Digital media exposure in childhood and adolescence is an increasing public-health concern. Pediatric recommendations emphasize not only the duration of screen exposure, but also content, context, timing, parental co-use, developmental stage, and the activities displaced by screen use. Community-based approaches may help families receive coherent and developmentally appropriate guidance across healthcare, educational, family, and social settings. This manuscript describes the development and implementation of the “Digital Pact of Imola”, a community-based public-health initiative conducted in the Imola area, Italy, between July 2024 and February 2026. The initiative involved healthcare services, schools, parents’ associations, pediatricians, religious institutions, sports organizations, cultural associations, local government representatives, and third-sector organizations. Activities included public educational events, stakeholder meetings, participatory discussions, visual campaigns, educational booklets, and the development of age-specific Digital Pacts for early childhood, primary school, and lower secondary school. This article is a descriptive implementation report and was not designed to evaluate behavioral, clinical, or developmental effectiveness. The initiative led to the establishment of a multidisciplinary community network and to the development of three age-specific Digital Pacts. Between July 2024 and the time of reporting, 11 community meetings and 16 public events were conducted. Overall, 119 public and private educational institutions were involved, including nursery schools, preschools, primary schools, and lower secondary schools. At the time of reporting, 298 Digital Pacts had been formally signed. The overall number of families reached by the initiative was substantially higher but could not be reliably quantified, as participation in project activities did not require formal signature of the Pact. Healthcare professionals, educators, community organizations, and local government representatives were involved throughout the Imola district. A total of 145 professionals and stakeholders participated across healthcare, education, public-health, and local government sectors. Dissemination activities included the distribution of 1,800 posters and 7,000 leaflets. The initiative promoted shared messages on delayed smartphone introduction, supervised internet access, parent-child interaction, outdoor play, reading, creative activities, and avoidance of smartphones as behavioral-regulation tools. The Digital Pact of Imola demonstrates the feasibility of developing a community-based, multisectoral framework to promote healthy digital habits in childhood and adolescence. The initiative established coordinated educational messages across healthcare, educational, family, and civic settings. However, the present report does not establish behavioral, clinical, or developmental effectiveness. Future prospective mixed-methods studies should evaluate reach, adherence, equity of access, sustainability, changes in digital-media practices, and child and family outcomes.
Chest pain in children is a common presentation in the emergency department (ED) and often generates significant parental concern [1, 2]. Although most cases are benign - most frequently musculoskeletal or gastrointestinal in origin - some presentations require prompt recognition of potentially serious conditions [3, 4]. We propose a multidisciplinary flowchart specifically designed for pediatric ED triage that integrates cardiological, respiratory, gastrointestinal, hematologic, poisoning and psychogenic considerations. Unlike existing pathways, this flowchart emphasizes rapid assessment, structured decision-making, and practical guidance for emergency clinicians, without replacing specialist consultation [5, 6]. We conducted a narrative review using a structured methodology, searching PubMed, Scopus, and CINAHL for studies published in English between 2015 and 2025, focusing on pediatric patients (≤ 18 years) presenting with chest pain [2, 3, 7]. Relevant articles were screened, summarized, and integrated with clinical experience to develop a structured flowchart based on expert opinion [4, 5]. Causes of pediatric chest pain were categorized as cardiovascular (29
To investigate the factors influencing mortality in children with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis and develops a predictive model to assess mortality risk. We retrospectively analyze the clinical data and laboratory results of 81 children diagnosed with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis during their initial hospitalization at the Children’s Hospital of Soochow University from January 2019 to November 2024, which includes 12 deceased cases. We employ univariate logistic regression and least absolute shrinkage and selection operator regression to screen variables. We subsequently perform cross-validation and variable dimensionality reduction. The final regression model facilitates the construction of a predictive nomogram to evaluate the discrimination ability and clinical net benefit of the proposed approach. Stepwise screening via univariate logistic regression, leave-one-out cross-validation, and Firth-penalized logistic regression identifies activated partial thromboplastin time and direct bilirubin as independent risk factors for mortality (P < 0.05). The constructed nomogram demonstrates strong discrimination capability, yielding an area under the receiver operating characteristic curve of 0.891 with a 95
