Italian Journal of Pediatrics最新文献

{"title":"The effects of energy drink consumption in children and adolescents: a cross-sectional study and the recommendations of the Italian Pediatric Society.","authors":"Elena Bozzola, Flavia Cirillo, Maria Rosaria Marchili, Livia Antilici, Chiara Mauro, Mariangela Irrera, Giulia Spina, Giulia Cafiero, Antonella Camera, Carmela Maradei, Luigina Rose, Cinthia Caruso, Vita Cupertino, Giampaolo De Luca, Rino Agostiniani","doi":"10.1186/s13052-026-02305-7","DOIUrl":"10.1186/s13052-026-02305-7","url":null,"abstract":"<p><strong>Background: </strong>Energy drinks are widely marketed to enhance alertness and performance and are increasingly consumed by children and adolescents, despite warnings from pediatric and public health organizations regarding potential health risks. This study aimed to investigate energy drink consumption, age of initiation, motivations, risk perception, and awareness of health guidelines among Italian adolescents, with comparisons across distinct clinical and non-clinical subgroups.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted between May and December 2025 using an anonymous questionnaire administered to adolescents aged 9-17 years. Participants were recruited from four settings: inpatients with eating disorders, other hospitalized patients, competitive athletes, and healthy controls. The questionnaire assessed demographics, familiarity and frequency of energy drink consumption, age of first use, motivations, perceived health risks, knowledge of official guidelines, and attitudes toward sales regulations. Data were analysed descriptively and using chi-square tests, with statistical significance set at p < 0.05.</p><p><strong>Results: </strong>In the study period, 430 participants were recruited. Overall, 96.5% of participants were familiar with energy drinks, and 65.1% reported at least occasional consumption. Early initiation was common, with 39.2% of consumers starting before age 12. Frequent consumption was relatively low (10.2%) but more prevalent among older adolescents and healthy controls. Only 52.3% perceived energy drinks as harmful, and awareness of official health guidelines was limited (40.4%). Consumption patterns, risk perception, and knowledge differed significantly across subgroups, with athletes showing greater awareness and eating disorder patients exhibiting higher uncertainty.</p><p><strong>Conclusions: </strong>Although frequent energy drink use was uncommon, early exposure and substantial knowledge gaps were identified. These findings highlight the need for routine screening, targeted education, and preventive strategies to reduce energy drink consumption and protect vulnerable pediatric populations.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404646","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":"Incidence, mortality, and survival trends of retinoblastoma in children: a systematic review and meta-analysis of population-based studies.","authors":"Yu Yan, Gangyi Li, Wei Wang, Ningjun Ni","doi":"10.1186/s13052-026-02296-5","DOIUrl":"10.1186/s13052-026-02296-5","url":null,"abstract":"<p><strong>Background: </strong>Retinoblastoma (RB) is the most common childhood intraocular malignancy, with substantial global disparities in outcomes. This study aimed to provide pooled estimates of incidence, survival, mortality, and metastasis based on population-based data.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library through August 2025. Eligible studies were population- or registry-based and reported at least one epidemiological outcome. Random-effects models were applied, with assessments of heterogeneity, publication bias, and subgroup analyses.</p><p><strong>Results: </strong>Twenty-five studies (52 study arms) were included. The global pooled incidence of RB was 0.12 per 1,000,000 (95% CI: 0.09-0.14), with high heterogeneity (I² = 95%). Incidence was highest in the Americas and Europe and lowest in Africa. One-, three-, and five-year survival rates were 94% (95% CI: 90-98), 81% (95% CI: 74-89), and 91% (95% CI: 87-94), respectively. Pooled mortality was 13% (95% CI: 9-16), and mortality increased with older age at diagnosis. The pooled metastasis rate was 6% (95% CI: 2-9).</p><p><strong>Conclusions: </strong>RB incidence and survival show striking geographic and socioeconomic disparities. Delayed diagnosis and limited access to care drive persistently poor outcomes in many low-resource regions, underscoring the need for improved registries, earlier detection, and equitable treatment worldwide.