal osteomyelitis based on cluster analysis: a 6-year cohort study.","authors":"Tong Yue, Chengdong Yu, Yuchun Yan, Weihong Chu, Baoping He, Min Kang, Yingjie Xu, Dan Zhang, Ming Li, Min Wen, Feifei Wu, Jun Hou, Gaixiu Su, Fengqi Wu, Jianming Lai, Jia Zhu","doi":"10.1186/s13052-025-02091-8","DOIUrl":"10.1186/s13052-025-02091-8","url":null,"abstract":"<p><strong>Background: </strong>This multicenter study aimed to address the heterogeneity of chronic recurrent multifocal osteomyelitis (CRMO) by identifying clinical subtypes through cluster analysis, exploring clinical features, treatment approaches, and short-term prognosis to improve management of pediatric CRMO.</p><p><strong>Methods: </strong>Data from 42 pediatric CRMO patients (47.6% male; mean age 7.87 ± 3.45 years) diagnosed between June 2018 and June 2024 were analyzed. Using cluster analysis with 17 variables, patients were categorized into phenotypic subgroups. Statistical tests assessed differences in clinical features, treatment, and outcomes. Kaplan-Meier survival analysis and log-rank tests evaluated recurrence risk and final Physician Global Assessment(PGA) scores.</p><p><strong>Results: </strong>Patients were classified into two groups: chronic bone pain and acute systemic inflammation. Significant differences were found in fever occurrence (P = 0.002), C-reactive protein (CRP), interleukin-6(IL-6), cytokines including tumor necrosis factor-α(TNF-α) elevation (P = 0.013, 0.003, 0.029), and Hemoglobin(HB), alkaline phosphatase (ALP) reduction (P = 0.007, < 0.001). PGA scores also differed significantly (P < 0.001). Although baseline differences existed, post-treatment recurrence risk and final PGA scores showed no significant differences (P = 0.247, P = 0.211). Treatment differed only in glucocorticoid use; non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs(DMARDs), TNF inhibitors, and diphosphonates showed no statistical differences. Both groups reached remission approximately 12 months post-diagnosis.</p><p><strong>Conclusion: </strong>Two distinct clinical phenotypes of pediatric CRMO were identified, each achieving favorable outcomes with tailored treatments. Recognizing these phenotypes may guide clinical strategies and improve prognosis for CRMO patients.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"257"},"PeriodicalIF":3.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882882","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":"Critical predictors of heart transplant necessity in children with advanced DCM.","authors":"Zubo Wu, Jiawei Shi, Hui Huang, Jie Liu, Qing Guo, Nianguo Dong, Jing Zhang, Wangzi Li, Lin Wang, Hua Peng","doi":"10.1186/s13052-025-02111-7","DOIUrl":"10.1186/s13052-025-02111-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dilated Cardiomyopathy (DCM) frequently culminates in Heart Failure (HF), positioning it as the primary instigator of cardiac transplantation among pediatric patients. Nevertheless, the issue of cardiac transplantation in children demands a comprehensive and judicious strategy. The aim of this research was to ascertain the clinical attributes at the point of diagnosis that could potentially signal the requirement for transplantation in pediatric patients diagnosed with Dilated Cardiomyopathy (DCM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In our study, we recognized 99 instances of pediatric cardiomyopathy accompanied by advanced heart failure (EF &lt; 30%). The patients were categorized into two cohorts, namely, the transplantation group and the non-transplantation group, based on whether they underwent cardiac transplantation. Each patient in both groups was administered conventional medication. Patients within the non-transplantation group demonstrated improved cardiac function following a minimum of six months of medication therapy. The identification of factors associated with heart transplantation in pediatric DCM was facilitated through the utilization of competing risks and multivariable modeling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;Out of a total of 99 children, 35 were recipients of transplants, henceforth referred to as the transplantation group, while the remaining 64, diagnosed with Dilated Cardiomyopathy (DCM), did not undergo transplantation, forming the non-transplantation group. A comparative analysis revealed no significant differences in age, gender, and weight between the two groups. However, the transplantation group demonstrated a significantly higher New York Heart Association (NYHA) class 4, incidence of galloping rhythm, hepatomegaly, morphological changes, ascites, and orthopnea in comparison to the non-transplantation group (all p &lt; 0.05).In the meantime, there was a significantly higher incidence of abnormal left ventricular end-diastolic diameter, aortic and pulmonary valve regurgitation rates, and incomplete myocardial compaction in the left ventricle within the transplant group as compared to the non-transplant group (p &lt; 0.05).Nonetheless, the analysis revealed no significant disparities in biochemical markers, which include BNP, CK-MB, CTnI, GOT, BUN, sCr, and GPT, between the two groups (all p &gt; 0.05). A univariate logistic regression analysis demonstrated that NYHA score [aOR (95%CI) = 2.78 (1.06-7.27), p = 0.037], Ascites [aOR (95%CI) = 12.93 (2.45-68.22), p = 0.003], and Left ventricular noncompaction [aOR (95%CI) = 3.73 (1.01-13.86), p = 0.048] were all significantly correlated with the Transplantation group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pediatric dilated cardiomyopathy (DCM) presenting with indicators of progressive heart failure, including an elevated New York Heart Association (NYHA) classification, ascites, and left ventricular non-compaction, necessitates increased vigilance. It is ","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"256"},"PeriodicalIF":3.