Sirenomelia is a rare and lethal congenital malformation representing the most severe form of caudal dysgenesis, with a stillbirth rate of up to 53
Neonatal Units (NUs) are high-risk environments for medication errors (MEs), mainly due to complex weight/gestational age-based dosing and frequent off-label drug use. Although the incidence of serious harm is low, medication errors remain a major safety concern. The aim of this study was to have a snapshot of MEs errors within Italian NUs. The Neonatal Pharmacotherapy Study Group and the Risk Management and Simulation Study Group of the Italian Society of Neonatology (SIN) conducted a national cross-sectional web-based survey between 2022 and 2023. Responding NUs were stratified into two groups: those reporting fewer than five MEs per year (< 5 MEs/y )and those with five or more (≥ 5 MEs/y). Descriptive and inferential statistics were applied. Prescription (33
Early identification of the severity of gastrointestinal (GI) involvement in children with IgA vasculitis (IgAV) is crucial for prognosis assessment and formulation of treatment plans. This study aimed to develop a risk predictive model for severe GI involvement in pediatric IgAV to assist clinicians in decision-making. In a single-center retrospective cohort study, 293 eligible children were divided into two cohorts based on the time of admission: a training set and a validation set. Candidate risk indicators were identified using binary logistic regression, and a predictive model was developed to predict severe GI involvement in pediatric IgAV based on training set. The receiver operating characteristic (ROC) curve was utilized as a tool to evaluate the performance of the logistic regression model. Furthermore, a nomogram model was developed, and its calibration curve was visualized using a 1000-time bootstrap resampling method. The validity of these results was verified on an independent validation set. Vomiting, lymphocyte count, C-reactive protein and thickening of intestinal wall displayed on abdominal ultrasound were identified as the potentially predictors for severe GI involvement in pediatric IgAV. The predictive model had area under the ROC curve of 0.816 and 0.802 in the training and validation set, with a sensitivity and specificity of 80.0
The study aimed to evaluate whether early quantitative lung ultrasound findings are associated with subsequent neonatal intensive care unit (NICU) admission and early respiratory distress (RD) in late-preterm and term newborns. The study was a single-center, prospective, observational design. Lung ultrasound (LUS) was used for all inborn late preterm and term neonates. A total of 4 LUSs were performed in the first 24 hours of life (within the first 30 minutes and at 2, 6 and 24 hours) for neonates who did not require NICU admission. For cases requiring NICU admission, 5th LUS was performed at 72 hours. Infants in need of NICU admission were divided into two sub-groups, with RD and without RD. A total of 149 newborns were admitted in the study. In NICU-admitted group, the median values of right, left and total LUS aeration scores were significantly higher within the first 30 minutes, at 2nd, 6th and 24th hours compared to non-NICU admission group. In RD group, the median values of total LUS were significantly higher within the first 30 minutes, at 2nd and at 6th hours. The cut-off scores for predicting NICU admission were 6 (61
Despite the progress made in the last few decades in diagnosis and therapy, children and adolescents still die of asthma worldwide. In this study, we collected all asthma-related death events in Italian children and adolescents (0–19 years old) from 2013 to 2023 through the Italian National Statistical Database. 46 deaths were recorded, with a mortality rate of 0.39 per million individuals aged 0–19 years old (population denominator: 10.7 million), with the highest number of deaths observed in North-East Regions (36.9
Macrolide-resistant Mycoplasma pneumoniae (MRMP) complicates the treatment of pediatric M. pneumoniae pneumonia (MPP). We evaluated whether treatment with doxycycline, compared with azithromycin, was associated with faster first documented negative conversion of M. pneumoniae RNA (MP-RNA) and clinical recovery during a period of high macrolide resistance prevalence. This retrospective cohort study included 137 children hospitalized with MPP between October 2023 and January 2025 who received azithromycin (n = 90) or doxycycline (n = 47) monotherapy initiated on admission. MP-RNA was monitored using simultaneous amplification and testing. The primary endpoint was the time from the first antibiotic dose to first documented MP-RNA negative conversion. Multivariable Cox regression, propensity score overlap weighting, and an approximate interval-censored Weibull accelerated failure time model were used. The doxycycline group was older and had greater baseline disease severity. The median time to first documented MP-RNA negative conversion was shorter with doxycycline than with azithromycin (6.0 vs. 10.0 days; P < 0.001). Doxycycline use was associated with faster negative conversion in the multivariable Cox model (summary HR 9.28, 95
