Italian Journal of Pediatrics最新文献

{"title":"A comprehensive benchmark of very preterm and extremely preterm infant care in Shenzhen: insights from the triple aim framework.","authors":"Lu Ding, Jinjie Huang, Xudong Yan, Guichao Zhong, Zhangbin Yu, Dong Liu, Benqing Wu","doi":"10.1186/s13052-025-02043-2","DOIUrl":"10.1186/s13052-025-02043-2","url":null,"abstract":"<p><strong>Background: </strong>To assess the baseline level of care for very preterm (VPI) and extremely preterm infants (EPI) in Shenzhen using the Triple Aim framework.</p><p><strong>Methods: </strong>This retrospective analysis utilized data from the Shenzhen Neonatal Data Network (SNDN) for 2022-2023. We assessed mortality rate, major morbidity rate, benefit metric (a risk-adjusted composite morbidity index), and per capita costs.</p><p><strong>Results: </strong>The study included 995 infants from 11 NICUs in the SNDN, with an overall mortality rate of 7.5%. The rates for the eight major morbidities were: bronchopulmonary dysplasia 22.6%, grade III-IV intraventricular hemorrhage 5.2%, periventricular leukomalacia 2.2%, stage II-III necrotizing enterocolitis 3.9%, focal intestinal perforation 0.8%, stage 3-5 retinopathy of prematurity 3.8%, discharge weight < 10th percentile 12.1%, and late-onset infections 9.4%. The benefit metric ranged from 0.7 to 3.3, with per capita costs between $212.3 and $342.4.</p><p><strong>Conclusion: </strong>This study provides baseline data on NICU preterm infant management in Shenzhen using the Triple Aim framework, highlights areas for quality improvement.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"186"},"PeriodicalIF":3.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266227","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":"Citrobacter and Acinetobacter are respectively involved in feeding intolerance in preterm infants of different gestational ages: a prospective case-control study.","authors":"Chunyan Fu, Jinglin Xu, He Wang, Dongmei Chen, Zhiyong Liu","doi":"10.1186/s13052-025-02034-3","DOIUrl":"10.1186/s13052-025-02034-3","url":null,"abstract":"<p><strong>Background: </strong>Feeding intolerance (FI) is a common feeding problem in preterm infants. The gut microbiota contributes significantly to its onset, progression, and outcome. In this study, we aimed to understand the differences in gut microbiota among preterm infants with FI of different gestational ages. The goal was to provide a basis for early probiotic intervention.</p><p><strong>Methods: </strong>We undertook a prospective case-control study in which we enrolled 80 preterm infants at a gestational age < 34 weeks. Participants were divided into four groups of 20 each: early preterm infants with FI (EFI group, gestational age < 32 weeks), early preterm infants with feeding tolerance (FT) (EFT group, gestational age < 32 weeks), moderate preterm infants with FI (MFI group, gestational age ≥ 32 weeks), moderate preterm infants with FT (MFT group, gestational age ≥ 32 weeks). 16 S rDNA high-throughput sequencing was employed to analyze the infants' fecal microbiota and examine the potential link between gut microbiota and gestational age. Statistical analysis was conducted for the collected data. The Statistical Package for Social Sciences software was used. T-tests or non-parametric tests were performed for comparison between groups of measurement data, and the χ2 test was used to compare between groups of count data. At the genus and species level, the potential association between intestinal microbiota and FI and the relationship with gestational age were explored.</p><p><strong>Results: </strong>The abundance of Citrobacter in the feces of the EFI group was significantly higher than that in the EFT group. Additionally, the abundance of Acinetobacter in the MFI group was significantly higher than that in the MFT group. The abundance of Clostridium XI was significantly low in the MFT group.</p><p><strong>Conclusions: </strong>Citrobacter and Acinetobacter genera are implicated in FI in preterm infants with gestational ages < 32 weeks and ≥ 32 weeks, respectively. However, Clostridium XI may be involved in regulating intestinal homeostasis in those with a gestational age ≥ 32 weeks.