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351895","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":"Epidemiological trends of multidrug-resistant organisms in a tertiary-care pediatric hospital, 2017-2023.","authors":"Carmen D'Amore, Paola Bernaschi, Gaetano Ciliento, Flavia Beccia, Leonardo Villani, Benedetta Zama, Elisa Cappelli, Lucilla Ravà, Carlo Federico Perno, Massimiliano Raponi, Marta Ciofi Degli Atti","doi":"10.1186/s13052-026-02300-y","DOIUrl":"10.1186/s13052-026-02300-y","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a growing global threat, particularly for children under 5 years. This study is aimed to investigate temporal trends and describe the epidemiological characteristics of MDR bacteria isolated in hospitalized children from 2017 to 2023 in an academic children's hospital in Italy.</p><p><strong>Methods: </strong>We included all bacterial isolates obtained from blood or cerebrospinal fluid (CSF) cultures collected from pediatric patients evaluated in both inpatient settings and the Emergency Department between 1 January 2017 and 31 December 2023. The study included the main ESKAPE pathogens (including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa) and other relevant MDROs such as Escherichia coli. Data were extracted from the hospital microbiology data warehouse, and resistance proportions were calculated as MDR isolates over total isolates for each pathogen. Associations between year, patient characteristics, ward type, and MDRO infections were evaluated using univariable and multivariable logistic regression; trends over time were evaluated using the Cochrane-Armitage test for categorical variables.</p><p><strong>Results: </strong>Out of 51,886 blood or CSF cultures, 1,528 (2.9%) were positive for microorganisms of interest, and 211 (13.8%) were MDROs. The highest resistance proportions were observed in Carbapenems-Resistant Pseudomonas Aeruginosa/Pseudomonas Aeruginosa (CRPA/PA, 52.8%), followed by Methicilln-Resistant Staphylococcus Aureus/Staphylococcus Aureus (MRSA/SA, 36.7%), Carbapenem-Resistant Klebsiella Pneumoniae/Klebsiella Pneumoniae (CRKP/KP, 12.6%), and Vancomycin-Resistant Enterococcus (VRE)/Enterococcus (VRE/E, 11.5%). Significant reductions were recorded for MRSA/SA (43.5% in 2017 to 25.7% in 2023; p = 0.001) and CRPA/PA (85.0% to 47.1%; p < 0.001), while CRKP/KP and VRE/E showed no significant temporal trends. Neonatology and PICU showed higher odds for MRSA isolation (p < 0.001) compared to medical wards. Onco-hematology displayed an adjusted OR of 3.0 (95% CI: 1.2-7.7) for VRE. Year was independently associated with CRPA, with adjusted ORs of 0.03 and 0.14 in 2020 and 2021 (p < 0.01) compared to 2017.</p><p><strong>Conclusions: </strong>Understanding local AMR patterns remains essential for guiding empirical therapy across heterogeneous hospital settings.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337716","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":"Practice and challenges of newborn hearing screening: analysis of a five-year database in Italy.","authors":"Davide Coraci, Marta Fantoni, Eleonora Tonon, Raffaella Marchi, Luca Ronfani, Eva Orzan","doi":"10.1186/s13052-026-02293-8","DOIUrl":"10.1186/s13052-026-02293-8","url":null,"abstract":"<p><p>Early identification and treatment of hearing impairments are essential for children's development. International guidelines recommend a stepwise approach to conduct hearing screening in newborns. However, while the majority of countries worldwide implemented universal newborn hearing screening, inconsistencies remain in procedures and data management. In particular, Level 3 of the screening pathway-comprising diagnostic confirmation and therapeutic management-has received limited attention in the literature, despite its central role in determining program effectiveness and patient outcomes. This study investigates the clinical and organizational aspects of Level 3 within the neonatal hearing screening program of the Friuli-Venezia Giulia Region in Italy, analyzing data from 106 children enrolled between 2019 and 2023. The analysis considers the regional protocol, the roles of birthing centers, pediatricians, hospitals, and the Regional Center for Pediatric Hearing Loss Care, and subdivides Level 3 into four Phases (A-D) reflecting both organizational and diagnostic functions. By examining patient flow, false positives, loss to follow-up/documentation, and management practices, the study highlights how organizational factors-particularly the coordination between local and specialized facilities-produce \"cascade\" outcomes directly affecting diagnostic timelines and treatment initiation. Findings provide critical insights into weaknesses of the current system and propose directions for improving program efficiency, accuracy, and overall quality of care.