Italian Journal of Pediatrics最新文献

{"title":"Micafungin versus Amphotericin B in treatment of invasive fungal infection in preterm neonates: a randomized control trial.","authors":"Mariam John Amin Ibrahim, Marwa Saad Mohammed Fathy, Mertte Ashraf Thabet Ghobrial, Maha Hassan Mohamed","doi":"10.1186/s13052-025-01852-9","DOIUrl":"10.1186/s13052-025-01852-9","url":null,"abstract":"<p><strong>Background: </strong>Micafungin, Amphotericin B, and Fluconazole are the primary therapeutic agents employed to address invasive fungal candidiasis in neonates. Resistance to fluconazole is gradually developing in neonatal intensive care units. We aimed to conduct a comparative analysis of Micafungin and Amphotericin B in terms of their effectiveness and safety in the treatment of invasive fungal infections in neonates.</p><p><strong>Methods: </strong>Fifty-six preterm neonates with invasive fungal infection proven by fungal culture and who had received fluconazole for at least one week were included in our study and were divided randomly into two groups. Micafungin group: twenty-eight preterms received Micafungin at a dose of 8 mg/kg/day for 14 days. Amphotericin B group: twenty-eight preterms received amphotericin B at a dose of 1 mg /kg/day for 14 days. Clinical and laboratory follow up by fungal culture were performed after 14 days.</p><p><strong>Results: </strong>Neonates in the Micafungin group showed significant increased percentage for complete cure of the fungal infection compared to Amphotericin B group 18(64.3%) vs. 10(35.7%) respectively and decreased percentage of incomplete cure 10(35.7%) vs. 18(64.3%) respectively with p-value 0.030. A higher percentage of neonates were completely cured for both candida albicans (65.2%) and non-albicans (60%) in the micafungin group. Duration of respiratory and circulatory support was significantly shorter also. No additional drug side effects were observed with Micafungin except for mild hypomagnesemia. There was an increase in blood urea nitrogen with Amphotericin B.</p><p><strong>Conclusion: </strong>Micafungin is effective and well tolerated for the treatment of invasive fungal infections in preterm neonates.</p><p><strong>Trial registration: </strong>The current study was approved by clinicaltrials.org and the protocol ID NCT06413056 was retrospectively registered in on 11th of march 2024. https://clinicaltrials.gov/study/NCT06413056?cond=micafungin%20in%20neonates&rank=2 .</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"61"},"PeriodicalIF":3.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523465","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":"The behavioral phenotype in a cohort of patients with chromosome 18 anomalies: a retrospective observational study.","authors":"Beatrice Allegri, Paola Francesca Ajmone, Giovanni Michelini, Virginia Antonietti, Silvia Tornielli, Fabio Bruschi, Francesca Dall'Ara, Federico Monti, Donatella Milani, Paola Giovanna Vizziello, Maria Antonella Costantino","doi":"10.1186/s13052-025-01902-2","DOIUrl":"10.1186/s13052-025-01902-2","url":null,"abstract":"<p><strong>Background: </strong>Genetic syndromes resulting from chromosome 18 structural abnormalities constitute a broad spectrum of conditions characterized by significant clinical heterogeneity. Most studies in the literature focus on case reports and clinical observations; the present study aims to assess the cognitive, communicative, behavioral, and adaptive abilities of different chromosome 18 abnormalities. In addition, this work aims to identify phenotype-genotype correlations by comparing individuals with 18p deletion, 18q deletion, and 18p tetrasomy.</p><p><strong>Methods: </strong>The sample included 24 patients with a definite genetic diagnosis of 18p deletion (N = 6), 18q deletion (N = 9), or 18p tetrasomy (N = 8). The assessment is provided by using a specific protocol based on direct and indirect clinical assessment of patients. Differences in IQ/GQ indexes, adaptive behavior, CARS scores, and CBCL internalizing and externalizing symptoms were assessed using ANCOVAs with age as covariate.</p><p><strong>Results: </strong>Our results showed more significant cognitive and behavioral impairment in tetrasomy 18 than in the other two conditions. Conversely, in 18p deletion group, we found greater behaviorally susceptibility to develop autistic traits.</p><p><strong>Conclusion: </strong>These preliminary findings should raise clinicians' awareness of the strengths and weaknesses of patients with chromosome 18 alterations, paving the way to targeted and more appropriate management.