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882891","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":"Mother infant zero separation for neonatal jaundice: we are getting closer.","authors":"Riccardo Davanzo, Paola Cavicchioli, Massimo Agosti, Carlo Dani","doi":"10.1186/s13052-025-02104-6","DOIUrl":"10.1186/s13052-025-02104-6","url":null,"abstract":"<p><strong>Background: </strong>Although phototherapy represents the standard of care for preventing bilirubin neurotoxicity, it can have both short- and long-term adverse effects. Moreover, phototherapy can interfere with mother-infant relationship and breastfeeding.</p><p><strong>Main body: </strong>As phototherapy quickly converts the bilirubin in the skin compartment and in the cutaneous circulation into harmless photo-isomers, during the following 2-3 h the effect of phototherapy is limited, leading to the plausibility for an effective intermittent phototherapy, which in fact has been recently documented both in preterm and term neonates.</p><p><strong>Conclusions: </strong>Cyclic phototherapy can help reduce mother-infant separation to a minimum, thus promoting the development of the mother-infant relationship and, ultimately, exclusive breastfeeding.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"254"},"PeriodicalIF":3.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859122","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":"New perspectives for optimizing fever and pain management in pediatrics: evidence supporting therapeutic awareness in clinical practice.","authors":"Gian Luigi de'Angelis, Francesca Vincenzi, Fabiola Fornaroli, Daniela Buonvicino, Alberto Chiarugi","doi":"10.1186/s13052-025-02107-3","DOIUrl":"10.1186/s13052-025-02107-3","url":null,"abstract":"<p><p>Fever and pain are common symptoms in pediatric patients, often presenting in a variety of clinical settings. Effective management of these conditions is essential to ensuring comfort and preventing complications. Paracetamol (acetaminophen) and ibuprofen are the most frequently used medications for treating fever and pain in children owing to their proven efficacy and safety profiles when used appropriately. However, despite their widespread use, both medications have the potential of having serious adverse effects if misused, highlighting the importance of therapeutic awareness among healthcare providers. A careful evaluation of current clinical guidelines for fever and pain management in children was carried out. A survey of recommendations regarding the dosing, timing, and combination of paracetamol and ibuprofen was also conducted in order to optimize treatment while minimizing risks. Recent evidence supports the combination of these two drugs as both effective and safe for managing moderate to severe pain in pediatric patients, offering enhanced symptom relief without significant increases in side effects. This combination has been shown to provide superior analgesic effects as compared to monotherapy, thus improving patient outcomes. However, it is critical that clinicians adhere to established guidelines to avoid potential complications, such as liver toxicity from excessive paracetamol dosing or gastrointestinal issues from ibuprofen. Overall, therapeutic awareness, guided by evidence-based practices and the careful application of clinical recommendations, is essential for optimizing fever and pain management in pediatric care, ensuring both efficacy and safety in treating these common yet distressing symptoms.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"255"},"PeriodicalIF":3.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859123","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":"Standard treatment regimen with and without dexamethasone on outcome of children aged 3-7 years with empyema: a randomized double blind clinical trial.","authors":"Alireza Eshghi, Nasrin Hoseiny Nejad, Azar Mohammadzadeh, Farhad Mansouri, Shabnam Aghajani","doi":"10.1186/s13052-025-02102-8","DOIUrl":"10.1186/s13052-025-02102-8","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids have an effective inhibitory effect on inflammatory factors and are used as adjunctive therapy for viral pneumonia. We conducted this study to compare the effects of a standard treatment regimen with and without dexamethasone on the outcomes of 3-7-year-old children with empyema.</p><p><strong>Methods: </strong>This randomized controlled trial was conducted at a university hospital in Iran from June 2023 to November 2024. Children aged 3-7 years with empyema were enrolled. All patients received standard antibiotic treatment (Vancomycin and Meropenem) and a fibrinolytic agent (alteplase). The dexamethasone group received additional intrapleural dexamethasone injections. Randomization was performed using block randomization with a block size of 4. Both children and outcome assessors were blinded to dexamethasone administration. The primary outcome was length of stay (LOS), with secondary outcomes including duration of fever, chest tube placement, oxygen saturation, and CRP levels.</p><p><strong>Results: </strong>Out of 47 patients (dexamethasone group = 23), 48.9% of the subjects (n = 23) were girls. The LOS in the dexamethasone group, with a median of 9.5 days and a range of 7-17 days, was significantly less than in the control group, with a median of 16 days and a range of 10-24 days. The duration of fever (median 5 vs. 11 days) and CRP level (median 12.5 vs. 21) in the dexamethasone group were significantly lower than in the control group. No significant difference was observed between the two groups in terms of PCR for COVID-19 and influenza, pleural fluid smear culture, blood culture, oxygen saturation, and duration of chest tube placement.</p><p><strong>Conclusions: </strong>Our findings showed that the use of dexamethasone decreases the duration of hospitalization, duration of fever, and CRP levels, leading to faster recovery in children with empyema. Dexamethasone can be a safe and effective adjunctive therapy for empyema in children.</p><p><strong>Trial registration: </strong>IRCT20240705062336N1, Retrospectively Registered (20241116).</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"253"},"PeriodicalIF":3.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859124","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}