Italian Journal of Pediatrics最新文献

{"title":"Active treatment vs. expectant management of patent ductus arteriosus in preterm infants: critical analysis of a meta-analysis.","authors":"Carlo Dani, Massimo Agosti, Daniele de Luca","doi":"10.1186/s13052-026-02244-3","DOIUrl":"10.1186/s13052-026-02244-3","url":null,"abstract":"<p><p>A recent meta-analysis on the active versus expectant management of patent ductus arteriosus in preterm infants, including 10 randomized control trials involving 2035 infants, found that the incidence of death at 36 weeks or moderate to severe bronchopulmonary dysplasia (BPD) and of death was higher in the active treatment group. The accompanying editorial suggested that “the use of early routine pharmacologic treatment no longer appears to be justifiable”. However, this meta-analysis is based on highly heterogeneous studies due to different diagnostic criteria used to define hemodynamically significant PDA, postnatal age at which the echocardiography was performed, pharmacological treatment, high frequency of open label treatment in the placebo/expectant management group. Moreover, authors did not explain the reduction in mortality that they reported. We concluded that clinical and methodological heterogeneity among studies may not be detected by statistical heterogeneity tests, reducing the interpretability of the results and weakening causal inferences. The high occurrence of open-label treatment indicates the need to perform a per-protocol analysis, which would have been possible if the authors had performed an individual participant data network meta-analysis. Furthermore, the current lack of pathophysiological plausibility suggests caution in interpreting the results of this meta-analysis.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"52 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654334","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":"Basilar artery flow velocities and optic nerve sheath diameter as adjuvant tools for early diagnosis of hypoxic ischemic encephalopathy in neonates.","authors":"Marwa Mohamed Farag, Mohamed Alaa Eldin Hassan Thabet, Islam Sh Ahmed, Husam Mohamed Abu Halawa","doi":"10.1186/s13052-026-02243-4","DOIUrl":"10.1186/s13052-026-02243-4","url":null,"abstract":"<p><p>OBJECTIVE: We investigated potentiality ultrasonography measured optic nerve sheath diameter (ONSD) and basilar artery (BA) velocities to identify neonates with HIE-requiring-TH. METHODS: Study was of a case-control-design. Thirty- five neonates with mild-to-severe HIE admitted to NICU of Alexandria-University-Maternity-Hospital and were monitored by ultrasound-measured ONSD and BA velocities, in first-12-hours, during TH, and after rewarming. First scan measures of patients were compared to healthy-control-neonates. Comparative statistics, ROC-curves, and correlation of different clinical and imaging parameters were used in analysis. RESULTS: Mean value of left-and-right-ONSD measurements in control group (0.31 cm, 0.30 cm, respectively) were significantly higher than asphyxiated-group (0.35 cm), with p-value<0.001. ONSDs of > 0.32 cm in right-and-left eyes carry 91% and 88% sensitivity, respectively, and 100% specificity in identifying patients with mild-to-severe HIE. Resistive index (RI) of BA decreased and EDV of BA increased in HIE-patients than healthy-control-neonates, with p value<0.001. Left-and-right-ONSD diameters are negatively correlated with BA-RI, with r=-.432; p < .01and r=-.34; P.046, respectively. ONSDs in both eyes, BA-RI and BA-EDV showed significant changes throughout three time points in HIE-patients. CONCLUSION: ONSD and BA-velocities can help in early identification of asphyxiated-neonates and therefore can be used to select patients candidate for TH. They also help in monitoring of asphyxiated-patient before, during and after TH. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"52 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654316","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":"Implementation of an antimicrobial stewardship program in Alexandria University Children's Hospital: an interventional study.","authors":"Sarah Elsayed Saad Refaei, Laila El-Attar, Amira Ezzat Khamis Amine, Marwa Ahmed Meheissen, Eman Hamza Hassan","doi":"10.1186/s13052-026-02236-3","DOIUrl":"10.1186/s13052-026-02236-3","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) represents a threat to global public health. The antibiotics' effectiveness against a variety of infections consequently has been declined with increasing morbidity, mortality, and treatment failure. To combat this, the implementation of Antimicrobial Stewardship Programs (ASPs) is essential for slowing the spread of resistant pathogens.