Fever without a source in well appearing young infants remains a challenge in pediatric emergency departments (PEDs). Although evidence-based decision rules exist, limited data are available on how these patients are managed in daily clinical practice. We conducted a multicenter cross-sectional survey among pediatricians working in 20 Italian PEDs. The 22-item questionnaire explored the definition of “well appearing”, clinical assessment, diagnostic workup, use of standardized protocols, antibiotic prescribing, and self-reported competence in managing well-appearing febrile young infants aged 29–90 days. Descriptive statistics and Chi-square tests were used to compare responses by geographic area and physician seniority. A total of 273 (response rate 84
Currently, no curative treatment is available for isolated sulfite oxidase deficiency (ISOD), and disease progression is primarily managed by restricting sulfur-containing amino acids in the diet. Furthermore, despite its overall rarity, ISOD prevalence in the Chinese population has demonstrated an upward trend in recent years. Accordingly, this study investigated the clinical phenotype, imaging characteristics, mutation spectrum, and prognosis of ISOD in Chinese newborns. We retrospectively analyzed the clinical data from seven neonates with genetically confirmed ISOD from southeastern China between November 2018 and March 2025. including maternal and infant factors, clinical manifestations, laboratory results, and neuroimaging and genetic findings. Given the rarity of ISOD and the limited number of cases, we also performed a narrative synthesis of previously reported Chinese neonatal ISOD cases (n = 13) identified through a structured literature search to provide additional clinical context. The retrospective case series and previously published cases are presented descriptively, resulting in a total cohort of 20 patients. All infants (20/20,100
To analyse the epidemiological, clinical, and laboratory differences among children, in Suzhou, with Mycoplasma pneumoniae (MP) mixed with viral or bacterial pneumonia and to provide evidence for early clinical differentiation and localised prevention. This retrospective study included 392 children with Mycoplasma pneumoniae pneumonia (MPP) who were divided into an MPP mixed with viral pneumonia group (n = 254) and a bacterial pneumonia group (n = 138). Epidemiological characteristics, clinical manifestations, immune, coagulation, and inflammatory indicators, pathogen distribution, and bacterial drug susceptibility were compared. The MPP mixed with viral pneumonia group had older children [6 (3, 8) vs. 4 (2, 6.25) years, P = 0.001], a higher incidence of pneumonia in spring (51.97
Abstract Background Lower respiratory tract infections (LRTIs) are a major cause of morbidity in children. While chest X-ray (CXR) is widely used for diagnosis, it has limitations including radiation exposure and suboptimal sensitivity. Lung ultrasound (LUS) is an emerging rapid, non-invasive alternative. This study aimed to evaluate the diagnostic performance of LUS versus CXR in pediatric LRTIs, with a focus on subgroup variability. Methods This prospective observational study included 338 children (aged 1 month–18 years) with suspected LRTIs admitted to a tertiary care hospital. All patients underwent clinical assessment, CXR, and LUS at admission and follow-up. LUS findings were compared with CXR using sensitivity, specificity, predictive values, accuracy, and Cohen’s kappa (κ) for agreement. Results LUS demonstrated high sensitivity for pulmonary pathology at admission (95.6%) and follow-up (96.7%), with specificity improving from 29.4% at admission to 62.9% at follow-up. Overall agreement between LUS and CXR progressed from fair at admission (Cohen’s κ = 0.311, 95% CI: 0.198–0.424) to substantial at follow-up (Cohen’s κ = 0.607, 95% CI: 0.501–0.713). Subgroup analysis demonstrated meaningful variation in LUS–CXR agreement across diagnostic categories. The highest concordance was observed in pneumonia (κ = 0.438–0.470, moderate agreement), consistent with LUS’s established strength in detecting parenchymal consolidation. Agreement was notably lower in recurrent wheezing (κ = 0.208–0.283, fair agreement) and was poor to negligible in acute bronchiolitis (κ = −0.029–0.000) and the heterogeneous “others” group (κ = −0.053–0.182). LUS demonstrated high accuracy in detecting consolidations, subpleural lesions, and pleural abnormalities, and facilitated serial monitoring of disease progression during hospitalization. Conclusion LUS is a promising, radiation-free imaging modality for the diagnosis and follow-up of pediatric LRTIs, particularly pneumonia, demonstrating moderate to substantial agreement with CXR. Its lower specificity and reduced performance in airway-predominant conditions highlight the importance of cautious interpretation alongside clinical findings.
