Italian Journal of Pediatrics最新文献

{"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}

{"title":"Congenital heart disease prolongs the time to full enteral feeding in neonates with abdominal operation: a dual-center, propensity score-matched retrospective cohort study.","authors":"Yao Liu, Jing Guo, Yiwen Tan, Yingyuan Wang, Xiying Xiang, Juan Du, Wenqing Kang, Mingyan Hei","doi":"10.1186/s13052-026-02291-w","DOIUrl":"10.1186/s13052-026-02291-w","url":null,"abstract":"<p><strong>Background: </strong>Congenital heart disease (CHD) may cause intestinal hypoperfusion and feeding intolerance. The aim of this study was to assess whether CHD prolongs the time to achieve full enteral feeding in neonates underwent abdominal surgery.</p><p><strong>Methods: </strong>This was a dual-center retrospective study. Neonates who underwent abdominal surgery were subdivided into two groups: those with CHD and those without. The primary outcome was the time to achieve full enteral feeding after abdominal surgery. Propensity score matching (ratio of 1:2) was performed to balance covariates. Cox regression analysis was used to evaluate the association. Subgroup analysis further stratified CHD patients based on hemodynamic significance as determined by echocardiographic criteria.</p><p><strong>Results: </strong>A total of 341 newborns were enrolled: 136 with CHD and 205 without. For infants with vs. without CHD, the median gestational age was 35.6 (32.4, 37.8) weeks vs. 36.6 (32.1, 39.0) weeks, birth weight was 2270.0 (1547.5, 3007.5) vs. 2630.0 (1700.0, 3300.0) g, corrected gestational age on surgery day was 37.2 (34.2, 39.4) weeks vs. 39.0 (35.1, 41.4) weeks, respectively (all P < 0.05). There was no significant difference between 2 groups in preoperative feeding nor in operation duration (both P > 0.05). After propensity score matching, 64 neonates with CHD and 128 without CHD were compared. The postoperative time to achieve full feeding was 21.6 days (95% CI: 15.1 ~ 28.1) for CHD and 17.4 (95% CI: 14.2 ~ 20.7) days for non-CHD (P = 0.014). Multivariable analysis found that CHD was an independent risk factor (HR = 2.046, 95% CI: 1.189 ~ 3.519, P = 0.010). Subgroup analysis revealed that only hemodynamically significant CHD (HR = 2.712, 95% CI: 1.414 ~ 5.198, P = 0.003) contributed to this association, while non-significant CHD did not (HR = 1.112, 95% CI: 0.523 ~ 2.370, P = 0.781).</p><p><strong>Conclusions: </strong>The presence of CHD significantly prolongs the time to achieve full enteral feeding postoperatively and increases the risk of feeding intolerance in neonates undergoing abdominal surgery, an effect primarily driven by hemodynamically significant CHD.</p><p><strong>Trial registration: </strong>This study was registered in the Chinese Clinical Trial Registry on November 8, 2025 (Registry website: http://www.chictr.org.cn ) (Registration No. ChiCTR2500112685).</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148225314","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":"Bilateral acute mastoiditis during Epstein-Barr virus infection in a child with alagille syndrome: a case report and scoping review.","authors":"Marco Guida, Piero Farruggia, Cataldo Pellegrino, Federica Mescolo, Giovanni Francesco Saia, Chiara Marino, Tiziana Guida Rutilio, Samentha Menager, Barbara Torrente, Sara Imparato, Flavia Volpe, Caterina Dalila Fernandez, Michelangelo Sciortino, Giovanni Corsello","doi":"10.1186/s13052-026-02290-x","DOIUrl":"10.1186/s13052-026-02290-x","url":null,"abstract":"<p><strong>Background: </strong>Bilateral acute mastoiditis is an uncommon complication of acute otitis media and is often associated with systemic infections or underlying predisposing conditions. Viral infections, particularly Epstein-Barr virus (EBV), may facilitate secondary bacterial complications in susceptible pediatric patients. Alagille syndrome, a multisystem genetic disorder, may further increase vulnerability to severe infections due to immune and anatomical factors.</p><p><strong>Methods: </strong>We report a case of bilateral acute mastoiditis occurring in a child with Alagille syndrome during acute EBV infection: clinical, laboratory, microbiological, and radiological findings were collected and analysed. Furthermore, a scoping review was conducted to contextualize diagnostic and therapeutic strategies in pediatric mastoiditis.</p><p><strong>Results: </strong>A 12-year-old boy with known Alagille syndrome presented with persistent fever during confirmed EBV infection. During hospitalization, he developed clinical signs of bilateral mastoiditis. Contrast-enhanced computed tomography confirmed bilateral mastoid involvement. Blood cultures yielded Streptococcus pneumoniae. The patient was treated with intravenous broad-spectrum antibiotics (ceftriaxone and vancomycin) and underwent bilateral myringotomy with drainage. Clinical conditions improved rapidly, allowing step-down to oral antibiotic therapy and complete recovery without complications.