Human metapneumovirus (hMPV) is a major cause of acute lower respiratory tract infection in children, older adults, and individuals with underlying medical conditions. In pediatric populations, hMPV contributes substantially to hospitalizations, morbidity, and healthcare costs, yet no licensed vaccine or monoclonal antibody is currently available for prevention. This narrative review summarizes current evidence on emerging preventive strategies against hMPV, with particular emphasis on monoclonal antibodies (mAbs) and vaccines for children. Advances in structural virology have identified the fusion glycoprotein as the principal target of neutralizing immunity and have provided a rationale for the development of hMPV-specific and cross-reactive RSV–hMPV mAbs. Several mAbs have shown potent neutralizing activity and protection in animal models, although clinical development remains limited. Vaccine development has progressed across multiple platforms, including live-attenuated, mRNA, protein-subunit, virus-like particle, and viral-vectored vaccines. However, key challenges remain, particularly regarding immunogenicity in seronegative infants, risk of enhanced respiratory disease, durability of protection, seasonality, and optimal target populations. Current evidence suggests that hMPV prevention in children will likely require a layered strategy combining maternal immunization, active vaccination during late infancy, and targeted protection for high-risk children beyond infancy.

Pneumococcal conjugate vaccines (PCVs) have substantially reduced the global burden of Streptococcus pneumoniae infections in children, yet serotype replacement and variability in immunogenicity continue to challenge long-term effectiveness. The recent introduction of the 20-valent vaccine (PCV20), which adds seven serotypes to those covered by PCV13, represents an important advance as these additional serotypes—such as 8, 10A, 11A, 12F, 15B, 22F, and 33F—are now recognized as significant contributors to invasive and noninvasive pneumococcal disease. To evaluate the potential and limitations of PCV20, we conducted a systematic literature search across PubMed, Scopus, and Web of Science through July 2025, supplemented by manual reference screening, including randomized trials, observational studies, systematic reviews, meta-analyses, and official reports from WHO, CDC, EMA, and FDA. Current evidence indicates that PCV20 elicits broadly noninferior immune responses compared to PCV13, though weaker responses have been observed for specific serotypes, notably 3, 6B, 9V, 19A, and 23F. Mathematical models suggest PCV20 could prevent thousands of additional pneumococcal cases annually compared with PCV13 or PCV15, but other analyzes predict increased breakthrough infections, particularly under reduced-dose regimens. The vaccine’s effectiveness may also be limited by the potential for new serotype replacement, and concerns persist regarding its performance in 2 + 1 or 1 + 1 schedules, with regulatory agencies currently approving only the 3 + 1 regimen. These findings highlight PCV20 as a promising step in pneumococcal prevention but not a definitive solution. Continued surveillance, real-world effectiveness studies, and accelerated development of next-generation higher-valency vaccines will be essential to sustain and expand protection against pneumococcal disease in children.

Background: Antimicrobial resistance (AMR) is a major global health threat, while conventional diagnostic, stewardship, dosing, and drug-development strategies remain limited by diagnostic delays, population-level decision-making, and a shrinking antibiotic pipeline. Artificial intelligence (AI) may help address these gaps by integrating complex clinical, microbiological, genomic, pharmacological, and chemical data. Methods: We conducted a narrative review of English-language publications issued between January 2010 and March 2026. PubMed/MEDLINE, Scopus, and Web of Science were searched using terms related to AI, machine learning, AMR, antimicrobial stewardship, diagnosis, susceptibility prediction, antibiotic dosing, pharmacokinetics, pharmacodynamics, and antibiotic discovery. ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and ISRCTN were additionally searched on 27 August 2026 for prospective interventional studies registered or publicly available by 31 March 2026. Results: AI-based systems demonstrated promising performance in differentiating bacterial from viral infections, predicting bacteremia and sepsis, enhancing matrix-assisted laser desorption/ionization time-of-flight interpretation, estimating antimicrobial susceptibility, supporting individualized empirical therapy, optimizing antibiotic dosing, and accelerating compound discovery. However, external and temporal validation frequently produced substantially poorer performance than internal validation. In representative resistance-prediction studies, AUROC declined from 0.94 internally to 0.55 during temporally independent external validation and by 0.10–0.25 over 18 months. Moreover, only six eligible prospective interventional studies were identified across the four domains examined: two concerning AI-assisted diagnosis or antibiotic-use decisions, three concerning resistance prediction or stewardship, one concerning model-informed precision dosing, and none concerning AI-assisted antibiotic discovery. Conclusions: Current evidence demonstrates that AI can generate technically promising predictions, but it does not yet establish consistent clinical or economic benefit. Discrimination alone is insufficient to demonstrate clinical usefulness. Prospective multicenter trials, clinically meaningful outcome measures, external validation, continuous monitoring for model drift, and formal implementation and cost-effectiveness evaluations are required before widespread adoption.