</p><p><strong>Trial registration: </strong>ChiCTR, ChiCTR2400086000. Registered 24 June 2024, https://www.chictr.org.cn/showprojEN.html?proj=210,126 .</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"184"},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258060","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":"Interpretable web-based machine learning model for predicting intravenous immunoglobulin resistance in Kawasaki disease.","authors":"Ying He, Fan Lin, Xin Zheng, Qiaobin Chen, Meng Xiao, Xiaoting Lin, Hongbiao Huang","doi":"10.1186/s13052-025-02036-1","DOIUrl":"10.1186/s13052-025-02036-1","url":null,"abstract":"<p><strong>Background: </strong>Kawasaki disease (KD) is a leading cause of acquired heart disease in children that is treated with intravenous immunoglobulin (IVIG). However, 10-20% of cases exhibit IVIG resistance, which increases the risk of coronary complications. Existing predictive models do not integrate multiple machine learning (ML) algorithms or facilitate real-time clinical use. This study presents a region-specific, interpretable ML model for early IVIG resistance prediction in KD.</p><p><strong>Methods: </strong>A retrospective cohort of 463 children diagnosed with KD at Fuzhou University Affiliated Provincial Hospital (2012-2024) was analyzed. Thirteen ML algorithms were evaluated via cross-validation, with performance assessed by AUC and other metrics. Feature importance was determined using SHapley Additive exPlanations (SHAP), and risk of bias was evaluated using the Prediction Model Risk of Bias Assessment Tool.</p><p><strong>Results: </strong>The random forest (RF) model demonstrated the highest predictive performance (AUC = 0.78). After feature selection based on SHAP values, a final interpretable RF model incorporating 10 key features was developed, and a web-based tool integrating the Youden index (16.9%) was deployed for real-time risk estimation.</p><p><strong>Conclusion: </strong>This region-specific, interpretable ML model ( https://milailai.shinyapps.io/data1/ ) is a practical tool for early risk stratification and personalized treatment of IVIG resistance in KD.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"181"},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247779","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":"Identifying potential drug targets for tourette syndrome: a Mendelian randomization study based on druggable genes.","authors":"Shilin Zhou, Lixin Li","doi":"10.1186/s13052-025-02048-x","DOIUrl":"10.1186/s13052-025-02048-x","url":null,"abstract":"","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"185"},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258063","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":"Hospital-acquired infections in neonatal ECMO patients: a systematic review and meta-analysis.","authors":"Ya-Ting Zeng, Yi-Nan Liu, Si-Jia Zhou, Qiang Chen, Qi-Liang Zhang","doi":"10.1186/s13052-025-02044-1","DOIUrl":"10.1186/s13052-025-02044-1","url":null,"abstract":"<p><p>To evaluate the impact of hospital-acquired infections ( HAIs ) on the prognosis of neonates treated with extracorporeal membrane oxygenation (ECMO) and analyzing related prognostic indicators, we conducted a systematic review and meta-analysis. Databases such as PubMed, Web of Science, Embase, and the Cochrane Library from the inception of each database to December 31, 2023 were searched to find related studies. Data were analyzed using RevMan 5.3 and Stata 17. Ten retrospective cohort studies were included. The meta-analysis shows that HAIs significantly increased mortality in neonates undergoing ECMO (95% confidence intervals (CI): 1.56-2.05, P < 0.001). These infections also significantly heightened the risk of mechanical complications (95% CI: 1.32-2.33, P = 0.0001), hemorrhagic complications (95% CI: 1.57-2.29, P < 0.00001), neurological complications (95% CI: 1.37-1.57, P < 0.00001), renal complications (95% CI: 1.77-1.96, P < 0.00001), cardiovascular complications (95% CI: 1.33-2.48, P = 0.0002), pulmonary complications (95% CI: 1.60-3.36, P < 0.00001), and metabolic complications (95% CI: 1.56-6.84, P = 0.002). Additionally, HAIs significantly extended the duration of ECMO support (95% CI: 85.49-133.61, P < 0.00001). HAIs substantially increase the relative risk of in-hospital mortality and other ECMO related complications in neonates, significantly prolonging the duration of ECMO support and adversely affecting overall prognosis.