</p><p><strong>Conclusions: </strong>This case underscores the rare association between bilateral mastoiditis, EBV infection, and Alagille syndrome and highlights the potential interplay between viral-induced immune dysregulation and genetic susceptibility in promoting severe bacterial complications. Early recognition, appropriate antimicrobial therapy, and timely surgical intervention are essential to ensure favourable outcomes. Children with underlying genetic conditions may require closer monitoring during systemic viral infections to prevent severe complications.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204609","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":"Risk factors analysis of poor prognosis in ICU-admitted children with severe influenza pneumonia: a retrospective case-control study.","authors":"Zhaoqian Shan, Wanyu Jia, Wanying Li, Peng Li, Chunlan Song","doi":"10.1186/s13052-026-02292-9","DOIUrl":"10.1186/s13052-026-02292-9","url":null,"abstract":"<p><strong>Background: </strong>This study investigated independent prognostic risk factors for adverse outcomes in children admitted to the ICU with severe influenza pneumonia to guide early risk stratification and timely clinical intervention.</p><p><strong>Methods: </strong>This retrospective study included 139 eligible pediatric ICU patients with severe influenza pneumonia. Univariate and multivariate logistic regression was applied to analyze the independent risk factors for poor prognosis with severe influenza pneumonia, and the Receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of risk factors.</p><p><strong>Results: </strong>Among the 139 children, 45 had a poor prognosis and 94 had a good prognosis. Multiple clinical and laboratory parameters differed significantly between the two groups (all P[Formula: see text]0.05). The three independent risk factors associated with poor prognosis were identified: fever peek [Formula: see text]41[Formula: see text](Odds ration [OR] [Formula: see text] 13.584, P[Formula: see text] 0.036), requirement for invasive mechanical ventilation (IMV) (OR [Formula: see text] 47.526, P[Formula: see text] 0.006), and elevated interleukin-6 (IL-6) levels (OR [Formula: see text] 1.049, P[Formula: see text] 0.002).The optimal cut-off value of IL-6 for predicting poor prognosis was 492.05 pg/mL (Area under the Curve [AUC] [Formula: see text] 0.755; sensitivity 46.7[Formula: see text], specificity 94.7[Formula: see text]; 95[Formula: see text] Confidence Interval [CI]: 0.666-0.844). The AUCs for fever peak [Formula: see text] 41[Formula: see text] and IMV were 0.623 and 0.737, respectively, whereas the combined AUC for all three indicators reached 0.848 [Formula: see text]95[Formula: see text] CI: 0.784-0.912).</p><p><strong>Conclusion: </strong>Fever peak [Formula: see text]41[Formula: see text], requirement for IMV, and IL-6 levels exceeding 492.05 pg/mL are robust independent early predictors of poor prognosis in children admitted to the ICU with severe influenza pneumonia. Combined assessment of these markers demonstrates strong predictive performance and supports targeted early intervention in high-risk patients.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204787","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":"Electrolyte balance and muscle damage after adolescent binge alcohol use: a retrospective study.","authors":"Isabella Hunjan, Enrico Pistritto, Antonio Corsello, Mario G Bianchetti, Ilaria Alberti, Emilia Vassilopoulou, Carlo Agostoni, Filippo Salvini, Camilla Lavagno, Gregorio P Milani","doi":"10.1186/s13052-026-02280-z","DOIUrl":"10.1186/s13052-026-02280-z","url":null,"abstract":"<p><strong>Background: </strong>Binge alcohol drinking is a recognized cause of peripheral muscle damage, leading to increased creatine kinase levels. However, the potential role of electrolyte and osmolality changes in muscle damage remains unclear. This study investigates the prevalence of muscle damage in adolescents after binge drinking and its association with ethanol, potassium, sodium, calcium, and osmolality levels.</p><p><strong>Methods: </strong>A retrospective review of medical records from the Pediatric Emergency Department, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, was conducted. The study included 150 adolescents (13.2 to 18.0 years of age, female to male ratio 1.03) diagnosed with binge drinking between 2013 and 2023. Exclusion criteria encompassed muscle trauma, crush syndrome, pre-existing conditions, or medications affecting muscle metabolism and electrolyte balance. Muscle damage was defined as creatine kinase levels exceeding 1.5 times the upper limit of normal.