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease, affecting countless individuals worldwide. PD is characterized by the onset of a marked motor symptomatology in association with several non-motor manifestations. The clinical phase of the disease is usually preceded by a long prodromal phase, devoid of overt motor symptomatology but often showing some conditions such as sleep disturbance, constipation, anosmia, and phonatory changes. To date, speech analysis appears to be a promising digital biomarker to anticipate even 10 years before the onset of clinical PD, as well serving as a useful prognostic tool for patient follow-up. That is why, the voice can be nominated as the non-invasive method to detect PD from healthy subjects (HS). Methods: Our study was based on cross-sectional study to analysis voice impairment. A dataset comprising 81 voice samples (41 from healthy individuals and 40 from PD patients) was utilized to train and evaluate common machine learning (ML) models using various types of features, including long-term (jitter, shimmer, and cepstral peak prominence (CPP)), short-term features (Mel-frequency cepstral coefficient (MFCC)), and non-standard measurements (pitch period entropy (PPE) and recurrence period density entropy (RPDE)). The study adopted multiple machine learning (ML) algorithms, including random forest (RF), K-nearest neighbors (KNN), decision tree (DT), naïve Bayes (NB), support vector machines (SVM), and logistic regression (LR). Cross-validation technique was applied to ensure the reliability of performance metrics on train and test subsets. These metrics (accuracy, recall, and precision), help determine the most effective models for distinguishing PD from healthy subjects. Result: Among all the algorithms used in this research, random forest (RF) was the best-performing model, achieving an accuracy of 82.72% with a ROC-AUC score of 89.65%. Although other models, such as support vector machine (SVM), could be considered with an accuracy of 75.29% and a ROC-AUC score of 82.63%, RF was by far the best one when evaluated across all metrics. The K-nearest neighbor (KNN) and decision tree (DT) performed the worst. Notably, by combining a comprehensive set of long-term, short-term, and non-standard acoustic features, unlike previous studies that typically focused on only a subset, our study achieved higher predictive performance, offering a more robust model for early PD detection. Conclusions: This study highlights the potential of combining advanced acoustic analysis with ML algorithms to develop non-invasive and reliable tools for early PD detection, offering substantial benefits for the healthcare sector.

Digital twins (DTs), virtual replicas that integrate mechanistic modeling with real-time clinical data, are emerging as powerful tools in healthcare with particular promise in pediatrics, where age-dependent physiology and ethical considerations complicate infectious disease management. This narrative review examines current and potential applications of DTs across antimicrobial stewardship (AMS), diagnostics, vaccine personalization, respiratory support, and system-level preparedness. Evidence indicates that DTs can optimize antimicrobial therapy by simulating pharmacokinetics and pharmacodynamics to support individualized dosing, enable Bayesian therapeutic drug monitoring, and facilitate timely de-escalation. They also help guide intravenous-to-oral switches and treatment durations by integrating host-response markers and microbiological data, reducing unnecessary antibiotic exposure. Diagnostic applications include simulating host–pathogen interactions to improve accuracy, forecasting clinical deterioration to aid in early sepsis recognition, and differentiating between viral and bacterial illness. Immune DTs hold potential for tailoring vaccination schedules and prophylaxis to a child’s unique immune profile, while hospital- and system-level DTs can simulate outbreaks, optimize patient flow, and strengthen surge preparedness. Despite these advances, implementation in routine pediatric care remains limited by challenges such as scarce pediatric datasets, fragmented data infrastructures, complex developmental physiology, ethical concerns, and uncertain regulatory frameworks. Addressing these barriers will require prospective validation, interoperable data systems, and equitable design to ensure fairness and inclusivity. If developed responsibly, DTs could redefine pediatric infectious disease management by shifting practice from reactive and population-based toward proactive, predictive, and personalized care, ultimately improving outcomes while supporting AMS and health system resilience.

