Fever in neonates and infants younger than 60 days is one of the most frequent cause of admission to the Paediatric Emergency Room and a significant clinical challenge. Although the majority of infections in this age group are viral, a non-negligible risk of invasive bacterial infections (IBIs), including bacteremia and bacterial meningitis, persists. The clinical presentation is often nonspecific and physical examination alone has low sensitivity for identifying serious bacterial disease. This paper provides a summary of the most recent evidence on the management of febrile newborns and infants (<60 days), with particular reference to the guidelines of the American Academy of Pediatrics, and compares them with European and British approaches. AAP recommendations propose an age-stratified decision-making model (8-21, 22-28, and 29-60 days) integrating clinical assessment with inflammatory biomarkers, particularly procalcitonin, C-reactive protein and absolute neutrophil count. This strategy allows clinicians to tailor the indication for invasive testing, hospitalisation and empiric antibiotic therapy according to the neonate/infant’s risk profile, thereby reducing unnecessary interventions in low-risk infants without compromising patient safety. Available evidence shows that the combined use of inflammatory biomarkers, especially procalcitonin, has a high negative predictive value for IBIs and supports a more selective approach to lumbar puncture and hospitalisation. In conclusion, the management of febrile neonates and infants younger than 60 days should be based on a structured and cautious approach able to balance the need for early identification of serious bacterial infections with the goal of limiting unnecessary diagnostic and therapeutic interventions
Una significativa esperienza che ci mostra le modalità con cui gli animali aiutino a ridurre lo stress e favorire relazioni nei contesti di assistenza ospedalieri.
Un importante approfondimento sui test rapidi ambulatoriali, tra epidemiologia e decisione clinica
A 10-month-old girl presents with isolated fatty liver and normal lab tests. Suspicion of Hereditary Fructose Intolerance (HFI) arose from her refusal of fruit and her father’s nausea after eating sweets. Genetic testing confirmed the diagnosis for both: the infant remained asymptomatic thanks to her natural ‘protective aversion’ to sugars.
Wheezing is a frequent respiratory condition in early childhood that affects up to one third of children in the first three years of life and represents a common cause of primary care visits, Emergency Unit access and hospital admission. In Italy, the 2014 AIFA regulatory note introduced major restrictions on the use of inhaled salbutamol in children younger than 2 years, by limiting administration to pressurised metered-dose inhalers (MDI) with spacer and recommending lower doses than those suggested by the international guidelines, without differentiating between care settings or disease severity. This precautionary approach, based on limited and heterogeneous evidence, has generated an ongoing debate within the paediatric community. Evidence suggests that short-acting β2-agonists (SABA) may be effective in selected cases of acute bronchospasm in infants and young children, particularly in wheezing phenotypes suggestive of reversible airway obstruction. They are not indicated for isolated cough or viral upper respiratory infections, and are not recommended in bronchiolitis according to the international guidelines. Since 2024, shortages of salbutamol MDI in Italy and across Europe have further complicated this scenario and increased the risk of undertreatment. Recent evidence, including a meta-analysis of randomised controlled trials, supports the short-term safety of inhaled salbutamol in children under 2 years with acute wheezing, with no increase in serious adverse events and a more favourable safety profile with MDI compared with nebulisation. Overall, the current framework highlights a gap between regulatory constraints, clinical evidence, real-world practice and drug availability, and underscores the need for an evidence-based revision of existing recommendations.
A 3-year-old boy with psychomotor delay and marked dietary selectivity (complete avoidance of fruits and vegetables) presented with a refusal to walk, lower limb pain, cutaneous haemorrhagic spots and spongy gums. Despite an initial history that suggested trauma, imaging - specifically an MRI showing bone marrow and subperiosteal oedema - led to the diagnosis of scurvy (vitamin C deficiency) that was confirmed by the rapid clinical improvement and the patient’s regained ability to walk after just one week of oral vitamin C supplementation
È proprio lì... e il ragionamento clinico (collegiale) mi ci ha fatto arrivare: nel duodeno
Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy targeting emotion dysregulation and self-destructive behaviours through the integration of cognitive-behavioural strategies and mindfulness-based acceptance. It is effective in reducing suicidal behaviours, emotional instability and impulsivity. The adolescent adaptation (DBT-A) involves shorter treatment, caregiver participation and focus on family processes. DBT-A targets self-harm, suicidal ideation and interpersonal difficulties by teaching emotion regulation, distress tolerance, mindfulness and interpersonal effectiveness skills. Evidence supports DBT-A as an effective intervention for adolescents with suicidal or high-risk behaviours
Una delle sfide educative dei prossimi anni sarà insegnare ai bambini (ma anche ai medici) non soltanto a usare strumenti intelligenti, ma a mantenere viva la propria intelligenza
Congenital adrenal hyperplasia (CAH) is a heterogeneous group of autosomal recessive disorders affecting adrenal steroidogenesis. The most common form is 21-hydroxylase deficiency (CYP21A2), while mutations in other genes, such as STAR, may cause rare and severe forms with subtle onset. The paper describes two clinical cases: a male newborn who, at two weeks of life, developed a salt-wasting adrenal crisis with mild signs of hyperandrogenism (penile hypertrophy and scrotal hyperpigmentation), and a female infant with congenital lipoid adrenal hyperplasia (CLAH) due to a STAR mutation, who presented with progressive lethargy, poor feeding and diffuse hyperpigmentation preceding a severe hyponatremic adrenal crisis at six months of age. In both patients diagnosis was based on hormonal findings (elevated ACTH, low or absent cortisol) and confirmed by genetic testing, while treatment included steroid replacement therapy, correction of electrolyte imbalance and specialist follow-up. These cases underline the need for careful clinical and biochemical assessment, even in the absence of genital anomalies, and highlight the importance of molecular studies to define the genetic profile and plan personalised therapy.
