Italian Journal of Pediatrics最新文献

{"title":"Seasonal allergic rhinitis in children: diagnostic markers of extreme allergic phenotype formation.","authors":"Tetyana O Kryuchko, Viktoriia V Shcherbak, Olha Ya Tkachenko, Inna M Nesina, Olha A Poda, Mariya O Melnyk","doi":"10.1186/s13052-026-02241-6","DOIUrl":"10.1186/s13052-026-02241-6","url":null,"abstract":"<p><strong>Background: </strong>Patients with severe allergic rhinitis may encounter an elevated risk of developing asthma and other associated allergic conditions. It is known that \"allergic rhinitis\" and \"allergic rhinitis + asthma\" are two clinically distinct phenotypes of allergic rhinitis. Consequently, the aim of our study was to establish the diagnostic criteria for the progression of the allergic phenotype in children with seasonal allergic rhinitis (SAR).</p><p><strong>Methods: </strong>This cohort study included 47 patients aged between 6 to 17 years diagnosed with SAR, who were categorised into two groups: SAR/SAR with associated allergic conjunctivitis (AC) (Group 1), SAR with concomitant asthma/atopic dermatitis (Group 2). All participants underwent assessments to evaluate their Quality of Life (QoL), as well as the overall severity of nasal and non-nasal symptoms. Serum levels of Interleukin-33 (IL-33.) and STimulation expressed gene 2 (ST2) were quantified using enzyme immunoassay techniques. Additionally, the number of blood eosinophils, nasal eosinophils, Immunoglobulin E (IgE), and Secretory Immunoglobulin A (SIgA) were measured. Statistical analyses were conducted employing SPSS version 26.0 program. The diagnostic accuracy of the revised and simplified system was assessed using the receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>Throughout the study, we observed a significant reduction in the estimated total QoL score among children in both groups, with scores of 69.73 and 86.75 for the first and second groups, respectively, indicating a significant decrease decline in quality of life. A particularly critical criterion that exhibited a strong statistically significant correlation was the stress factor. Nearly 90% of patients in the second group, who are currently residing in conflict-affected areas, reported experiencing anxiety, which serves as a significant trigger for exacerbations. In our examination of the primary diagnostic criteria for the progression of SAR, we conducted a ROC analysis to assess the significance of predictors that may indicate an extreme allergic phenotype. These predictors included Visual Analogue Scale scores, blood eosinophil counts, nasal eosinophil levels, IgE, SIgA, IL-33, and ST2 levels. The analysis of potential prognostic factors allowed the creation of a practical algorithm for identifying patients at risk of developing an extreme allergic phenotype. This algorithm illustrates how our findings can be used to prognostically assess the severity of seasonal allergic rhinitis from a practical point of view.</p><p><strong>Conclusions: </strong>The conducted study identified the main diagnostic criteria that characterise the extreme allergic phenotype in children with SAR and determine the severity of its progression. Future research in this area will not only expand the existing diagnostic capabilities, but also contribute to the development of new treatment strategi","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/PMC13147581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529115","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 critical moment for neonatology: appeals from the Lancet Child & Adolescent Health Commission.","authors":"Carlo Dani, Giovanni Corsello, Daniele De Luca, Massimo Agosti","doi":"10.1186/s13052-026-02214-9","DOIUrl":"10.1186/s13052-026-02214-9","url":null,"abstract":"<p><p>BACKGROUND: The Lancet Child and Adolescent Health Committee on the Future of Neonatology has published an important document on the future of neonatology to highlight the significant challenges hindering the development of research in this field of medicine. MAIN BODY: The number of preclinical and clinical studies in neonatology is insufficient due to a lack of interest from industry and insufficient support from public agencies. In many countries, neonatology is not formally recognized as a medical specialty, which fosters a shortage of academic positions, with negative effects on both neonatology research and the training of young neonatologists. This situation is exacerbated by excessive bureaucracy, which hinders productive interaction with regulatory agencies and ethics committees and makes conducting randomized controlled clinical trials excessively expensive. The lack of shared standardized outcome definitions and the limited use of real-world data contribute to making neonatology research more difficult. CONCLUSION: We support the Commission’s proposal for a Global Alliance for Innovation in Neonatal Health (GAINH), which would include neonatologists, former patients, families, industry, and public bodies, such as governments and universities, to address and remove barriers to advancing neonatal health through high-impact research and innovation. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"52 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147520944","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":"Assessment of ventilation distribution in overweight and obese children with asthma using electric impedance tomography: a cross-sectional study.","authors":"Antonella Gambadauro, Simone Gambazza, Sara Manti, Mara Lelii, Barbara Madini, Alessia Rocchi, Beatrice Andrenacci, Giovanna Chidini, Maria Francesca Patria","doi":"10.1186/s13052-026-02251-4","DOIUrl":"10.1186/s13052-026-02251-4","url":null,"abstract":"<p><p>BACKGROUND: Several studies have demonstrated an association between excessive body weight and asthma in children, underlining the link between obesity and resistance to treatments. The aim of this study is to investigate the pattern of ventilation distribution and to assess the response to bronchodilator (BD) in a cohort of overweight/obese children with asthma, using standard spirometry and Electric Impedance Tomography (EIT). METHODS: Single-centre, cross-sectional study. Eligible children with asthma and excessive weight were enrolled during outpatient follow-up; EIT and spirometry were performed before and after the administration of 400 µg of inhaled salbutamol. RESULTS: A FEV1 < −1.64 z-score was found in 2/27 (7.4%) children (median age 12.4 yrs, 7 females); four children (14.8%) fulfilled the criteria for airway dysanapsis. Through EIT, a greater ventilation distribution was identified in the dorsal regions of the lungs. After BD, an increase in FEV1 z-score was observed, however, only 8/27 (29.6%) children reported a significant bronchodilation at spirometry; the median total %GI index and total %RVD40 remained unchanged, while a significant reduction in the VL %ROI was observed. No significant correlations were observed between pre-post BD differences in FEV1 z-score, %GI index, %RVD40 and anthropometric measures. CONCLUSION: Children with asthma and excessive weight had a peculiar pattern of regional ventilation distribution. BD administration generally resulted in a suboptimal spirometric response, with no significant changes in EIT measurements. The relatively limited response to BD could have several interpretations, and future studies are needed to better understand the mechanisms behind these findings. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147520933","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":"Causal inference between neurodevelopmental disorders and brain structure among individuals with congenital heart disease: Insights from meta-analysis and Mendelian randomization.","authors":"Jia An, Xueying Du, Mingtang Ye, Zihao Bai, Feng Yang, Di Yu, Xuming Mo","doi":"10.1186/s13052-026-02242-5","DOIUrl":"10.1186/s13052-026-02242-5","url":null,"abstract":"<p><p>BACKGROUND: To systematically review and meta-analyze the evidence on neurodevelopmental outcomes from infancy to adolescence among patients with congenital heart disease (CHD) and to explore the causal relationships among CHD, neurodevelopmental (ND) and brain structure. METHODS: The PubMed, Embase, and Web of Science databases were searched for relevant studies. Genetic variants from genome-wide association studies (GWASs) were used to elucidate the causal relationships between CHD, ND, and brain structure. RESULTS: A total of 5824 studies were initially retrieved; ultimately, 23 studies were included (2069 CHD cases). Nine studies used the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) to assess language, motor and cognitive skills; 10 studies used the Wechsler Intelligence Scale (WIS) to assess the intelligence quotient (IQ); 3 studies used the Social Reactive Score (SRS) to assess social communication; and 1 study used both the SRS and the WIS. We found that the CHD group had worse language (mean 94.40, 95% CI 92.98–95.81) and motor (mean 95.35, 95% CI 92.11–98.59) skills during infancy as well as lower IQ (mean 95.94, 95% CI 93.59 ~ 98.29) and worse social communication abilities (mean 53.82, 95% CI 51.75–55.90) in the preschool and adolescence periods than did the age-matched healthy group. There were no significant genetic associations between CHD, ND and brain structure. We observed causal links between brain structure and both cognitive function and behavioral functions. CONCLUSION: ND delay is common among non-genetic CHD patients from infancy to young adulthood. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512127","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":"Bridging eosinophilic esophagitis: healthcare transition from pediatric to adult patients.","authors":"Edoardo Vincenzo Savarino, Roberta Giodice, Marianna Morani, Marzia Bonfanti, Martina Fardella, Maria Beatrice Bilò, Nicola De Bortoli, Antonio Di Sabatino, Roberto Penagini, Francesca Rea, Sara Renzo, Claudio Romano, Giovanni Sarnelli, Irene Spinelli, Caterina Strisciuglio, Edoardo Vespa, Salvatore Oliva","doi":"10.1186/s13052-026-02235-4","DOIUrl":"10.1186/s13052-026-02235-4","url":null,"abstract":"<p><p>Eosinophilic esophagitis (EoE) is a chronic and progressive type 2 immune-mediated disease resulting in esophageal dysfunction. As with other chronic conditions, therapeutic continuity is crucial to ensure patient benefits, particularly during the transition of patients with EoE from pediatric to adult care. This investigation aimed to establish an algorithm to assist healthcare providers in optimizing the healthcare transition pathway through a multistep collaborative process that encompassed an initial analysis of the three principal currently available guidelines, the formulation of recommendations by a steering committee, and their validation through deliberation with a panel of 11 Italian EoE experts. Three essential criteria have been elucidated to define the healthcare transition pathway for pediatric patients with EoE to adulthood: readiness to transition, patient’s age, and disease control (from clinical, endoscopic, and histological perspectives). The algorithm incorporates the utilization of the STARx questionnaire as an efficacious instrument to assess patient’s readiness to transition, identifies the optimal age for this phase within the range of 14–18 years, and considers clinical, endoscopic, and histological control maintained for a minimum of 6 months. The availability of a standardized and well-defined pathway supporting healthcare professionals during the transition process of pediatric EoE patients to adulthood is associated with therapeutic continuity, enhancement of clinical outcomes, and prevention of long-term fibrostenotic complications, which may result in economic benefits for the Italian health system.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512124","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":"Analysis of cerebral hemodynamics in neonates receiving extracorporeal membrane oxygenation support.","authors":"Jian-Feng Liu, Ya-Ting Zeng, Yi-Nan Liu, Zhe-Yuan Gao, Heng Cai, Yi-Rong Zheng, Qiang Chen","doi":"10.1186/s13052-026-02238-1","DOIUrl":"10.1186/s13052-026-02238-1","url":null,"abstract":"<p><p>BACKGROUND: Cerebral hemodynamic disturbances are common in neonates receiving extracorporeal membrane oxygenation (ECMO), yet systematic data describing changes in cerebral hemodynamics during ECMO support remain limited. This study was conducted to evaluate the changes in cerebral hemodynamics in neonates undergoing ECMO support. METHODS: This single-center retrospective study included 32 neonates who received ECMO from July 2021 to December 2023 as the ECMO group. Relevant clinical data were collected, including cranial ultrasound examinations before and during ECMO support. Cranial ultrasound data from normal neonates matched for age and sex with the ECMO group were collected as a normal group. RESULTS: A total of 32 neonates received ECMO support, among whom 12 (37.5%) developed cerebrovascular complications. After ECMO initiation, the peak systolic velocity (PSV) of the anterior cerebral artery (ACA) increased from 27.8 ± 5.2 cm/s to 43.9 ± 7.5 cm/s, the mean velocity (MV) increased from 15.8 ± 3.6 cm/s to 27.6 ± 3.2 cm/s, and the end-diastolic velocity (EDV) increased from 9.9 ± 3.1 cm/s to 19.6 ± 2.9 cm/s, with all changes reaching statistical significance (P < 0.05). These parameters remained relatively stable during ECMO support but were still lower than the corresponding values observed in the normal control group. CONCLUSIONS: Cranial ultrasound can serve as an effective tool for assessing cerebral hemodynamics in neonates during ECMO support. Although ECMO significantly improves cerebral perfusion in these patients, their cerebral blood flow velocities during support remain lower than the normal ranges typically observed in healthy neonates. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503900","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":"Anemia in children with congenital heart disease and its association with postoperative prognosis.","authors":"Yang Zhou, Congcong Chen, Jing Wang, Bo Zhai, Ruiling Feng, Penggao Wang, Hui Yan","doi":"10.1186/s13052-026-02252-3","DOIUrl":"10.1186/s13052-026-02252-3","url":null,"abstract":"<p><p>BACKGROUND: This study aimed to investigate the prevalence and influencing factors of preoperative anaemia in Chinese children with congenital heart disease (CHD), as well as its implications for clinical management and postoperative outcomes.​ METHODS: A cross-sectional study was performed using a pediatric CHD database from Central China. We calculated the prevalence and proportion of anaemia in different subgroups and genders. A visualization of the distribution of hemoglobin in males and females of different age groups was then plotted. Multivariate logistic regression model and forest plots were used to identify influencing factors (presenting odds ratios [OR] and 95% confidence intervals [CI]), and the relationship between preoperative anaemia and postoperative prognosis was evaluated.