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"182"},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258062","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 and genetic analysis and literature review of children with myotonia congenita due to CLCN1 mutations.","authors":"Xin Wang, Shangyu Wang, Hongdan Qi, Bing Wu, Mingying He, Gang Zhang","doi":"10.1186/s13052-025-02028-1","DOIUrl":"10.1186/s13052-025-02028-1","url":null,"abstract":"<p><strong>Background: </strong>Myotonia congenita (MC) is mainly caused by variants in the CLCN1 Gene, which is characterized by having difficulty in relaxing the muscle after active contraction, known as myotonia. This study aims to investigate the clinical characteristics and gene mutations of myotonia congenita caused by CLCN1 mutation.</p><p><strong>Case presentation: </strong>Five children with myotonia congenita due to CLCN1 mutations admitted to Nanjing Children's Hospital were included. All five children had a juvenile onset of the disease (1 to 11 years of age). Two had onset before 2 years of age, and three had onset after 10 years of age. All patients experienced muscle stiffness (5/5, 100.0%), two reported delayed relaxation of the hand after forceful grasping (2/5, 40.0%), and three reported that the muscle stiffness worsened with changes in motor status (3/5, 60.0%). These symptoms improved with exercise (warm-up phenomenon) (5/5, 100.0%).Two children had elevated CK (2/5, 40.0%), and EMG showed muscle tonic potentials in all five children (5/5, 100.0%). Eight CLCN1 gene mutation sites were identified in five patients, including four unreported variants: c.688G > A (p.G230R), c.2653_c.2654insC (p.A885Afs*27), c.1938G > T (p.M646I) and c.1825 A > G (p.M609V). In this paper, we also summarized the Chinese CLCN1 mutation sites reported in the last 10 years, revealing that exons 8 and 15 may be the hotspot regions of mutation in Chinese children.</p><p><strong>Conclusion: </strong>This study expands the clinical and genetic spectrum of Chinese children with myotonia congenita. The clinical manifestations observed in these children were similar with those previously reported in the literature. Additionally, exons 8 and 15 may be the hotspot regions for gene mutations in Chinese children with myotonia congentia.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"183"},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258061","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":"Bronchoalveolar lavage cytokine profile and clinical features as risk predictors of plastic bronchitis in children with Mycoplasma pneumoniae pneumonia.","authors":"Pei Wang, Rui Duan, Qiong Wang, Di Xiao","doi":"10.1186/s13052-025-02041-4","DOIUrl":"10.1186/s13052-025-02041-4","url":null,"abstract":"<p><strong>Background: </strong>Plastic bronchitis (PB), a condition in which mucus plugs block the bronchial tree, is a serious complication of Mycoplasma pneumoniae pneumonia (MPP). This study investigated whether clinical features and cytokine levels in bronchoalveolar lavage fluid (BALF) distinguish MPP from MPP complicated by PB and sought to identify risk factors for PB in children with MPP.</p><p><strong>Methods: </strong>A total of 128 children 3-14 years of age with MPP who underwent bronchoscopy at Jingmen Central Hospital, China, between 1 April 2023 and 31 March 2024 were enrolled. Patients were divided into a PB and a non-PB group based on bronchoscopy findings. Clinical manifestations and laboratory findings, including BALF cytokine levels, were compared. A risk prediction nomogram for PB was constructed and evaluated.</p><p><strong>Results: </strong>Of 128 children with MPP, 40 (31%) had PB. Multivariate logistic regression analysis showed that clinically severe MPP (OR = 8.78; P = 0.002), systemic inflammatory response syndrome (SIRS) (OR = 2.78; P = 0.049) and elevated BALF interleukin-6 (IL-6) (OR = 1.01; P < 0.001) were independent risk factors for PB. The area under the receiver operating characteristic (ROC) curve (AUC) value for the combination of severe MPP, SIRS and IL-6 was 0.852 (95% confidence interval, 0.77-0.93). A calibration curve showed good agreement between nomogram prediction and actual observations (P = 0.723). A decision curve analysis indicated that the nomogram demonstrated good clinical applicability.