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"60"},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501375","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":"Knowledge and management of Münchausen's Syndrome by proxy: a survey conducted through the compilation of a questionnaire by pediatricians belonging to the Italian Society of Pediatrics.","authors":"Rosaria Nardello, Giada Cordova, Corinne La Spina, Ettore Piro, Gregorio Serra, Giovanni Corsello, Antonina Argo","doi":"10.1186/s13052-025-01878-z","DOIUrl":"10.1186/s13052-025-01878-z","url":null,"abstract":"<p><strong>Background: </strong>Munchausen syndrome by proxy represent forms of abuse with long-term psychiatric outcomes. Since the prevalence of Munchausen Syndrome by proxy is uncertain and underestimated, this study aimed to investigate and analyze the phenomenon through the compilation of an anonymous questionnaire that explores the knowledge of the phenomenon and above all its management.</p><p><strong>Methods: </strong>the study was conducted by sending an anonymous questionnaire to pediatricians who are part of the Italian Society of Pediatrics. The questionnaire consists of 18 multiple choice questions and was completed by 511 professionals.</p><p><strong>Results: </strong>The main results highlighted that the majority of doctors knows Münchausen Syndrome by proxy. However, when there is a strong suspicion of the syndrome, they mostly seek discussion with the parent or with another specialist instead of referring to the competent authorities.</p><p><strong>Conclusions: </strong>starting from the consideration that timely diagnosis is fundamental for the protection of the child, we emphasize the urgency of enhancing the recognition and management of Munchausen Syndrome by Proxy. Early diagnosis, appropriate reporting, and collaboration with child protection authorities are essential in safeguarding the well-being of vulnerable individuals.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"59"},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501373","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":"Comorbidity of diarrhea and respiratory infection symptoms, and associated factors among under-five children in Gondar City, Northwest Ethiopia: a community-based cross-sectional study.","authors":"Lidetu Demoze, Awrajaw Dessie, Jember Azanaw, Gelila Yitageasu, Kidist Asrat, Zemichael Gizaw","doi":"10.1186/s13052-025-01866-3","DOIUrl":"10.1186/s13052-025-01866-3","url":null,"abstract":"<p><strong>Background: </strong>Childhood morbidity is frequently characterized by more than one health condition. Children under the age of five in low- and middle-income countries including Ethiopia experience multiple episodes of diarrhea and respiratory infection symptoms. However, there have been limited studies on comorbidities of diarrhea and respiratory infection symptoms. In addition, most studies conducted in Ethiopia seek separate outcomes for diarrhea and respiratory infection symptoms. Therefore, this study aimed to determine the prevalence of diarrhea and respiratory infection symptoms comorbidity, and associated factors among under-five children in Gondar City.</p><p><strong>Methods: </strong>Community-based cross-sectional study was conducted in Gondar City among under-five children from April 05 - May 04, 2023. Multi-stage sampling technique was used to collect a sample of 836. A structured questionnaire was employed through an interview-administered method for data collection at participants' homes. Bivariable and multivariable binary logistic regression analyses were undertaken to identify predictors of childhood comorbidity of diarrhea and respiratory infection symptoms.</p><p><strong>Results: </strong>The comorbidity prevalence of diarrhea and respiratory infection symptoms in under-five children was 17.22% [CI: 14.8%-19.9%]. Mothers/caretaker age < 25 years (AOR = 3.52 at 95% CI:1.64,7.5), mothers/caretakers who had no formal education (AOR = 4.42 at 95% CI: 2.08,9.9.40), family size > 5 (AOR = 4.52 at 95% CI: 2.13,9.61), second birth order (AOR = 2.67 at 95% CI: 1.31,5.41), children playground not clean(AOR = 2.19 at 95% CI:1.01,4.71), started supplementary feeding at age > 6 months (AOR = 4.51 at 95% CI:1.50,13.58), mothers/caretakers who didn't wash their hands after visiting latrine (AOR = 2.03 at 95% CI: 1.03,4.03), mothers/caretakers who didn't wash their hands with soap and water (AOR = 1.92 at 95% CI: 1.00,3.69) were significantly associated factors with under five children comorbidity of diarrhea and respiratory infection symptoms.</p><p><strong>Conclusions: </strong>According to the findings, the prevalence of diarrhea and respiratory infection symptoms comorbidity was higher and variation in the amount of comorbidity is explained by maternal and child predictors. Educating mothers/caregivers about hand washing, sanitation, hygiene, and supplementary feeding is a key approach for the prevention and control of comorbidities in children.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"58"},"PeriodicalIF":3.