</p><p><strong>Aim of the work: </strong>The current study aimed to assess the outcomes following implementation of Antimicrobial Stewardship Program (ASP) at Alexandria University Children's Hospital.</p><p><strong>Method: </strong>The study was conducted over nine months in a general pediatric ward. First, the medical records and microbiological reports were reviewed to establish tailored antibiotic guidelines. During the intervention phase, the ASP focused on prospective audits and physicians' education. The program's impact was evaluated through several key metrics: adherence to the guidelines, patient outcome (mortality rate and length of stay) and antibiotic consumption (expenditure, days of therapy, and treatment duration). All statistical analyses were conducted using IBM SPSS version 20.0.</p><p><strong>Results: </strong>219 patients in the preintervention phase were compared to 214 patients (post-intervention). Following ASP, the use of single antibiotics increased in post-intervention (69.6% versus 26%). During the study period, 70 interventions were required with a high acceptance rate (59%). The mean length of hospital stays decreased [10.80 (3-26) versus 12.89 (4-33) days], and both DOT/1000 patients and the average cost of antibiotics decreased (27.82% and 44.94%, respectively). Following ASP, the use of Tigecycline (-100%), Meropenem (-57.79%), and Vancomycin (-46.35%) reduced with an increase in the use of Cefotaxime (80.43%), Ceftriaxone (20.27%), and Ceftazidime (62.87%).</p><p><strong>Conclusion: </strong>The implementation of institutional guidelines along with Prospective Audit and Feedback (PAF) was associated with improvements in antibiotic utilization, particularly in the resource-limited settings.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"52 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654320","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":"Guidelines on diagnosis and management of gastroesophageal reflux disease in infants, children and adolescents: a joint consensus from Italian pediatric societies (SIP and SIGENP) -Part II: management.","authors":"Silvia Salvatore, Caterina Strisciuglio, Elena Bozzola, Stefania Cappa, Antonio Corsello, Giovanni Di Nardo, Maurizio Fuoti, Liliana Guadagni, Antonino Gulino, Chiara Mameli, Massimiliano Orso, Licia Pensabene, Renato Tambucci, Francesca Vassallo, Claudio Romano, Annamaria Staiano","doi":"10.1186/s13052-026-02255-0","DOIUrl":"10.1186/s13052-026-02255-0","url":null,"abstract":"<p><p>BACKGROUND: Suspected gastroesophageal reflux disease (GERD) is one of the most common reasons for referral to pediatric and gastroenterology clinics, and proton pump inhibitors (PPIs) are frequently prescribed. Currently, there is still wide heterogeneity in treatment, especially in neonates and extraesophageal presentations. This article aimed to provide guidelines and a consensus of Italian experts on the management of GERD in infants, children, and adolescents, in order to improve the care and treatment of these patients. METHODS: A multidisciplinary pediatric panel identified four key clinical questions (PICOs) regarding pharmacological and non-pharmacological treatments, surgical intervention, and prognosis of pediatric GERD. Four databases (PubMed/Medline, Embase, Web of Science, and Google Scholar) were searched from inception to May 2024, using a specific search string for each PICO and limiting the search to children (0–18 years) and to English language. Previous pediatric guidelines, systematic reviews, and clinical trials focused on the treatment of GERD were considered to formulate evidence-based recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) and AGREE II systems were used to assess study quality; a 9-point Likert scale was used to rate the recommendations. A two-round Delphi method was conducted to reach consensus, defined as ≥ 80% agreement or disagreement. RESULTS: The systematic review identified three previous pediatric guidelines, eight systematic reviews, 83 RCTs, and three observational studies. The panel provided 26 recommendations regarding the management and treatment of GERD in pediatric patients. All reached consensus, with the majority expressing strong support for the intervention. The panel also provided practice insights for each PICO to improve the clinical application and clarity of these guidelines. CONCLUSION: Regurgitation is common in infants, but in most cases, no treatment is necessary. When regurgitation causes discomfort, a brief trial