Early identification of newborns at risk for respiratory support remains challenging. Lung ultrasound (LUS) provides real-time information on pulmonary aeration, while right diaphragmatic ultrasound evaluates respiratory muscle function. To assess whether lung and right diaphragmatic ultrasound findings obtained at one hour of life differed between term and near-term newborns who subsequently required free-flow oxygen supplementation within the first 48 h after birth and those who did not. This prospective observational study included term and near-term newborns undergoing standardized lung ultrasound and right diaphragmatic ultrasound at one hour of life. Lung ultrasound was performed using a six-region protocol with a 0–3 scoring system. Right diaphragmatic function was assessed by diaphragmatic thickening fraction and excursion. The primary outcome was the requirement for free-flow oxygen supplementation at any time during the first 48 h of life. Continuous variables are reported as median and interquartile range (IQR), and categorical variables as counts and percentages. Group comparisons, logistic regression, and receiver operating characteristic (ROC) curve analysis were performed. A total of 121 newborns underwent ultrasound assessment at one hour of life. Free-flow oxygen supplementation within the first 48 h was required in 28 newborns (23.1
Pediatric female dystrophinopathy may be asymptomatic at evaluation or may show skeletal muscle and cardiac manifestations, but childhood presentations are often subtle. We aimed to characterize the clinical spectrum, ascertainment pathways, subclinical muscle involvement, and inheritance patterns in this population. This single-center retrospective case series was conducted between January 2024 and December 2025 and included 35 girls with genetically confirmed DMD gene variants identified from existing clinical records. Primary ascertainment route was recorded separately from cross-sectional clinical status at evaluation and classified as symptom-driven presentation, incidental or unexplained hyperCKemia, family-based cascade screening, or incidental genomic discovery. Clinical status at evaluation was assigned after systematic clinical review with reference to published female dystrophinopathy classifications. Statistical analyses were exploratory. The median age was 5 years (range, 1–10). Primary ascertainment routes were symptom-driven presentation in 8/35 (22.9
To investigate the clinical characteristics of macrolide resistance - associated mutations in hospitalized children with Mycoplasma pneumoniae pneumonia (MPP) and to evaluate their associations with severe Mycoplasma pneumoniae pneumonia (SMPP) and prolonged cough. A total of 1,094 hospitalized children with MPP were retrospectively enrolled. Among them, 1,069 underwent A2063G/A2064G mutation testing, whereas 25 were not tested. Patients were classified into mutation-positive, mutation-negative, and untested groups according to mutation testing results. Clinical features, laboratory parameters, treatment profiles, and outcomes were compared among groups. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify risk factors for SMPP and prolonged cough. The proportion of SMPP was higher in the mutation-positive group than in the mutation-negative group. In addition, patients in the mutation-positive group exhibited a more pronounced inflammatory response and greater immune imbalance, as reflected by increased neutrophil percentage and D - dimer levels, along with decreased CD4 and CD8 counts. Univariate analysis showed that A2063G/A2064G mutation status was associated with both SMPP and prolonged cough. However, multivariable analysis identified fibrinogen and AST as independent factors associated with SMPP, while prolonged cough was additionally associated with the duration of azithromycin and clarithromycin therapy, as well as CD8 levels. Children with macrolide resistance-associated mutations exhibited a higher inflammatory burden and a higher unadjusted proportion of SMPP. However, after adjustment, A2063G/A2064G mutation status was not independently associated with SMPP or prolonged cough. Clinical management should integrate inflammatory markers, oxygenation status, and clinical presentation for individualized monitoring and treatment.