</p><p><strong>Results: </strong>Muscle damage was identified in 61 (41%) cases, predominantly in males (female to male ratio 0.24; p < 0.0001). Ethanol levels (1.87 [1.57-2.30] versus 2.01 [1.61-2.36] g/L; median and interquartile range), potassium (3.6 [3.3-3.9] versus 3.7 [3.5-3.9] mmol/L), sodium (140 [139-142] versus 140 [138-142] mmol/L), total calcium (2.31 [2.27-2.37] versus 2.29 [2.25-2.31]; mmol/L), albumin-adjusted calcium (2.27 [2.22-2.32] versus 2.29 [2.18-2.31]; mmol/L), effective osmolality (286 [283-290] versus 287 [284-290] mosm/kg), and total osmolality (333 [326-342] versus 337 [326-342] mosm/kg) were similar in individuals without and with muscle damage.</p><p><strong>Conclusions: </strong>In adolescents, muscle damage is common after binge alcohol drinking, particularly in males. The pathogenesis appears to be independent of ethanol concentration, electrolyte imbalances, and osmolality changes.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204647","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":"Management of acute otitis media with otorrhea in Italian pediatric practice: a national survey.","authors":"Paola Marchisio, Michele Miraglia Del Giudice, Antonio d'Avino, Stefania Zampogna, Giorgio Ciprandi, Gianluigi Marseglia","doi":"10.1186/s13052-026-02286-7","DOIUrl":"10.1186/s13052-026-02286-7","url":null,"abstract":"<p><strong>Background: </strong>Acute otitis media (AOM) is a common pediatric infection, and spontaneous tympanic membrane perforation and otorrhea represent a clinically significant subset that requires specific management. Understanding current practices among pediatricians is crucial for identifying areas of concordance with guidelines, management strategies, and potential educational needs.</p><p><strong>Methods: </strong>A national survey was conducted among Italian pediatricians, including both family pediatricians and hospital-based specialists, to assess their attitudes and practices regarding the definition, epidemiology, diagnosis, and treatment of AOM with otorrhea. A dedicated questionnaire included 20 items concerning different aspects of AOM management, including the potentiality of topical treatment for otorrhea. Data were also stratified for age, type of work, and geographic area.</p><p><strong>Results: </strong>Five hundred pediatricians participated in the survey. The survey revealed that 57.6% of respondents preferred \"acute otitis media with otorrhea\" as the disease definition. AOM with otorrhea is most frequently observed in winter (45%) and autumn/spring (25% each). Approximately two-thirds of pediatricians (66%) manage 5-20 cases monthly during peak incidence. Otorrhea is reported in <10% of AOM cases by 58.6% of practitioners. A substantial majority (80.2%) initiate antibiotic treatment at the first observation in the presence of otorrhea, primarily systemic (78.2%), with amoxicillin-clavulanate (60.2%) being the preferred drug for 8-10 days (72.4%). Recurrences within 3 months are reported by 72.8% of respondents, with <10% of patients reporting them. There is raised interest in treatment alternatives (85.8%) and a preference for topical administration for specific patient categories (60.6%).</p><p><strong>Conclusions: </strong>This national survey suggests that Italian pediatricians commonly favor early antibiotic treatment for acute otitis media with otorrhea, while areas of uncertainty remain regarding watchful waiting, treatment duration, and the role of topical therapy. These findings highlight the need for clearer, practice-oriented guidance and further research.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"52 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148198939","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":"S. aureus infections in hospitalized children with hematological, hepatological or kidney diseases over a 16-year period at a tertiary care hospital in Sweden: a retrospective observational study.","authors":"Susan Farmand, Hannah Kurz, Jack Isaksson, Milan Chromek, Birgitta Henriques-Normark, Mikael Sundin","doi":"10.1186/s13052-026-02289-4","DOIUrl":"10.1186/s13052-026-02289-4","url":null,"abstract":"<p><strong>Background: </strong>Staphylococcus aureus (S. aureus) continues to be a significant pathogen responsible for a wide spectrum of infections with potentially fatal outcomes. The existing literature on S. aureus infection in children is still limited and highly heterogeneous, making it difficult to establish standardized indicators for complicated infections-especially in children with underlying medical conditions. Within this study we describe the clinical course and outcome of S. aureus infections in hospitalized pediatric patients with significant underlying disease or risk factors and assess whether clinical and/or laboratory features may be associated with the infectious course.</p><p><strong>Methods: </strong>Patients receiving inpatient care for S. aureus infection at the Karolinska University Hospital Huddinge, Sweden were identified by ICD-coding. Infection frequency, clinical course, underlying disease and medication were reviewed. Events were grouped according to severity (mild versus complicated) and subgroup analysis was performed.