​​ RESULTS: A total of 12,294 CHD patients were included, with an overall anaemia prevalence of 41.5%. The neonate was the most critical period (52.5% prevalence), and higher rates were observed in complex CHD (47.2%), low birth weight (LBW, 69.1%), and rural patients (45.3% vs. 37.1% in urban areas). Double-outlet right ventricle (DORV) was most strongly associated with anaemia. Median hemoglobin levels in both genders were below age-specific standards. Preoperative anemia was associated with adverse postoperative outcomes. CONCLUSIONS: Preoperative anaemia is highly prevalent in Chinese CHD children, particularly in high-risk subgroups. These findings emphasize the clinical necessity of early screening and targeted intervention to improve postoperative outcomes and quality of life. Future prospective longitudinal studies are warranted to comprehensively elucidate the long-term association between anaemia and CHD across the lifespan. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512093","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":"Development and validation of a clinical prediction model for neonatal seizures among neonates admitted to public health hospitals in Northwest Ethiopia: retrospective follow-up study.","authors":"Tilahun Degu Tsega, Almaw Genet Yeshiwas, Wolde Melese Ayele, Chalachew Abiyu Ayalew, Assefa Andargie Kassa, Abathun Temesgen, Gashaw Melkie Bayeh, Chalachew Yenew, Getaneh Atikilt Yemata, Tesfaneh Shimels, Rahel Mulatie Anteneh, Getasew Yirdaw, Habitamu Mekonen, Berhanu Abebaw Mekonnen, Meron Asmamaw Alemayehu, Sintayehu Simie Tsega, Zeamanuel Anteneh Yigzaw, Amare Genetu Ejigu, Wondimnew Desalegn Addis, Birhanemaskal Malkamu, Abraham Teym, Kalaab Esubalew Sharew, Tamiru Alene, Daniel Adane, Ahmed Fentaw Ahmed","doi":"10.1186/s13052-026-02246-1","DOIUrl":"10.1186/s13052-026-02246-1","url":null,"abstract":"<p><p>BACKGROUND: Neonatal seizures are sudden, abnormal brain activities that occur during the neonatal period, are the most common neurological emergencies in newborns, and are associated with high morbidity and mortality rates. Approximately 2–20% of neonates admitted to neonatal intensive care units (NICUs) worldwide experience neonatal seizures. Although established guidelines for managing neonatal seizures are available, no risk prediction models exist to help the clinical decision-making process; thus, the practices remain inconsistent across local facilities and resources. This study aims to develop and validate a neonatal risk prediction model for seizures among neonates admitted to NICUs at comprehensive specialized hospitals in Northwest Ethiopia. METHODS: A retrospective follow-up study was conducted among 907 neonates admitted to the NICU in comprehensive specialized hospitals in Northwest Ethiopia. A systematic random sampling technique was employed to select the neonates’ records. Predictors for multivariable binary logistic regression analysis were selected via penalized LASSO for the variable selection method. A risk prediction nomogram was constructed from the simplified model. The discriminatory, prediction and calibration power of the risk prediction model was evaluated. Using the Youden index-identified cutoff point criterion, the level of risk of neonates for seizures was determined. Finally, decision curve analysis was performed to assess its clinical utility. For analysis purposes, Stata 17 and R.4.4.0 were used. RESULTS: The incidence of neonatal seizures among neonates admitted to the NICU was 21.39% (95% CI: 18.83, 24.18%). The neonatal risk prediction nomogram was constructed using preterm birth, subgaleal hemorrhage, perinatal asphyxia, maternal history of seizure, hypoglycemia, and phototherapy as independent predictors. The internally validated discriminatory power of the model was 77.735% (95% CI: 73.912%, 81.634%), with a calibration plot test value of 0.056. The optimism coefficient of the simplified model was 0.0197. Decision curve analysis revealed a greater net benefit of the model in clinical practice than the “treat all” or “treat none” strategies did. CONCLUSIONS: The incidence of neonatal seizures among neonates admitted to the NICU was relatively high. The predictive power of the constructed nomogram was good. Despite some limitations, the model offers superior net clinical benefit compared with the “treat all” or “treat none” strategies; however, further external validation is recommended for its wider application. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503881","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":"Retrospective study: clinical analysis of Kawasaki disease complicated with macrophage activation syndrome.","authors":"Wenhui Bie, Yuqiang Guan, Qingxia Du, Lei Li, Peiru Yu","doi":"10.1186/s13052-026-02239-0","DOIUrl":"10.1186/s13052-026-02239-0","url":null,"abstract":"<p><p>BACKGROUND: Kawasaki disease complicated with macrophage activation syndrome (KD-MAS) has the characteristics of low incidence, high rate of sequelae, and high mortality. We aims to explore early warning indicators that can be used for the diagnosis of KD-MAS, providing a reference basis for early clinical intervention. METHODS: The clinical data of 15 children with KD-MAS and 140 children with Kawasaki disease (KD) admitted to Jinan Children’s Hospital from January 2020 to March 2025 were retrospectively collected, and statistical analysis was conducted on the above data of the KD-MAS group and the KD group. RESULTS: There were no statistically significant differences between the two groups in terms of gender ratio, the proportion of incomplete Kawasaki disease, the incidence of coronary artery lesion, peripheral blood white blood cell(WBC) count, neutrophil ratio(N%), C-reactive protein(CRP), serum total bilirubin(STB) and serum potassium༈K+༉ level (P > 0.05). The age of onset in the KD-MAS group was significantly younger than that in the KD group, and the hospitalization time was longer (P < 0.05). Among the 9 KD-MAS children who completed bone marrow smear examination, 6 showed hemolysis phenomenon.The incidence of hepatosplenomegaly, organ damage, and insensitivity to intravenous immunoglobulin (IVIG) was higher in the KD-MAS group than in the KD group (P < 0.05).The levels of serum ferritin(SF), alanine aminotransferase(ALT), aspartate aminotransferase(AST), lactate dehydrogenase(LDH) and triglyceride(TG) in the KD-MAS group were higher than those in the KD group, while the levels of hemoglobin(HB), platelet(PLT) count, serum albumin(ALB), erythrocyte sedimentation rate(ESR), fibrinogen(FIB) and serum natrium(Na+) level were lower than those in the KD group (P < 0.05).The ROC curve analysis showed that the AUC values for indicators such as hepatomegaly, no response to IVIG treatment, SF, AST, FIB, PLT count, ALT, LDH, TG, and HB were all relatively high. CONCLUSION: When children with KD show significant elevation of SF, hepatomegaly or no response to IVIG treatment, the possibility of concurrent MAS should be vigilant. Moreover, the simultaneous increase of AST, ALT, LDH and TG, along with the decrease of HB, PLT and FIB, has certain clinical significance in suggesting the occurrence of MAS. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493944","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":"Availability of diagnostic tools and stewardship protocols for managing infectious diseases in Italian paediatric emergency departments: a nationwide survey.","authors":"Marco Denina, Giulia Mazzetti, Emanuele Castagno, Stefania Zampogna, Claudia Bondone","doi":"10.1186/s13052-026-02197-7","DOIUrl":"10.1186/s13052-026-02197-7","url":null,"abstract":"<p><p>BACKGROUND: Infectious diseases are a leading cause of Paediatric Emergency Department (PED) visits worldwide, characterised by significant clinical variability in both presentation and severity. Literature highlights that infection biomarkers and rapid etiological tests, when integrated into standardised clinical protocols, are essential for timely diagnosis and appropriate treatment, reducing misdiagnosis and antibiotic misuse. However, these tools are not consistently available in Italian PEDs. The objective of this survey is to assess the availability of diagnostic tools and current diagnostic practices in Italian PEDs, focusing on infection biomarkers, Point-of-Care (PoC) technologies, and the presence of disease-specific antimicrobial stewardship protocols. METHODS: A cross-sectional survey, in collaboration with the Italian Society of Paediatric Emergency Medicine (SIMEUP), was conducted among clinicians working in PEDs across Italy. An online questionnaire was submitted at one referent for each centre, collecting data about each hospital activity, availability of diagnostic biomarkers, the use of PoC technologies, microbiological test reporting times, and availability of disease-specific protocols. RESULTS: Data were collected from 55 PEDs representing almost all Italian regions, with a predominance of first- and second-level centres. Venous blood sampling was the primary method for investigating febrile children (80%), while only 20% of centres used capillary sampling as the initial diagnostic method. Limited access to PoC technologies for capillary samples (blood count and C-reactive protein available in 27.3%) contributed to this preference. Except for the SARS-CoV-2 nasopharyngeal swab (85% of PEDs), other PoC microbiological tests were less frequently available, making rapid etiological diagnosis more difficult. Laboratory-based microbiological tests were widely available (blood cultures, 93%; culture testing on specific samples, 84%; nasal swabs for influenza, 84%), but they often had reporting times exceeding 48 hours, which delays clinical decisions. Only 3.6% of centres had formal antibiotic prescription and de-escalation protocols, possibly leading to variability in clinical practice and overuse of antibiotics. CONCLUSIONS: This study highlights the fragmentation of diagnostic resources and practices in Italian PEDs, particularly in first-level centres. There is a clear need to expand access to PoC technologies, reduce test reporting times, and implement standardised protocols to improve diagnostic accuracy and enhance antibiotic stewardship. </p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493901","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}