Plexiform neurofibromas (PNs) are benign tumors that can cause pain, disfigurement, and disability in patients with neurofibromatosis type 1. Selumetinib, a MEK1/2 inhibitor, is the first drug who showed efficacy in inducing PNs shrinkage, reducing the associated morbidities in pediatric patients. Overall, selumetinib showed a good safety profile. However, multiple adverse effects have been reported both in pediatric and adult patients, including respiratory ones. Serial spirometry is suggested in patients with thoracic neurofibromas to detect changes that may underly PN’s modifications. The aims of this study are to investigate the trend of pulmonary function in pediatric patients with NF1 treated with selumetinib and to determine the onset of respiratory adverse events. This is a retrospective study conducted at the Pediatric Department of the Institute for Maternal and Child Health IRCCS “Burlo Garofolo” in Trieste, Italy. We identified all the patients diagnosed with NF1 at our institution who received selumetinib. We excluded patients unable to perform spirometry at treatment start, and patients above 18 years of age. We registered patients’ forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) for the first two years of follow-up and record any possible respiratory adverse effect since the beginning of the treatment. A total of 21 patients were included (7 females, 14 males) out of the 24 treated with selumetinib. Patients’ median age when selumetinib was started was 12 years. Neurofibromas were located mostly in the upper body, but 13 of them were in the thoracic area. The duration of the clinical follow-up ranged from 9 months to 72 months (6 years), with a mean follow-up length of 37 months. During the follow-up period, none of the patients reported pulmonary symptoms and no significant changes of the spirometry values were detected. Among those with thoracic plexiform neurofibromas, no correlation was found between spirometry values and PN’s volumetric changes at the MRI. Our experience suggests that selumetinib does not impact on pulmonary function in children and young adults. Serial spirometry should not be mandatory or could be at least distanced since it is not an appropriate method to precisely monitor plexiform neurofibromas changes over time.
Retinoblastoma (RB) is the most common childhood intraocular malignancy, with substantial global disparities in outcomes. This study aimed to provide pooled estimates of incidence, survival, mortality, and metastasis based on population-based data. A systematic review and meta-analysis was conducted in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library through August 2025. Eligible studies were population- or registry-based and reported at least one epidemiological outcome. Random-effects models were applied, with assessments of heterogeneity, publication bias, and subgroup analyses. Twenty-five studies (52 study arms) were included. The global pooled incidence of RB was 0.12 per 1,000,000 (95
Early identification and treatment of hearing impairments are essential for children’s development. International guidelines recommend a stepwise approach to conduct hearing screening in newborns. However, while the majority of countries worldwide implemented universal newborn hearing screening, inconsistencies remain in procedures and data management. In particular, Level 3 of the screening pathway—comprising diagnostic confirmation and therapeutic management—has received limited attention in the literature, despite its central role in determining program effectiveness and patient outcomes. This study investigates the clinical and organizational aspects of Level 3 within the neonatal hearing screening program of the Friuli-Venezia Giulia Region in Italy, analyzing data from 106 children enrolled between 2019 and 2023. The analysis considers the regional protocol, the roles of birthing centers, pediatricians, hospitals, and the Regional Center for Pediatric Hearing Loss Care, and subdivides Level 3 into four Phases (A–D) reflecting both organizational and diagnostic functions. By examining patient flow, false positives, loss to follow-up/documentation, and management practices, the study highlights how organizational factors—particularly the coordination between local and specialized facilities—produce “cascade” outcomes directly affecting diagnostic timelines and treatment initiation. Findings provide critical insights into weaknesses of the current system and propose directions for improving program efficiency, accuracy, and overall quality of care.