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492111","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":"Swallowing disorders in cerebral palsy: a systematic review of oropharyngeal Dysphagia, nutritional impact, and health risks.","authors":"Andrea Calderone, David Militi, Davide Cardile, Francesco Corallo, Rocco Salvatore Calabrò, Angela Militi","doi":"10.1186/s13052-025-01903-1","DOIUrl":"10.1186/s13052-025-01903-1","url":null,"abstract":"<p><p>Cerebral palsy (CP) is a permanent disorder affecting movement and posture due to nonprogressive brain issues, often leading to various sensory, cognitive, and musculoskeletal challenges. Among these complications, oropharyngeal dysphagia (OPD) is prevalent, impacting up to 85% of children with CP and resulting in significant nutritional deficits. This systematic review aims to explore the prevalence and types of OPD in CP patients, its effects on nutritional status, and its associated health complications, emphasizing the need for thorough assessment and intervention to mitigate risks. The review adheres to PRISMA guidelines, searching five major databases (PubMed, Web of Science, Embase, Cochrane Library, and Scopus) without time range restrictions to capture studies addressing swallowing disorders and their impact on nutritional status in CP. This review has been registered on Open OSF (n) 3KUQX. Individuals with CP often experience swallowing impairments, including delayed pharyngeal transit and aspiration. Research indicates that 81.5% of kids with CP suffer from dysphagia, commonly associated with reduced motor skills and general health. Moreover, as a result of these swallowing difficulties, nutritional complications may occur, with elevated levels of gastroesophageal symptoms causing malnutrition and growth delays, which require thorough evaluations and personalized interventions for successful treatment. Tools like the Videofluoroscopic Swallowing Study were identified as primary methods for evaluation, but assessment remains limited by methodological inconsistencies. This systematic review underscores the significant health impacts of OPD in children with CP, which affects nutrition and overall well-being. Future research should address the need for standardized evaluation methods and effective interventions to balance nutritional needs with practical mealtime strategies.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"57"},"PeriodicalIF":3.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476626","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":"Association of Kawasaki disease with intellectual disability, attention deficit hyperactivity disorder, and autism spectrum disorder: a systematic review and meta-analysis.","authors":"Chih-Wei Hsu, Yu-Wei Lin, Yang-Chieh Brian Chen, Liang-Jen Wang, Ho-Chang Kuo","doi":"10.1186/s13052-025-01897-w","DOIUrl":"10.1186/s13052-025-01897-w","url":null,"abstract":"<p><strong>Background: </strong>The relationship between Kawasaki disease (KD) and neurodevelopmental disorders (NDDs) remains unclear. This study aims to explore the association between them.</p><p><strong>Method: </strong>A systematic review was conducted using PubMed and Embase databases from inception to May 1, 2024 (INPLASY202450017). We included case-control or cohort studies comparing KD patients to healthy controls in assessing attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID). The meta-analysis employed a random-effects model to calculate effect sizes using hazard ratios (HRs) with 95% confidence intervals (CIs) for the disease occurrence. Moreover, mean differences (MDs) were used to calculate intelligence quotient (IQ).</p><p><strong>Results: </strong>Four eligible studies, including 1,454,499 participants, were analyzed for ADHD, ASD, and ID. The risk of ADHD in KD patients was higher than in healthy controls (HR[95%CI] = 1.76[1.21-2.57]). However, the risks of ASD (HR[95%CI] = 1.68[0.47-5.94]) and ID (HR[95%CI] = 1.39[0.52-2.63]) were not significantly different between KD and controls. Additionally, three studies with 365 participants were analyzed for IQ. IQ comparisons showed no significant differences in full IQ (MD[95%CI]=-0.01[-2.44-2.42]), verbal IQ (MD[95%CI]=-1.05[-4.42-2.33]), and performance IQ (MD[95%CI]=-0.08[-2.75-2.59]).</p><p><strong>Conclusion: </strong>This study indicates that individuals with KD have a higher risk for ADHD but not for ASD or ID.</p><p><strong>Trial registration: </strong>INPLASY, INPLASY202450017. Registered 05 May 2024, https://inplasy.com/inplasy-2024-5-0017/ .