Plastic production and subsequent environmental contamination have increased substantially in recent decades, resulting in pervasive human exposure to microplastics (MPs), nanoplastics (NPs), and plastic-associated additives such as bisphenols and phthalates. These substances are known to induce toxic effects via multiple biological mechanisms, including oxidative stress, inflammation, apoptosis, immune system disruption, and genotoxicity. While exceptions exist, current research generally indicates that these exposures may adversely affect fertility. Notably, children constitute the most vulnerable demographic due to behavioral tendencies, higher intake-to-body-weight ratios, underdeveloped detoxification systems, and critical developmental periods of susceptibility. Evidence demonstrates that exposure commences in utero, with MPs, NPs, and additives identified in placental tissue, amniotic fluid, cord blood, and meconium-factors associated with impaired fetal growth and reduced gestational duration. After birth, additional exposure occurs through diet, inhalation, household dust, feeding equipment, toys, and consumer products. Experimental and epidemiological studies suggest that plastics may adversely affect multiple physiological systems. Reported outcomes include altered pubertal development, reduced fertility, neurodevelopmental abnormalities, respiratory diseases such as asthma, and increased risks of metabolic disorders, including obesity and insulin resistance. However, substantial knowledge gaps remain: the relative toxicity of different polymers and additives, dose-response relationships, critical exposure periods, and long-term consequences are not yet fully defined. Given growing concern and mounting evidence of harm, precautionary measures are warranted. Reducing nonessential plastic use, strengthening regulatory actions, improving product labeling, and promoting public awareness are urgent priorities, particularly in vulnerable and resource-limited communities. Further mechanistic studies and longitudinal human research are essential to clarify health risks, guide safer material substitutions, and inform evidence-based policies aimed at protecting children from avoidable plastic-related toxicity.

BackgroundAir pollution is a significant global health concern, particularly for younger children who are especially susceptible to its adverse effects. Pollutants such as particulate matter (PM), nitrogen oxides (NO and NO₂), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) are associated with increased risks of upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI). While this association is well-documented, there are critical gaps in understanding the magnitude of these risks, the roles of specific pollutants, and the influence of age, sex, and exposure duration.MethodsTo confirm the relationship between air pollution and respiratory tract infections in children and to identify areas for further research on reducing pollution-related respiratory damage, a literature review was conducted using the MEDLINE/PubMed database for studies published from January 2000 to December 2024. Eligible studies included randomized controlled trials, cohort studies, and meta-analyses focusing on the relationship between air pollution and respiratory infections in children. Studies were grouped by pollutant type, exposure timing, and infection type.ResultsThe literature analysis confirmed that pollution significantly increases the risk of URTI and LRTI in children, with infants and young children being the most vulnerable. Potential mechanisms for the development of respiratory tract pollution-related diseases include the promotion of oxidative stress, induction of inflammatory responses, deregulation of the immune system, and genetic alterations. Prenatal exposure significantly alters respiratory tract development, increasing the risk of LRTI and acute otitis media (AOM) early in life. Both short-term and long-term postnatal exposures can cause severe and recurrent LRTIs, reducing quality of life and leading to frequent hospitalizations and early death. However, the available data do not allow for precise definition of the magnitude of the risk, the individual and combined roles of specific pollutants, and the influence of factors such as age, sex, duration, and site of exposure on the development and severity of respiratory infections. Inconsistent findings on pollutant combinations and specific diseases like otitis media highlight the need for further research.ConclusionAir pollution is a major risk factor for respiratory infections in children, both prenatal and postnatal exposure can have significant negative impact. However, present knowledge is inadequate to develop effective preventive and therapeutic measures. Further studies are needed to minimize these cultural limits. In particular, it is necessary to delve deeper into how the various pollutants circulate, how they interact with each other, and how they are influenced by climate change and other environmental drivers. Results of these key researches can be translate into clinical and public health practice capable to help protect and improve children’s environmental health.