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148329807","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 in antibody-positive pediatric patients with immune-mediated necrotizing myopathy.","authors":"Yiwen Xu, Zhanwei Zhang, Yixuan Chu, Fang He, Leilei Mao, Li Yang, Fei Yin, Jing Peng, Lifen Yang, Ciliu Zhang","doi":"10.1186/s13052-026-02278-7","DOIUrl":"10.1186/s13052-026-02278-7","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical characteristics and therapeutic strategies of childhood immune-mediated necrotizing myopathy (IMNM) and to provide evidence for clinical diagnosis and management.</p><p><strong>Methods: </strong>This single-center retrospective study analyzed the clinical data of 10 children diagnosed with antibody-positive IMNM at the Children's Medical Center, Xiangya Hospital, Central South University, from January 2016 to May 2025. The onset features, clinical manifestations, laboratory findings, muscle magnetic resonance imaging (MRI) characteristics, treatment modalities, and prognosis were summarized.</p><p><strong>Results: </strong>Among the 10 patients, 4 were male and 6 were female, with a median age at onset of 5.5 years (range: 3-16 years). The main clinical manifestations included symmetric proximal muscle weakness (100%) and cutaneous manifestations (50%, including Gottron's sign and periorbital rash). Creatine kinase (CK) levels were markedly elevated, with a median of 3988.5 U/L (range: 2080-13524 U/L). Muscle MRI revealed edema or fatty infiltration in the thigh muscles. Anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies were detected in 4 patients (40%), and anti-signal recognition particle (SRP) antibodies in 6 patients (60%). Electromyography (EMG) showed myopathic changes in all tested cases (8/10 patients). Muscle histopathology was available for one patient, demonstrating myofiber necrosis, regeneration, and inflammatory cell infiltration. All patients received glucocorticoid therapy, combined with oral methotrexate. Additionally, 5 patients were treated with rituximab, and 9 patients received intravenous immunoglobulin (IVIG). During follow-up, 2 patients achieved complete remission, 1 patient showed partial remission, 3 patients exhibited no significant remission, and 4 patients experienced relapse.</p><p><strong>Conclusion: </strong>Childhood IMNM is characterized by proximal muscle weakness, typical rash, and significantly elevated CK levels, frequently accompanied by anti-SRP or anti-HMGCR antibodies. Early immunosuppressive therapy, including glucocorticoids combined with immunosuppressants or IVIG, may be associated with clinical improvement in this small retrospective series.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317138","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 comparison of pediatric sepsis definitions based on systemic inflammatory response syndrome and Phoenix criteria: a single-center PICU retrospective study.","authors":"Liang Zhou, Shaojun Li, Qiuyuan Ding, Tian Tang, Jie Cheng, Haiping Yang, Liping Tan","doi":"10.1186/s13052-026-02298-3","DOIUrl":"10.1186/s13052-026-02298-3","url":null,"abstract":"<p><strong>Background: </strong>The 2024 international pediatric sepsis consensus definition has undergone a paradigm shift from a systemic inflammatory response syndrome (SIRS)-based framework to the organ dysfunction-centered Phoenix Sepsis Criteria (PSC). We aimed to evaluate the diagnostic concordance, predictive performance for 28-day pediatric intensive care unit (PICU) mortality, and phenotypic overlap between these two pediatric sepsis definitions.