</p><p><strong>Conclusion: </strong>Pronounced inflammatory responses and increased clinical severity of MPP are associated with PB. A nomogram that integrates clinical features and BALF IL-6 levels may be used for risk assessment and management of PB in MPP after initial bronchoscopy.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"175"},"PeriodicalIF":3.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247862","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":"Clinico-epidemiological profile and prediction of outcome in children with Guillain-Barre syndrome.","authors":"Debashree Priyadarshini, Velaga Anuhya, Anuspandana Mahapatra","doi":"10.1186/s13052-025-02037-0","DOIUrl":"10.1186/s13052-025-02037-0","url":null,"abstract":"<p><strong>Background: </strong>Guillain-Barré Syndrome (GBS) is a rare but serious immune-mediated neuropathy characterized by acute-onset motor weakness and potential respiratory failure. Its pathogenesis often involves molecular mimicry triggered by antecedent infections, leading to autoimmune targeting of peripheral nerves. Epidemiological data suggest a correlation between infectious outbreaks and increased GBS incidence, as exemplified by the 2025 surge in cases associated with Campylobacter jejuni enteritis in Pune, India.</p><p><strong>Methods: </strong>This prospective observational study was conducted over 24 months in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital. Ethical approval was obtained. Consecutive enrolment included children aged 2-14 years diagnosed with GBS who presented within two weeks of symptom onset. Comprehensive clinical, electrophysiological, and treatment data were collected. Patients were prospectively followed for six months, and outcomes were assessed using the GBS Disability Score. The modified Erasmus GBS outcome Score (mEGOS) and Erasmus GBS Respiratory Insufficiency Score (EGRIS) were applied for prognostic evaluation.</p><p><strong>Results: </strong>The study cohort comprised 27 children, with males aged 5-9 years being the most commonly affected. The mean (± SD) age was 6.56 (± 3.00) years. All participants reported antecedent illnesses, predominantly gastroenteritis. Clinically, symmetric motor weakness was observed in 81.5%, and 77.8% exhibited sensory involvement. Respiratory compromise requiring mechanical ventilation occurred in 11.1% of patients. Electrophysiological studies identified acute motor axonal neuropathy (AMAN) as the predominant variant, with acute motor sensory axonal neuropathy (AMSAN) demonstrating more severe clinical courses, including higher ventilation requirements and poorer functional outcomes. Prognostic assessment revealed median (IQR) mEGOS scores of 5 (4,6) at admission and 4 (3,6) at 1-week post-admission. These scores significantly predicted outcomes at 4 weeks, 3 months, and 6 months, with higher scores correlating with greater disability. The cohort's mean EGRIS score was 5.67, with higher scores predictive of increased mechanical ventilation requirements.Notably, all patients achieved favourable outcomes with no mortality, highlighting the effectiveness of the implemented management protocol.</p><p><strong>Conclusion: </strong>Our findings demonstrate that mEGOS and EGRIS are effective prognostic tools in pediatric GBS. The mEGOS reliably predicts functional outcomes at multiple recovery stages, while the EGRIS is particularly useful in early identification of patients at risk for respiratory failure requiring mechanical ventilation.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"179"},"PeriodicalIF":3.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247863","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":"Negative pressure pulmonary edema and hemorrhage after near fatal suffocation in an infant: a case report.","authors":"Valentina Tonazzo, Chiara Po', Silvia Bertolo, Valentina Agnese Ferraro, Stefania Zanconato, Stefano Martelossi, Silvia Carraro","doi":"10.1186/s13052-025-02015-6","DOIUrl":"10.1186/s13052-025-02015-6","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hemorrhage is rare but potentially life-threatening in children. Many causes are usually described, as cardiogenic, infective or immune. Pulmonary hemorrhage related to negative pressure pulmonary edema (NPPE) is uncommon in the pediatric population and there is limited literature about it. This is one of the few case reports regarding NPPE in infants presenting with pulmonary hemorrhage.