</p><p><strong>Results: </strong>Between 01/2004 and 12/2019, 38 patients with proven inpatient S. aureus infection were identified. These patients displayed a high number of recurrence accounting for a total number of 68 S. aureus infection episodes. All patients had significant underlying co-morbidities and risk factors. In 58 episodes (85.3%) an indwelling device was present. No S. aureus related mortality occurred and sequelae were extremely rare. Patients with complicated infection were more likely to display fever and elevated CRP at presentation, while leukocyte and neutrophil numbers did not significantly differ. Outpatient care prior to infection, local infection signs and a good or excellent status at presentation were associated with mild infection in our cohort.</p><p><strong>Conclusions: </strong>Recurrent infections were frequent among affected patients. Prompt antibiotic treatment upon suspicion of infection as well as the removal of indwelling devices may have contributed to the overall favorable outcomes in our cohort. Further studies are required to address the usefulness of identified variables to guide clinical decision making.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156376","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":"Accurate prediction of mortality in children with sepsis: development and validation of an explainable model based on real-world data.","authors":"Xue-Jing Yang, Wei Gu, Hong-Jun Miao, Dan Shi, Ya-Li Qian, Meng-Yuan Wu, Xiao-He Chen, Yan-Qun Sun, Xu-Hua Ge","doi":"10.1186/s13052-026-02287-6","DOIUrl":"10.1186/s13052-026-02287-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis remains the leading cause of in-hospital deaths among children, and there is currently a lack of precise early prediction models. This study aimed to develop an interpretable machine learning (IML) model to predict in-hospital mortality in pediatric patients diagnosed with sepsis according to the 2024 Phoenix Sepsis Diagnostic Criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective cohort study analyzed 464,459 children who were hospitalized in the Children's Hospital Affiliated to Nanjing Medical University from January 2018 to December 2023 were screened. Based on the Phoenix Sepsis Score, 2,477 cases of childhood sepsis were finally diagnosed. The features were filtered using three methods the minimum absolute contraction and selection operator (LASSO) regression, the Boruta algorithm, and random forest importance ranking, ultimately identifying 12 features. Eight machine learning algorithms were trained on 70% of the data and evaluated on a 30% test set. The optimal model was screened based on the accuracy of the test set and the area under the receiver operating characteristic curve (AUC). The interpretability of the model is enhanced by leveraging SHapley Additive exPlanations (SHAP) summary graphs, individual SHAP force maps, and partial dependency plots (PDPs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 2,477 patients with sepsis met the participation criteria, with a median age of 26 months (IQR, 5-78 months). Among the 2,477 participants, 1,448 (58.5%) were boys. The CatBoost model demonstrated the best performance among the 8 constructed models, achieving an AUC of 0.889 and an accuracy of 92.9% in the test set. Notably, at the default decision threshold, the model demonstrated high specificity but relatively low sensitivity. However, by optimizing the decision threshold using the Youden Index, the model's sensitivity was substantially improved to 83.05%, effectively mitigating the potential risk of missed diagnoses for high-risk patients in clinical practice. Feature importance analysis indicated that invasive mechanical ventilation, Glasgow Coma Scale score, platelet count, uric acid, and SpO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; ratio were the top five features that had the greatest impact on the CatBoost model. SHAP analysis provided both global feature importance and individualised risk explanations, and the model has been deployed as a freely accessible web calculator.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The IML model developed in this study provides a highly interpretable and accurate tool for the early prediction of in-hospital mortality in pediatric sepsis patients. The SHAP approach improves model interpretability and helps clinicians understand the factors driving those predictions. However, as a single-center retrospective study, the generalizability of our findings to other clinical settings may be limited. Future multi-center prospective studies are necessary to further vali","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156060","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":"Measles challenges: global resurgence and factors affecting eradication.","authors":"Eltayib H Ahmed Mohamedosman, Mohammad Fahad Ullah, Tarig M S Alnour, Elmutuz H Elssaig, Aadil Yousif, Mohamed I Holie","doi":"10.1186/s13052-026-02283-w","DOIUrl":"10.1186/s13052-026-02283-w","url":null,"abstract":"<p><p>Measles is one of the most highly