</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"52"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472420","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":"KBG syndrome: report and follow-up on three unrelated patients observed at different ages.","authors":"Gregorio Serra, Pierandrea Elefante, Ylenia Gazzitano, Luigi Memo, Valeria Mineo, Carla Morando, Rosaria Nardello, Ettore Piro, Laura Travan, Giovanni Corsello","doi":"10.1186/s13052-025-01884-1","DOIUrl":"10.1186/s13052-025-01884-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;KBG syndrome (MIM #148050) is a rare genetic disease, showing an autosomal dominant pattern of inheritance. It was first described by Herrmann et al. in 1975 in three affected families, whose initial letters gave origin to the acronym. A peculiar facies including triangular face, synophrys, macrodontia of the upper central incisors, as well as short stature, skeletal defects and neurodevelopmental disorders (developmental delay, intellectual disability, epilepsy) are the main features of the syndrome. Mutations of the ankirin repeat domain 11 gene (ANKRD11), which harbors at chromosome 16q24.3, have been associated to the syndrome. The encoded protein inhibits ligand-dependent activation of transcription. Due to the growing number of detected ANKRD11 variants associated to phenotypes with various degree of severity, the precise definition of the clinical and genomic profiles of patients is important, also in the perspective of a better understanding of the molecular bases of the disease, genotype-phenotype correlation, and management of affected subjects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Cases presentation: &lt;/strong&gt;We report on three unrelated patients, observed in as many different Italian (Sicily, Veneto and Friuli-Venezia-Giulia regions) Pediatric Neurology and Medical Genetics outpatient services, showing variously present typical dysmorphic features (e.g., triangular face, macrodontia of upper incisors, brachydactyly), growth retardation and impaired neurodevelopmental profiles (i.e. developmental delay, EEG abnormalities/epilepsy) compatible with KBG syndrome diagnosis. In Patient 1, next generation sequencing analysis of a panel of genes involved in developmental delay and autism spectrum disorders detected two mutations, a pathogenic heterozygous frameshift variant of the ANKRD11 gene (already described in the literature), and a heterozygous missense one in EHMT1 (previously reported as well, and associated with Kleefstra syndrome); in Patient 2, array comparative genomic hybridization (a-CGH) analysis identified a 634 Kb 16q24.3-24.3 deletion involving several genes (CDT1, APRT, GALNS, TRAPPC2L, ACSF3, CDH15), besides ANKRD11, some of which are related with developmental disorders. Finally in Patient 3, Sanger sequencing of the ANKRD11 gene, performed due to the specific diagnostic suspicion raised for precocious teething observed at age 3 months, evidenced an intragenic deletion allowing thus an early diagnosis of disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We underline similarities and differences among our patients, and their specific genetic and clinical features, in addition to the variable diagnostic tests used for the diagnosis, reached at different developmental age, i.e. infancy, childhood and adolescence. Pediatricians must be aware of KBG syndrome and should be able, as well, to raise the diagnostic suspicion, especially in the presence of peculiar dysmorphic features, short stature, developmental delay, intelle","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"54"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476644","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 blue blood toddler- a case report of methemoglobinemia and literature review.","authors":"Dorina Pjetraj, Madiha El Mechri, Silvia Bacelli, Elisabetta Fabiani, Laura Caponi, Simona Gatti, Elena Lionetti","doi":"10.1186/s13052-025-01886-z","DOIUrl":"10.1186/s13052-025-01886-z","url":null,"abstract":"<p><strong>Background: </strong>Methemoglobinemia (MetHb) is a rare and potentially life-threatening condition caused by oxidation of ferrous hemoglobin (Fe2+) to the ferric (Fe3+) state, making it incapable of binding oxygen and resulting in cyanosis and tissue ischemia.</p><p><strong>Case presentation: </strong>This case presentation describes a 1-year-old boy who developed sudden cyanosis and reduced consciousness disorder. An initial assessment showed decreased oxygen saturation (SpO2 85%) despite oxygen therapy, while point-of-care venous blood gas (VBG) analysis assessed high rates of MetHb (72.7%). Methylene blue and ascorbic acid were administered, resulting in in rapid clinical recovery and normalized VBG test results. The trigger for this condition was not identified, however the most likely cause of poisoning was attributed to food oxidants.</p><p><strong>Conclusion: </strong>Starting from the description of a clinical case, this paper discusses the causes and mechanisms of possible poisoning and reviews recent guidelines for methemoglobinemia management.