of alginate or thickened formulas or a cow’s milk elimination diet may be considered, particularly if other symptoms, including crying and dermatitis, are associated. For children who complain of heartburn or have severe neurologic deficits, a short course of empirical PPIs treatment may be considered, monitoring the clinical response and testing if no improvement is seen. PPIs are recommended in infants and children with reflux esophagitis, or acid reflux detected by esophageal pH monitoring. Children at high- risk for chronic GERD requiring prolonged treatment and multidisciplinary care have been identified. Surgery should be considered for severe or complicated GERD after a comprehensive diagnostic workup and optimal pharmacological management. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654322","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":"Seizures and Apneas as clinical manifestations of brain lesions in term infants: a single center experience.","authors":"Aleksandra Skubisz, Andrea Calandrino, Francesco Vinci, Paolo Massirio, Chiara Andreato, Samuele Caruggi, Marcella Battaglini, Alessandro Parodi, Giorgia Brigati, Mariya Malova, Marta Bertamino, Domenico Tortora, Mariasavina Severino, Martina Resaz, Elisabetta Amadori, Sara Uccella, Lino Nobili, Andrea Rossi, Pasquale Striano, Luca Antonio Ramenghi","doi":"10.1186/s13052-026-02257-y","DOIUrl":"10.1186/s13052-026-02257-y","url":null,"abstract":"<p><p>BACKGROUND: Seizures and apneas are always concerning symptoms in near-term and term newborns, but finding a clear explanation is not always easy. In addition, it is not always clear which investigations should be promptly conducted. We aimed to evaluate the relationship (or lack thereof) between apneas and seizures and the role of MRI and EEG in their investigation. METHODS: We conducted a retrospective analysis including infants born at ≥ 36 + 0 weeks of gestational age who presented with seizures or apneas soon after birth and underwent brain magnetic resonance imaging (MRI) during their stay at a tertiary-level academic Neonatal Intensive Care Unit (NICU) in Italy between January 2016 and July 2024. Brain MRI was systematically planned for to all term infants with clinical presentations of seizures, recurrent unexplained apneas, or abnormal aEEG/EEG. RESULTS: Our inclusion criteria were met by 58 (18%) patients; 31/58, (53%) presented with seizures and 27/58 (47%) with apneas without overt seizures manifestation. Apgar scores at 1 and 5 min were similar across clinical subgroups. Neurophysiological monitoring (EEG/aEEG) was performed in 50/58 (86%) infants; all 31 infants with clinical motoric seizures had abnormality on the EEG, though in 20 (65%) apneas were still their primary manifestation. Of the 27 presenting with apneas without documented EEG seizures, 6 experienced apneas only shortly after birth, 6 only with feeding (EEGs not done consistently) and of the other 15 the EEG was normal in the 12 who were monitored. Abnormal MRI findings were present in 27/31 (87%) infants with seizures and in 10/27 (37%) in the apnea only group. Focal arterial territory ischemic stroke was the commonest single diagnosis. Seizure-related apneas were associated with punctate white matter injury, focal ischemic stroke and severe intraventricular hemorrhage. CONCLUSIONS: Seizures and apneas occur with similar frequency in newborns born near or at term investigated with cerebral MRI for seizures and apneeas-related encephalopathy. The majority of infants had abnormal brain imaging, almost all of an ischaemic or haemorrhage nature. We strongly recommend brain imaging to assess potential brain injury in (near)term neonates with either of these clinical signs. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615951","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":"Macrolide-induced hypersensitivity reactions in the pediatric population.","authors":"Silvia Caimmi, Lucia Liotti, Sara Riscassi, Greta Rosset, Paolo Bottau, Annamaria Bianchi, Giuseppe Crisafulli, Fabrizio Franceschini, Francesca Mori, Francesca Saretta, Rocco Luigi Valluzzi, Enrico Vito Buono, Gian Luigi Marseglia, Carlo Caffarelli","doi":"10.1186/s13052-026-02234-5","DOIUrl":"10.1186/s13052-026-02234-5","url":null,"abstract":"<p><p>Macrolides are widely prescribed antibiotics in pediatric practice and are commonly used as alternatives in children with suspected or confirmed beta-lactam allergy. Although generally considered safe and associated with low allergenic potential, hypersensitivity reactions to macrolides do occur and may lead to inappropriate drug avoidance. This review