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 1034 children aged > 1 month to < 18 years with confirmed or suspected infection who were directly admitted to the PICU of Children's Hospital of Chongqing Medical University between January 1, 2020, and November 21, 2023. All patients were independently evaluated for sepsis using both the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) SIRS criteria and the 2024 PSC. Diagnostic agreement was assessed using the Kappa coefficient. Binary logistic regression was employed to establish association models between factors and phenotypes, as well as between factors and PICU 28-day mortality. Predictive performance was compared using the C-statistic.</p><p><strong>Results: </strong>Among 1034 patients, 613 (59.3%) met the Sepsis-SIRS criteria with a 28-day PICU mortality of 15.2% (93/613), 744 (72.0%) met the Sepsis-Phoenix criteria with a mortality of 16.3% (121/744), 489 (47.3%) met both criteria with a mortality of 18.6% (91/489), and 166 (16.1%) met neither criterion with a mortality of 2.4% (4/166). Agreement between the two criteria was poor (kappa = 0.202, 95% CI: 0.143-0.261). After adjusting for clinically relevant confounders, the PSC remained a strong independent predictor of 28-day mortality (adjusted OR = 5.123, 95% CI: 2.128-12.333, p < 0.001), whereas the SIRS criteria showed no independent predictive value (adjusted OR = 0.937, 95% CI: 0.523-1.678, p = 0.827). The PSC demonstrated significantly superior discriminatory ability compared with the SIRS criteria (C-statistic = 0.809 vs. 0.589, p < 0.001). Notably, 20.2% of SIRS-positive patients were not classified as sepsis by the Phoenix Criteria, and this subgroup had an extremely low mortality of 1.6%, reflecting higher specificity of the PSC.</p><p><strong>Conclusions: </strong>The SIRS and PSC identify partially overlapping populations with distinct risk stratification, showing poor diagnostic concordance. The PSC has superior independent predictive performance for PICU 28-day mortality and may be considered for prognostic assessment of infected children in the PICU setting. Importantly, historical study results based on the SIRS criteria should be extrapolated cautiously to PSC-defined populations.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283609","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 comparison between early onset sepsis (EOS) risk calculator and modified new protocol in a newborn ≥ 35 weeks: a simulation study.","authors":"Silvia Armiraglio, Simona Perniciaro, Angela Bossi, Massimo Agostino Agosti","doi":"10.1186/s13052-026-02271-0","DOIUrl":"10.1186/s13052-026-02271-0","url":null,"abstract":"<p><strong>Background: </strong>Early onset sepsis (EOS) is a potentially fatal condition in neonates and its correct management is still a challenge for neonatologists. Early antibiotic administration in the neonatal period may carry risks and reducing unnecessary antibiotic therapy remains a key objective. It is well known that EOS risk calculator has reduced investigations and antibiotics for suspected EOS, but many limitations have been identified (e.g. strong value to respiratory symptoms, lack of standardized neonatal monitoring). To develop a new protocol, called Neosafe, for the management of newborn ≥ 35 weeks at risk of EOS based on the EOS risk calculator and serial physical examination with the aim of reducing blood investigations and unnecessary antibiotic therapy.</p><p><strong>Methods: </strong>In this single-center observational retrospective study 2000 Neonates ≥ 35 weeks were enrolled. A new protocol called Neosafe has been developed, which deviates from the original for two major changes: (1) different serial physical examination (SPE) recommendation for each risk situations (2) clinical scenario revisited with multiple signs. Comparison between Neosafe protocol and EOS risk calculator simulated data were performed using McNemar's test (statistical significance p < 0,05) and the Cohen's kappa coefficient was used to assess the degree of agreement among them.</p><p><strong>Results: </strong>48/2000 infants (2,4%) would have performed blood investigations versus 82/2000 (4,1%) whether Neosafe protocol would have been applied (p < 0,0001). 43/2000 infants (2,2%) with Neosafe protocol would have received antibiotics versus 80/2000 (4,0%) with EOS risk calculator (p < 0,0001). All infants who would not receive antibiotics for Neosafe protocol were infants with equivocal signs and isolated mild to moderate respiratory distress, but predisposed to advanced medical monitoring. Proven sepsis during the study period were 4, 2 of them were lost by both (no symptoms at birth, blood tests performed for non-infectious reasons). 