contagious and inflictive human viral infections, and approximately 90% of exposed individuals become infected following the exposure. The infection is communicable from one day before the prodromal symptom onset until four days after rash onset. Up to 40% of people who attract measles will have other health problems arising during the course of infection. There is no specific treatment for measles. Recent reports highlight that measles infection erases the already existing immune memory of various pathogens. The latest measles outbreaks in sub-Saharan Africa and Europe show the ease with which measles virus can re-enter communities. However, measles outbreaks in recent years have been reported in all regions of the world, including countries that had previously declared the disease eliminated such as United Kingdom and the United States. The present review article provides an outlook of the current epidemiology and challenges to support the global efforts in controlling the disease through discussion on the recent resurgence and enumerating the factors hindering the eradication of measles. This constellation of factors contributing to measles resurgence and outbreak propagation is multifactorial. Key drivers include suboptimal vaccine coverage, stemming from either outright vaccine refusal or barriers to healthcare access leading to incomplete vaccination schedules. This results in a diminution of herd immunity, compromising community-wide protection. Furthermore, primary or secondary vaccine failure, while rare, contributes to a residual pool of susceptible individuals. Diagnostic challenges, including the misdiagnosis of measles as other exanthematous illnesses, can delay outbreak containment and facilitate silent transmission. An epidemiological consequence of prolonged low transmission is an upward shift in the age-specific susceptibility profile, exposing older children and adults who lack natural immunity. Finally, sociopolitical instability, conflict, and resultant internal displacement create conditions conducive to outbreaks by disrupting healthcare infrastructure, hampering vaccination campaigns, and fostering high-density living conditions among vulnerable populations. This review addresses a major gap in measles eradication by integrating scattered evidence on measles resurgence into an integrated comprehensive framework, encompassing health system, epidemiological, immunological, and sociopolitical factors.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13465144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156101","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":"Ultrasound elastography in pediatric care: bridging innovation and noninvasive diagnostics.","authors":"Martina Piersanti, Federica Ferrari, Marisa Piccirillo, Rino Agostiniani, Marta Zerunian, Damiano Caruso, Fortunata Civitelli, Marco Graziani, Pasquale Parisi, Elisabetta Cortis, Giovanni Di Nardo, Maurizio Mennini","doi":"10.1186/s13052-026-02279-6","DOIUrl":"10.1186/s13052-026-02279-6","url":null,"abstract":"<p><p>This review explores the application and limitations of ultrasound elastography (USE) in the pediatric population, addressing its diagnostic value across different organs and suggesting future directions for research and clinical practice. A literature review was conducted using PubMed to identify studies published between 2010 and 2025 that examined USE applications in children. The search focused on studies assessing the liver, kidney, bowel, pancreas, muscle, connective tissue, and lung. The review highlights the established clinical application of USE in the assessment of liver fibrosis. It also provides an overview of new potential applications in kidney diseases, inflammatory bowel disease, cystic fibrosis, and muscle disorders. Two-dimensional shear wave elastography (2D-SWE) demonstrates excellent diagnostic accuracy in liver disease. However, in kidney applications, variability in results and the lack of standardized protocols limit clinical utility. SWE has shown promise in in the early detection of pancreatic insufficiency and muscle stiffness in cerebral palsy. Emerging applications include monitoring lung fibrosis and assessing fetal lung development. Despite its advantages-being noninvasive, repeatable, and well tolerated-USE remains limited by operator dependency, lack of standardization, and poor reproducibility in specific organs remain a major challenge. USE demonstrates significant potential for noninvasive diagnostics in pediatric care, especially in reducing invasive procedures and improving patient follow-up. However, further studies are needed to establish standardized protocols, reliable cut-off values, and broader applications across different organ systems. Integration of USE with other imaging modalities and utilizing advancements in artificial intelligence may enhance its diagnostic yield.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149956","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}