Children, particularly infants and those with chronic conditions, are highly vulnerable to heat-induced health risks, similarly to the elderly. This narrative review synthesizes current evidence on the impact of heat exposure on pediatric and perinatal health. A systematic literature search was conducted using PubMed/MEDLINE and manual reference checks, focusing on studies from 2000 to 2024. Findings indicate that maternal heat exposure is associated with adverse pregnancy outcomes, including pre-eclampsia, gestational diabetes, hypertension, and increased hospital admissions. Additionally, prenatal heat stress correlates with preterm birth, low birth weight, birth defects, and stillbirth. In childhood, heat-related health consequences range from heatstroke and dehydration to renal impairment, respiratory diseases, and gastrointestinal infections. Psychosocial effects, including cognitive impairment, sleep disturbances, and mental health issues, have also been reported in school-age children and adolescents. Despite strong epidemiological evidence, critical knowledge gaps remain, including the exact temperature thresholds that increase disease risk and how these thresholds vary by age and underlying health conditions. Urgent public health measures are required to mitigate these risks, while further research is needed to define exposure–response relationships and effective interventions. Addressing the rising burden of heat-related pediatric illness is essential in the context of climate change and increasing global temperatures.

BackgroundUnderage alcohol consumption remains a critical global public health concern, contributing to a wide spectrum of short- and long-term health risks. Despite age-based legal restrictions, alcohol persists as the most commonly used psychoactive substance among minors, outpacing tobacco, cannabis, and other drugs. Early initiation of alcohol use is strongly associated with heightened risks of addiction, impaired brain development, mental health disorders, and engagement in high-risk behaviors such as unintentional injuries, violence, and academic underperformance. Most research has focused on adolescents, while data on younger children remain scarce. Moreover, methodological inconsistencies in defining and measuring alcohol use across countries complicate international comparisons and the evaluation of policy interventions.MethodsThis narrative review synthesizes contemporary literature on the epidemiology, determinants, and consequences of underage alcohol use. It examines genetic predispositions, family dynamics, peer influence, socioeconomic context, mental health, and exposure to alcohol-related media and advertising. It also evaluates the effectiveness of intervention strategies, including parental engagement, school-based education, extracurricular activities, community-level regulation, and professional health services.ResultsEvidence highlights significant variability in the prevalence of underage drinking across regions, influenced by cultural, legal, and socioeconomic factors. Parental modeling, permissive attitudes, and weakened family structures are major contributors, while peer pressure and media exposure further normalize early alcohol use. Although various prevention strategies have demonstrated short-term benefits (particularly those involving active parental involvement and skill-based school programs), long-term effectiveness is limited due to inconsistent implementation, lack of standardization, and inadequate policy enforcement. Community-level interventions, such as increasing the legal drinking age and conducting compliance checks, have shown measurable success, but are underutilized in many regions.ConclusionAddressing underage drinking requires a coordinated, multifactorial strategy. Broader investment in early prevention, standardized assessment tools, and targeted research on younger populations is essential. Strengthening policy enforcement and cross-sector collaboration will be critical to mitigate this growing public health challenge.