1829 infants (91,5%) would receive routinal nursing SPE monitoring, 128 advanced medical SPE monitoring and 43 advanced medical SPE+vital for neonatal intensive care unit (NICU).</p><p><strong>Conclusions: </strong>In our study Neosafe protocol could have reduced blood investigations and antibiotic therapy. Neosafe protocol could be a promising tool that integrates the use of digital technologies and direct attention to the patients. More trials are needed for further improvements.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264461","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":"Impact of regional heterogeneity of RSV infection prophylaxis on bronchiolitis in Italy.","authors":"Raffaele Badolato, Viola Ceconi, Roberto Bellu', Eugenio Baraldi, Chiara Azzari, Renato Cutrera, Fabio Midulla, Roberto Bernardini, Domenico Cipolla, Daniela Concolino, Alessandro Consolaro, Elisabetta Cortis, Antonio Cualbu, Marisa D'Andrea, Grazia Dinnella, Simonetta Fain, Enrico Felici, Santina Gaggiano, Paola Giordano, Alfredo Guarino, Lorenzo Iughetti, Eustachio Lapacciana, Angelo Pietrobelli, Guido Pennoni, Ermanno Ruffini, Camilla Gizzi, Massimo Agosti, Rino Agostiniani","doi":"10.1186/s13052-026-02211-y","DOIUrl":"10.1186/s13052-026-02211-y","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) remains a leading cause of bronchiolitis and hospitalization in infants across Italy, particularly during predictable seasonal outbreaks. With the 2023-2025 RSV seasons marking the first large-scale rollout of the monoclonal antibody nirsevimab, this study aimed to evaluate the implementation strategies, regional variability, and early clinical impact of RSV prophylaxis at the national level. We conducted a nationwide, multicenter, observational study across 19 Italian regions. Data were collected through the Italian Society of Pediatrics and the Italian Society of Neonatology, focusing on regional differences in rollout timing, organizational models, logistical challenges, and RSV-related hospitalizations and pediatric intensive care unit (PICU) admissions. The results highlighted significant regional heterogeneity. Northern and central regions such as Veneto, Lombardy, and Tuscany initiated prophylaxis earlier and experienced fewer logistical barriers, resulting in marked reductions in RSV hospitalizations - up to 83.7% in Friuli-Venezia Giulia. Conversely, southern and smaller central regions, including Molise, Marche, and Umbria, faced delayed starts, supply shortages, and bureaucratic challenges, leading to more modest decreases. PICU admissions mirrored these trends. Overall, the national introduction of nirsevimab correlated with a significant reduction in RSV-related morbidity, especially in regions with early, well-organized rollouts. Comparative international studies from France, Spain, and Luxembourg reinforce the Italian findings: timely and universal prophylaxis leads to substantial public health benefits. The study concludes that early campaign activation, consistent drug availability, and efficient organization are critical for maximizing the protective effect of RSV immunization.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251453","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":"Perceptions of challenges in clinical pediatric research: a survey of Italian pediatricians.","authors":"Alberto Eugenio Tozzi, Ileana Croci, Claudio Pignata, Rino Agostiniani, Viviana Moschese","doi":"10.1186/s13052-026-02282-x","DOIUrl":"10.1186/s13052-026-02282-x","url":null,"abstract":"<p><strong>Background: </strong>Clinical research is essential for advancing pediatric care, yet pediatricians often face unique structural, organizational, and methodological barriers that may hinder their participation in scientific activities. Understanding these obstacles is crucial to designing effective strategies that strengthen pediatric research capacity in Italy, a country with a leading role in European pediatric output. This study aimed to investigate Italian pediatricians' perceptions of barriers, facilitators, and needs related to conducting research, applying evidence in clinical practice, and publishing scientific work.</p><p><strong>Methods: </strong>We conducted a cross-sectional online survey of Italian pediatricians using an 18-item questionnaire administered between April and May 2025. Data were analyzed descriptively, and multilevel logistic regression assessed associations between perceived barriers and respondents' characteristics.