critically appraises the current evidence on macrolide-induced hypersensitivity reactions in the pediatric population, focusing on clinical manifestations, diagnostic approaches, cross-reactivity, and management strategies. Hypersensitivity reactions to macrolides are estimated to occur in 0.4–3% of treatments, with immediate reactions such as urticaria and angioedema being the most frequently reported. Anaphylaxis is exceedingly rare, while delayed reactions, particularly maculopapular exanthema, represent the most common non-immediate presentations. Severe cutaneous adverse reactions, including Stevens–Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, and fixed drug eruptions, have been reported but remain exceptional in children. The diagnostic workup of suspected macrolide allergy is challenging due to the limited sensitivity and poor predictive value of skin tests and the lack of validated in vitro assays. Current evidence supports the use of drug provocation tests as the gold standard for diagnosis, particularly in children with non-severe, skin-limited reactions. Recent guidelines increasingly favor direct oral challenge without prior skin testing in low-risk pediatric patients. Studies consistently demonstrate that most children with suspected macrolide allergy tolerate re-exposure, confirming that true allergy is uncommon. Cross-reactivity among macrolides appears to be infrequent in children but may occur, especially in severe reactions. Desensitization protocols, although not standardized, have been successfully applied in selected pediatric cases when macrolides are indispensable. Overall, accurate diagnosis through appropriate testing is essential to avoid unnecessary antibiotic restrictions, ensure optimal antimicrobial therapy, and reduce the burden of incorrect allergy labeling in pediatric patients.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616033","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":"Comparison of two targeted rescue treatments after the first week of expectant managment for very preterm infants with hemodynamically significant patent ductus arteriosus: a prospective study.","authors":"Leyao Wang, Siyuan Xu, Hongshan Shi, Chongxun Zhang, Bingjie Wang, Zhongyi Sun, Min Li, Tianruo Gao, Xiangyu Gao","doi":"10.1186/s13052-026-02259-w","DOIUrl":"10.1186/s13052-026-02259-w","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BACKGROUND : To investigate the clinical value of early expectant management of very preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA), and the efficacy and safety of rescue treatment with oral acetaminophen or high-dose ibuprofen. METHODS: The very preterm infants with hsPDA (gestational age ≤ 32 weeks and age 4-6 days) who were admitted to the neonatal intensive care unit of Xuzhou Central Hospital between February 2022 and December 2024 were enrolled in the study. If the patient still met the diagnostic criteria of hsPDA after 3-4 days of expectant management, the rescue treatment shall be given. They were randomly divided into the acetaminophen group (oral acetaminophen 15 mg/kg, once every 6 hours for 3 days) and the high-dose ibuprofen group (oral ibuprofen 20 mg/kg for the first time, 10 mg/kg for the 24 hours and the 48 hours respectively). Before and after treatment, routine blood tests, biochemical items (including serum Cystatin C, serum creatinine, alanine aminotransferase and total serum bilirubin), urinary Cystatin C, B-type natriuretic peptide, and fecal occult blood were measured; bedside echocardiography and brain standard ultrasound were performed; and urine output and complications were recorded. The data were analyzed by t-test, rank sum test and chi-square test with SPSS 20.0 statistical software. RESULTS: 167 (54.4%) of 307 very preterm infants with hsPDA showed spontaneous closure in the first 7-10 days of life. There was no significant difference in the success rate of rescue treatment between the acetaminophen group and the high-dose ibuprofen group [82.0% (50/61) vs. 77.8% (49/63), P=0.561]. During rescue treatment, the upper gastrointestinal bleeding rate, positive fecal occult blood tests and oliguria rate of high-dose ibuprofen group were higher than those of the acetaminophen group, but the difference was not statistically significant (P&gt;0.05). The incidence of stage Ⅱ-Ⅲ necrotizing enterocolitis and stage Ⅲ-Ⅳ intraventricular hemorrhage in the two groups were lower, and the difference was not statistically significant (P&gt;0.05). After rescue treatment, the serum Cystatin C of high-dose ibuprofen group was higher than that of acetaminophen group [(1.66±0.30) mg/L