Background: Increasing evidence suggests that diabetes increases the risk of developing different types of cancer. Hyperinsulinemia, hyperglycemia and chronic inflammation, characteristic of diabetes, could represent possible mechanisms involved in cancer development in diabetic patients. At the same time, cancer increases the risk of developing new-onset diabetes, mainly caused by the use of specific anticancer therapies. Of note, diabetes has been associated with a ∼10% increase in mortality for all cancers in comparison with subjects who did not have diabetes. Diabetes is associated with a worse prognosis in patients with cancer, and more recent findings suggest a key role for poor glycemic control in this regard. Nevertheless, the association between glycemic control and cancer outcomes in oncologic patients with diabetes remains unsettled and poorly debated. Purpose: The current review seeks to summarize the available evidence on the effect of glycemic control on cancer outcomes, as well as on the possibility that timely treatment of hyperglycemia and improved glycemic control in patients with cancer and diabetes may favorably affect cancer outcomes.

Phase I clinical trials represent a critical point in drug development because the investigational medicinal product is being tested in humans for the first time. For this reason, it is essential to evaluate and identify the Maximum Tolerated Dose (MTD) and the safety of the new compound. To mitigate the possible risks associated with drug administration and treatment, the European Competent Authority issued various guidelines to provide provisions and harmonize risk management processes. In the UK and Italy, particular attention should be paid to the Medicines & Healthcare Products Regulatory Agency (MHRA) phase I accreditation scheme and the specific rules set by the Italian Drug Authority through the AIFA Determination no. 809/2015. Both reference documents are based on the concept of quality risk management while conducting phase I clinical studies. Moreover, the AIFA determination outlines specific requirements for those sites that want to conduct non-profit phase I clinical trials. Indeed, the document reports peculiar activities to the “Clinical Trial Quality Team”, which is a team that should support the clinical site researchers in designing, starting, performing, and closing non-profit phase I studies. In this paper, we provide a general overview of the main European guidelines concerning the management of risks during phase I trials, focusing on the main peculiarities of the schemes and rules set by the MHRA and AIFA.

Increasing evidence suggests that patients with diabetes, particularly type 2 diabetes (T2D), are characterized by an increased risk of developing different types of cancer, so cancer could be proposed as a new T2D-related complication. On the other hand, cancer may also increase the risk of developing new-onset diabetes, mainly caused by anticancer therapies. Hyperinsulinemia, hyperglycemia, and chronic inflammation typical of T2D could represent possible mechanisms involved in cancer development in diabetic patients. MicroRNAs (miRNAs) are a subset of non-coding RNAs, ⁓22 nucleotides in length, which control the post-transcriptional regulation of gene expression through both translational repression and messenger RNA degradation. Of note, miRNAs have multiple target genes and alteration of their expression has been reported in multiple diseases, including T2D and cancer. Accordingly, specific miRNA-regulated pathways are involved in the pathogenesis of both conditions. In this review, a panel of experts from the Italian Association of Medical Oncology (AIOM), Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology (SIE), and Italian Society of Pharmacology (SIF) provide a critical view of the evidence about the involvement of miRNAs in the pathophysiology of both T2D and cancer, trying to identify the shared miRNA signature and pathways able to explain the strong correlation between the two conditions, as well as to envision new common pharmacological approaches.

Technological innovation can contribute to a reorganization of healthcare, particularly by supporting the shift in the focus of care from the hospital to the territory, through innovative citizen-centered models, and facilitating access to services in the territory. Health and social care delivery modalities, enabled by telemedicine, are crucial in this regard. The objective of this Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, is to define a standard for its use at the territorial level in various declinations in the pediatric field; this paper also identifies priority areas for its application and the types of services that most require intervention and investment. The changes that are underway in digital transformation in all sectors are unstoppable, and for the digital transformation to take place in a productive sense, the contribution of not only all health professionals, but also of patients, is necessary. From this perspective, authors from different backgrounds were involved in the drafting of this Consensus and, in the future, other figures, primarily patients, are expected to be involved. In fact, this belongs to the vision of connected care, in which the citizen/patient actively participates in the treatment path so that they are assisted in a personalized, predictive and preventive way. The future scenario must be able to provide for the involvement of patients from the initial stages of planning any treatment path, even in the pediatric age, and increasing, where possible, the proximity of the health service to the families.