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"53"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472419","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":"Proteomic insights into molecular alterations associated with Kawasaki disease in children.","authors":"Chengyi Wang, Wenxin Yu, Xinyue Wu, Shibiao Wang, Lumin Chen, Guanghua Liu","doi":"10.1186/s13052-025-01853-8","DOIUrl":"10.1186/s13052-025-01853-8","url":null,"abstract":"<p><strong>Background: </strong>Kawasaki disease (KD) is a pediatric vasculitis that can lead to coronary artery complications if not promptly diagnosed. Its nonspecific early symptoms, primarily fever, often result in misdiagnosis. This study aimed to identify potential biomarkers for early KD diagnosis using proteomic analysis of blood samples.</p><p><strong>Methods: </strong>Serum samples were collected from three groups: children with acute KD (n = 20, CQB group), age-matched febrile children with bacterial infections (n = 20, C group), and children recovered from KD (n = 8, CQBC group). Proteomic analysis was performed to identify differentially expressed proteins in serum specimens, followed by functional and pathway enrichment analysis.</p><p><strong>Results: </strong>Compared to controls, 92 proteins were upregulated and 101 were downregulated in acute KD, with significant enrichment in the AMPK pathway. In recovered KD, 537 proteins were upregulated and 231 downregulated, predominantly affecting the PI3K-Akt pathway. A total of 56 proteins showed contrasting expression patterns between acute and recovery phases, implicating the complement and coagulation cascades. Notably, complement component 6 (C6), complement component 3 (C3), and α1-antitrypsin (A1AT) emerged as potential biomarkers involved in KD progression and recovery.</p><p><strong>Conclusions: </strong>C6, C3, and A1AT may serve as novel biomarkers for early KD diagnosis and monitoring. These findings provide new insights into KD pathogenesis and potential targets for clinical application.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"56"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472486","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":"Establishment and validation of risk prediction model to predict intravenous immunoglobulin-resistance in Kawasaki disease based on meta-analysis of 15 cohorts.","authors":"Shuhui Wang, Na Sun, PanPan Liu, Weiguo Qian, Qiuqin Xu, DaoPing Yang, Mingyang Zhang, Miao Hou, Ye Chen, Guanghui Qian, Chunmei Gao, Ling Sun, Haitao Lv","doi":"10.1186/s13052-025-01889-w","DOIUrl":"10.1186/s13052-025-01889-w","url":null,"abstract":"<p><strong>Background: </strong>Pediatric Kawasaki disease (KD) patients showing resistance to intravenous immunoglobulin (IVIG) are at risk of coronary artery lesions; thus, early prediction of IVIG resistance is particularly important. Herein, we aimed to develop and verify a novel predictive risk model for IVIG resistance in KD based on meta-analyses.</p><p><strong>Methods: </strong>PubMed, Embase, and Web of Science databases were searched for cohort studies on the risk factors for IVIG resistance from January 2006 to December 2022. Data were extracted from the screened literature, followed by quality assessment using the Newcastle-Ottawa scale. meta-analyses used Stata 17.0 software to extract the risk factors with significant combined effect sizes and combined risk values, followed by logistic regression prediction model construction. The model was prospective validated using data from 1007 pediatric KD cases attending the Children's Hospital of Soochow University. The model's predictive ability was assessed using the Hosmer-Lemeshow test and area under the receiver operating characteristic curve (AUC) and the clinical utility was assessed using decision curve analysis(DCA).</p><p><strong>Results: </strong>Fifteen cohort studies reporting 4273 patients with IVIG resistance were included. The incidence of IVIG resistance was 16.2%. Six risk factors were reported ≥ 3 times with significant results for the combined effect size: male sex, rash, cervical lymphadenopathy, % neutrophils ≥ 80%, Age ≤ 12 months and platelet count ≤ 300 × 10⁹/L. The logistic scoring model had 83.8% specificity, 70.4% sensitivity, and an optimal cut-off value of 23.500.</p><p><strong>Conclusion: </strong>The risk prediction model for IVIG resistance in KD showed a good predictive performance, and pediatricians should pay high attention to these high-risk patients and develop an appropriate individual regimens to prevent coronary complications.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"55"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476638","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}