vs. (1.55±0.24) mg/L], the urinary Cystatin C of high-dose ibuprofen group was higher than that of acetaminophen group [(80.00±32.96) ng/mL vs. (66.50±26.77) ng/mL], and the 24-hours urine output was lower than that of acetaminophen group [(2.66±1.32) ml/(kg•h) vs. (3.29±1.15) ml/(kg•h)], with statistical significance (P=0.018, 0.014, 0.290). After rescue treatment, there were no significant differences in serum creatinine, platelet count, B-type natriuretic peptide, alanine aminotransferase, and total serum bilirubin between the two groups (P&gt;0.05). CONCLUSION: In the early stage (7-10 days after birth) of very preterm infants with hsPDA, the spontaneous closure rate of hsPDA during expectant management can reach more th","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13170143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608998","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 clinical-biomarker fusion model for risk prediction of coronary artery lesions in Kawasaki disease.","authors":"Qiongdan Zhao, Yonghong Miao","doi":"10.1186/s13052-026-02250-5","DOIUrl":"10.1186/s13052-026-02250-5","url":null,"abstract":"<p><p>OBJECTIVE: This study aimed to develop and validate a predictive model integrating multidimensional clinical indicators and laboratory biomarkers for the early and precise assessment of coronary artery lesion (CAL) risk in Kawasaki disease. METHODS: A retrospective analysis was conducted on 320 children with Kawasaki disease admitted between January 2020 and June 2024. The sample size was calculated using PASS 2021 software (α = 0.05, 1-β = 80%), with post-hoc power exceeding 85%. Patients were randomly allocated into a training set (n = 224) and a validation set (n = 96) in a 7:3 ratio. In the training set, univariate analysis identified CAL-associated indicators (P < 0.05). Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for variable compression and feature selection. The core variables were incorporated into a multivariate logistic regression to identify independent risk factors. Based on these factors, three machine learning models—Gradient Boosting Machine (GBM), Support Vector Machine (SVM), and Convolutional Neural Network (CNN)—were constructed. Model performance was evaluated using the AUC, calibration curves, and DCA. Interpretability was analyzed using SHapley Additive exPlanations (SHAP) values. RESULTS: No significant differences in baseline characteristics were observed between the training and validation sets (P > 0.05). Univariate analysis identified seven significant indicators. LASSO regression refined these to five core variables. Multivariate logistic regression confirmed all five as independent risk factors for CAL (P < 0.05). Among the machine learning models, the GBM model demonstrated superior performance, with AUC of 0.872 (95% CI: 0.798–0.945) in the training set and 0.790 (95% CI: 0.623–0.957) in the validation set. Calibration curves were closest to the ideal line. DCA indicated net clinical benefit across a wide threshold probability range. SHAP analysis provided intuitive prediction interpretability. CONCLUSION: An integrated clinical-biomarker model was developed and validated for the early prediction of CAL in Kawasaki disease. The model demonstrates good discriminative ability, calibration, and clinical utility. and provides a promising tool for the early identification of high-risk children and the optimization of intervention strategies. CLINICAL TRIAL NUMBER: Not applicable. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13162393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592250","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":"Perinatal factors and their association with cardiometabolic profile in schoolchildren.","authors":"Kamila Mohammad Kamal Mansour, Luciana Tornquist, Nicholas Mortensen, Karin Allor Pfeiffer, Dulciane Nunes Paiva, Cézane Priscila Reuter","doi":"10.1186/s13052-026-02253-2","DOIUrl":"10.1186/s13052-026-02253-2","url":null,"abstract":"<p><strong>Background: </strong>Developmental origins of health and disease suggest a link between the periconceptual, fetal, and early infant phases of life and the persistent development of metabolic disorders. Therefore, this study aimed to verify the associations between perinatal variables and cardiometabolic profiles in school-aged children and adolescents.