Cancer management has significantly evolved in recent years, focusing on a multidisciplinary team approach to provide the best possible patient care and address the various comorbidities, toxicities, and complications that may arise during the patient’s treatment journey. The co-occurrence of diabetes and cancer presents a significant challenge for health care professionals worldwide. Management of these conditions requires a holistic approach to improve patients’ overall health, treatment outcomes, and quality of life, preventing diabetes complications and cancer treatment side-effects. In this article, a multidisciplinary panel of experts from different Italian scientific societies provide a critical overview of the co-management of cancer and diabetes, with an increasing focus on identifying a novel specialty field, ‘diabeto-oncology’, and suggest new co-management models of cancer patients with diabetes to improve their care. To better support cancer patients with diabetes and ensure high levels of coordinated care between oncologists and diabetologists, ‘diabeto-oncology’ could represent a new specialized field that combines specific expertise, skills, and training.

Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.

Telemedicine has entered the daily lives of doctors, although the digital skills of healthcare professionals still remain a goal to be achieved. For the purpose of a large-scale development of telemedicine, it is necessary to create trust in the services it can offer and to favor their acceptance by healthcare professionals and patients. In this context, information for the patient regarding the use of telemedicine, the benefits that can be derived from it, and the training of healthcare professionals and patients for the use of new technologies are fundamental aspects. This consensus document is a commentary that has the aim of defining the information on and training aspects of telemedicine for pediatric patients and their caregivers, as well as pediatricians and other health professionals who deal with minors. For the present and the future of digital healthcare, there is a need for a growth in the skills of professionals and a lifelong learning approach throughout the professional life. Therefore, information and training actions are important to guarantee the necessary professionalism and knowledge of the tools, as well as a good understanding of the interactive context in which they are used. Furthermore, medical skills can also be integrated with the skills of various professionals (engineers, physicists, statisticians, and mathematicians) to birth a new category of health professionals responsible for building new semiotics, identifying criteria for predictive models to be integrated into clinical practice, standardizing clinical and research databases, and defining the boundaries of social networks and new communication technologies within health services.

Although vaccines are the safest and the most effective measure to prevent disease, disability, and death from various pediatric infectious diseases, parental vaccine hesitancy is a common and increasing phenomenon worldwide. To contribute to improving our knowledge on parental willingness and hesitancy toward COVID-19 vaccine administration in children aged 5–11 years, an anonymous online questionnaire was disseminated in Italy after the COVID-19 vaccine’s authorization for this age group. An online survey was conducted using the Crowd Signal platform from 15 December 2021 to 15 January 2022 in Italy among parents of children 5–11 years old. A total of 3433 questionnaires were analyzed. Overall, a “Favorable” position was observed in 1459 (42.5%) parents, a “Doubtful” one in 1223 (35.6%) and a “Hesitant/Reluctant” one in 751 (21.9%). The univariate multinomial logistic regression analysis and the multivariate multinomial logistic regression analysis showed that the Hesitant/Reluctant parents were younger than 40 years of age, mostly female, with a secondary or middle school degree, an annual income below EUR 28,000, more than one child in the age range from 5 to 11 years, an underestimated consideration of the severity of COVID-19’s effects, and concern regarding the COVID-19 vaccines in general. These results show that in Italy, most parents of children aged 5 to 11 were doubtful or hesitant/reluctant to vaccinate their children against the COVID-19 virus. Poor trust in health institutions as well as poor consideration of the epidemiological and clinical relevance of COVID-19 in children seem to have played the biggest roles in forming these attitudes. Moreover, the negative attitude of several parents who previously agreed to immunize their children against other childhood illnesses according to the official national pediatric immunization schedule clearly indicates that only the COVID-19 vaccine was put in doubt or rejected. All these findings lead us to conclude that to improve COVID-19 vaccination coverage in children aged 5 to 11, health authorities should increase parental education on the true clinical relevance of COVID-19 and on the importance of its prevention to hinder the evolution of the pandemic in pediatric subjects and the emergence of new variants, and its relative weight in influencing the efficacy of vaccines.