</p><p><strong>Results: </strong>A total of 717 pediatricians involved in clinical and/or research activities were included. Among those engaged in research (n = 385), the most frequently reported personal barriers were difficulties balancing clinical and research duties (79.3%) and limited access to funding (67.9%). Operational issues such as delayed Ethics Committee approvals (80.8%) and challenges in multicenter data sharing (55.9%) were also prominent. Many respondents expressed dissatisfaction with current research evaluation systems: 78.2% believed that metrics should reflect long-term patient impact, and 73.1% reported that existing criteria penalize pediatric researchers in low-resource settings. Regarding scientific publishing, major obstacles included limited time (75%), complexity of data analysis (58.7%), and publication costs (55%). Interest in support initiatives was high, particularly for monthly evidence summaries (88.5%) and training in artificial intelligence tools (74.3%). Multivariate analysis revealed significant differences by age, gender, and professional role, especially concerning perceived research training adequacy and data analysis difficulties.</p><p><strong>Conclusions: </strong>Italian pediatricians face substantial structural, organizational, and methodological barriers to conducting research. Despite this, they show strong motivation to engage in scientific activities and express clear needs for training, infrastructural support, and improved evaluation systems. Strengthening funding opportunities, enhancing institutional support, and streamlining ethical and administrative procedures are essential to advancing pediatric research capacity and improving future child health outcomes.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239214","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":"Predictive value of the hemoglobin-albumin-lymphocyte-platelet score for intravenous immunoglobulin resistance in children with Kawasaki disease.","authors":"Kai Li, Fei Li, Na Zeng, Haiyan Sang, Ya Zhao, Mingwu Chen","doi":"10.1186/s13052-026-02288-5","DOIUrl":"10.1186/s13052-026-02288-5","url":null,"abstract":"<p><strong>Background: </strong>Intravenous immunoglobulin (IVIG) resistance is a major clinical challenge in children with Kawasaki disease (KD) and is associated with an increased risk of coronary artery lesions. Early identification of patients at high risk of IVIG resistance remains clinically important.</p><p><strong>Methods: </strong>Medical data were collected from KD patients at Anhui Provincial Hospital between January 2018 and December 2023. Multivariable logistic regression was performed to identify independent risk factors for IVIG resistance in KD. The study further performed subgroup analyses and restricted cubic spline (RCS) to visualize the dose-response association between hemoglobin-albumin-lymphocyte-platelet score (HALP) and IVIG resistance. The predictive performance of HALP was evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA), and internal validation was performed using bootstrap resampling.</p><p><strong>Results: </strong>A total of 598 patients were included, of whom 58 (9.7%) were identified as IVIG-resistant. Patients with IVIG-resistant KD had significantly lower HALP scores, and low HALP was identified as an independent risk factor for IVIG resistance. The association was consistent across subgroups defined by age, sex, and incomplete KD (IKD). The area under the curve (AUC) for HALP in predicting IVIG resistance was 0.854, outperforming NLR (AUC = 0.751), PLR (AUC = 0.793), and SII (AUC = 0.759). In addition, DCA showed that HALP provided greater net benefit when the threshold probability ranged from 0.02 to 0.63. Moreover, subgroup ROC indicated that HALP had higher predictive value in patients aged ≤ 6 months (AUC = 0.934) and ≥ 48 months (AUC = 0.947).</p><p><strong>Conclusions: </strong>HALP is independently associated with IVIG resistance in children with KD and demonstrated good performance for early risk stratification, particularly in patients aged ≤ 6 months and ≥ 48 months. As a simple and readily available biomarker, HALP may serve as a useful complementary tool in routine pediatric clinical practice.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"52 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239171","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}