</p><p><strong>Methods: </strong>Retrospective study that used cross-sectional data from a database of a larger study named \"Schoolchildren's health\". The study was carried out using a sample comprising children and adolescents, ranging from 6 to 17 years old from both genders. All participants were enrolled in private and public schools in the city of Santa Cruz do Sul, Brazil. A self-administered questionnaire was applied to children and parents, then anthropometric measurements of body mass index (BMI), body fat percentage (BF%), and waist circumference (WC) were obtained, followed by a cardiorespiratory fitness (CRF) test. ​The association of perinatal variables with BMI, WC, BF%, and CRF was tested by multiple linear regression, using the \"Enter\" input method, being the unstandardized coefficient (B) and 95% confidence intervals of the associations were estimated. Data were analyzed with Statistical Package for the Social Sciences software, version 23.0 (IBM, Armonk, NY, USA). Statistical significance was established as p < 0.05.</p><p><strong>Results: </strong>A total of 1,431 children and adolescents were evaluated, with 803 (56.1%) of them being females and white subjects (83%) with mean age of 11.48 ± 2.75 years. Associations between perinatal factors and anthropometric measurements were found birth weight (BW) and BMI (B:1.13; 95%CI:0.74;1.51), BW and WC (B:2.20; 95%CI:1.37;3.04), BW and BF% (B:1.84; 95%CI:0.83;2.84). Gestational age also had associations with BMI (B:1.00; 95%CI:0.25;1.74); WC (B:1.88; 95%CI:0.25;3.50) and CRF (B:-168.91; 95%CI:-299.53;-38.29). Complications during pregnancy and BMI (B:0.48; 95%CI:0.02;0.93) and cesarean birth and BMI (B:0.43; 95%CI:0.01;0.86).</p><p><strong>Conclusions: </strong>Associations exist between perinatal factors and future cardiometabolic profiles. It is imperative to establish and reinforce efforts geared towards enhancing the health literacy of both adolescent boys and girls, along with pregnant women.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592247","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":"Trends in otitis media burden among BRICS from 1990 to 2023 and projections to 2040: an age-period-cohort analysis based on the 2023 global burden of disease study.","authors":"Xiaoting Chen, Xin Yang, Deying Gu","doi":"10.1186/s13052-026-02237-2","DOIUrl":"10.1186/s13052-026-02237-2","url":null,"abstract":"<p><strong>Background: </strong>Otitis media (OM) is a prevalent ear disease that can lead to severe complications, including hearing loss. As significant emerging economies, the BRICS countries warrant focused attention on the evolving trends in OM burden.</p><p><strong>Objective: </strong>To systematically analyze trends in OM burden in BRICS from 1990 to 2023 and forecast developments.</p><p><strong>Methods: </strong>Using data from the 2023 GBD study, we analyzed the age-standardized incidence rate (ASIR) and age-standardized disability-adjusted life year (DALY) rate (ASDR) of OM in BRICS countries from 1990 to 2023, along with their temporal trends. The age-period-cohort model was employed to dissect age, period, and cohort effects on disease burden. Trends between 2024 and 2040 were projected using a Bayesian age-period-cohort model.</p><p><strong>Results: </strong>Over the 33 years, the ASIR of OM remained relatively stable across countries, while the ASDR showed a significant decline, with China exhibiting the largest reduction (31.348%). Females consistently showed higher ASIR but lower ASDR than males across all five countries. Within BRICS, the OM burden was predominantly concentrated among children aged 0-9 years. Period effect analysis revealed an overall decreasing trend in DALY rates. Incidence rates remained stable or showed a slight decrease in most countries, with minor increases observed in India and Brazil. Birth cohort analysis revealed a sharp decline in disease burden among recent birth cohorts in China, but a gradual increase among those born since the 1950s in India. Net drift analysis demonstrated a consistent decline in DALY rates across all countries, with China showing the greatest annual decrease (-1.549%/year). In contrast, India (0.007%/year) and Brazil (0.003%/year) exhibited slight increases in incidence rates. Projections for 2024-2040 indicate a continued downward trend in ASIR for Brazil, China, and India, while Russian Federation and South Africa are projected to experience sustained increases. ASDR is projected to rise in all countries except India.</p><p><strong>Conclusion: </strong>Over 1990-2023, ASIR of OM in BRICS remained stable, while ASDR declined. Countries should improve the quality of care to effectively reduce the disease burden of OM, based on their own epidemiological trends.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529075","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}