Overuse and misuse of antibiotics have strongly accelerated the progressive increase in bacterial antimicrobial resistance (AMR). The evidence that antimicrobial selective pressure was greater the longer the antibiotic therapy was continued has led some experts to reconsider duration of antibiotic therapy testing the use of short-term drug administration. If as effective as long-term therapy, short-term therapy could have been an easy measure to limit AMR emergence. In the present narrative review, whether present knowledge on short-term therapy of acute streptococcal pharyngitis (ASF), acute otitis media (AOM) and mild to moderate community-acquired pneumonia (CAP) allows systematic use of short-term therapy in infants and children with these diseases is discussed. Literature analysis showed that reducing the duration of antibiotic therapy for some of the most common pediatric respiratory infections could be a valid measure to contain the antibiotic abuse and the consequent impact on the emergence of AMR. Several data seem to indicate that this type of intervention is possible, as short-term therapy has been found as effective as the traditionally recommended long-term therapy in some cases of ASF, AOM and mild to moderate CAP. However, further studies are needed to better characterize infants and children who can have benefit with short-term antibiotic therapy in common bacterial respiratory infections.

Introduction The aim of our single-center case–control study is to evaluate whether minipuberty occurs in patients with hypoxic ischemic encephalopathy (HIE) who underwent therapeutic hypothermia (TH). We intend to conduct this evaluation by confronting the values of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and the values of testosterone in males and estradiol in females between newborns with HIE and in subsequent TH and healthy controls. Methods We enrolled 40 patients (age: 56–179 days; 23 males), of whom 20 met the inclusion criteria for the case group and who underwent TH. A blood sample was taken from each patient at approximately 10 weeks of age to evaluate FSH and LH from the serum samples of all patients and to evaluate 17-beta estradiol (E2) and testosterone levels, respectively, from the serum samples of female and male patients. Results It was found that minipuberty occurred in the case group patients, with no significant differences reported from the control group and with hormonal serum levels comparable to healthy infants of the control group (FSH 4.14 mUI/ml ± 5.81 SD vs. 3.45 mUI/ml ± 3.48 SD; LH 1.41 mUI/ml ±1.29 SD vs. 2.04 mUI/ml ±1.76 SD; testosterone in males 0.79 ng/ml ± 0.43 SD vs. 0.56 ng/ml ± 0.43 SD; 17-beta estradiol in females 28.90 pg/ml ± 16.71 SD vs. 23.66 pg/ml ± 21.29 SD). Discussion The results of the present study may pave the way for further research and the evaluation of more possible advantages of TH.

Myocarditis (MYO) is a relatively uncommon inflammatory disease that involves the heart muscle. It can be a very severe disease as it can lead to the development of acute or chronic heart failure and, in a not marginal number of cases, to death. Most of the cases are diagnosed in healthy people younger than 30 years of age. Moreover, males are affected about twice as much as females. Viruses are among the most common causes of MYO, but how viral infection can lead to MYO development is not precisely defined. After COVID-19 pandemic declaration, incidence rate of MYO has significantly increased worldwide because of the SARS-CoV-2 infection. After the introduction of anti-COVID-19 vaccines, reports of post-immunization MYO have emerged, suggesting that a further cause of MYO together with the SARS-CoV-2 infection could increase the risk of heart damage during pandemic. Main aim of this study is to discuss present knowledge regarding etiopathogenesis and clinical findings of MYO associated with COVID-19 vaccine administration and whether the risk of this adverse events can modify the initially suggested recommendation for the use of COVID-19 vaccines in pediatric age. Literature analysis showed that MYO is an adverse event that can follow the COVID-19 immunization with mRNA vaccines in few persons, particularly young adults, adolescents, and older children. It is generally a mild disease that should not modify the present recommendations for immunization with the authorized COVID-19 mRNA vaccines. Despite this, further studies are needed to evaluate presently undefined aspects of MYO development after COVID-19 vaccine administration and reduce the risk of development of this kind of vaccine complication. Together with a better definition of the true incidence of MYO and the exact role of the various factors in conditioning incidence variations, it is essential to establish long-term evolution of acute COVID-19 related MYO.