</p><p><strong>Case presentation: </strong>We describe the story of a 6-weeks-old boy who presented epistaxis and hemoptysis associated with symptoms related to NPPE after near fatal suffocation. Radiological findings were consistent with alveolar hemorrhage. Supportive therapy was performed, with clinical recovery within a few days and radiological normalization within one month.</p><p><strong>Conclusion: </strong>NPPE associated with pulmonary hemorrhage is a dramatic condition but usually has a quick recovery with just supportive therapy. The aim of our report is to increase the awareness and emphasizes the importance of including this entity in the differential diagnosis of pulmonary hemorrhage in children with a suspicious anamnestic history of upper airway obstruction.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"178"},"PeriodicalIF":3.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247780","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":"Histopathological examination of lung from infant with lethal COVID-19 with special attention on pneumocytes type II and the immune infiltrate: a case study.","authors":"Maya Gulubova, Vesselina Merhar, Dimitar Chonov, Mitko Mitev, Lilia Pekova, Julian Ananiev","doi":"10.1186/s13052-025-01984-y","DOIUrl":"10.1186/s13052-025-01984-y","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 is a complex disease caused by SARS-CoV-2. The molecular and cellular mechanisms of the disease are unclear and their study is one of the greatest challenges for the modern science. Since the lung is the biggest target for SARS-CoV-2, the studies on cellular and molecular changes in this organ are essential to establish the pathogenesis of the disease. To date there is increasing number of reports on the lung pathology of fatal COVID-19 and the results are mainly obtained by autopsies of elderly patients, since this age group shows highest mortality. Little is known about the progression of the disease in children and especially newborn and infants and, to our knowledge, there are no reports on the lung features of fatal COVID-19 in this age group.</p><p><strong>Methods: </strong>In the present case study, we have investigated the lung morphological features in 11-months old infant who has died as a result of complications from COVID-19. Immunohistochemistry for immune cell markers and transmission electron microscopy for alveolocytes type II (ATII) are made.</p><p><strong>Results: </strong>Immediate cause of the death was acute respiratory failure resulting from bilateral interstitial pneumonia and subsequent acute cardiovascular failure. The histopathology shows lung edema, hyaline membranes, airway mucus plugging and interstitial inflammation. On cellular level we have observed a substantial increase in the number of ATII cells. ATII cells were marked with cytokeratin 19, TTF1 and napsin A. Transmission elec-tron microscopy reveals ongoing apoptosis in these cells with a typical chromatin clustering and condensation towards the inner nuclear membrane. Immunohisto-chemistry shows significant increase of CD68+ macro-phages in the alveoli, increase of IL-6 in immune and stromal cells, moderate elevation of FOXP3+ and IL-17+ cells and expression of CD4+ and CD8+ cells in alveolar walls. Immune cell interactions are discussed in the sense of ongoing cytokine storm.</p><p><strong>Conclusions: </strong>Our findings highlight the complexity of COVID-19 lung affection, involving ATII cell hyperplasia, interstitial mononuclear cell infiltration and macrophages increase. The findings provide an additional knowledge on the pathophysiology of COVID-19 in the lung and can serve as a basis for investigation of molecular mechanisms of this disease.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"174"},"PeriodicalIF":3.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247778","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}