Background: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection and hospitalization in infants. Nirsevimab, a long-acting monoclonal antibody, provides single-dose protection during the RSV season, but the effectiveness of prophylaxis programs depends on sustained parental acceptance and high uptake. This study evaluated changes in parental knowledge, perceptions, and willingness to accept nirsevimab across two consecutive RSV seasons in Emilia-Romagna, Italy. Methods: Two multicenter cross-sectional surveys were conducted during consecutive RSV seasons, 2024–2025 and 2025–2026, using a comparable questionnaire and recruitment approach. Parents or legal guardians of infants eligible for nirsevimab completed a semi-structured questionnaire during routine counseling in neonatal units. Survey 1 included 1042 respondents and survey 2 included 867 respondents. Sociodemographic characteristics, RSV awareness, knowledge and perception of nirsevimab, willingness to accept prophylaxis, trust in healthcare providers and the healthcare system, preferred information sources, and willingness to pay were compared between seasons. Results: Willingness to administer nirsevimab remained high and stable—87.04% in survey 1 and 88.00% in survey 2. Awareness of RSV-related risks increased from 68.23% to 73.47% (p < 0.05), and correct identification of nirsevimab as an antibody increased from 65.93% to 71.74% (p < 0.01). Explicit refusal rose slightly from 2.21% to 3.81% (p < 0.05). In survey 2, acceptance was associated with higher education, awareness of RSV risks, perceived child susceptibility, confidence in efficacy, lower concern about side effects, trust in pediatricians and the healthcare system, and willingness to pay. Notably, acceptance in 2025–2026 was higher among infants born in September–December than among those born in January–March, indicating a late-season decline. Conclusions: Parental acceptance of nirsevimab remained high across two seasons. Future campaigns should address residual knowledge gaps, reinforce communication on safety and efficacy, and sustain high coverage throughout the entire RSV season, particularly among infants born in its final months.

BACKGROUND AND AIM:Familial hypercholesterolemia (FH) is a common genetic disorder characterized by elevated low-density lipoprotein cholesterol (LDL-C) from early life, significantly increasing lifetime risk of atherosclerotic cardiovascular disease. Early identification and initiation of lipid-lowering therapy (LLT) are crucial. This study aimed to describe the timing, pharmacological approach, and early outcomes of LLT initiation in children and adolescents with FH from the Italian LIPIGEN registry. METHODS:We analysed 341 paediatric FH patients who were untreated at baseline and had follow-up data within 3 years. Data included clinical features, LDL-C levels, genetic testing results, and treatment patterns. Outcomes included time to LLT initiation, type of therapy, LDL-C reduction, and achievement of guideline-recommended goals. RESULTS:Mean age at baseline was 10.8 years. At the end of the first year of follow-up, 51.6% initiated LLT, increasing to 78.9% after 3 years (mean age at treatment initiation: 10.9 years), with earlier initiation among those with higher baseline LDL-C. Statins were the most used agents (43.9%), especially in children ≥8 years, followed by combination statin-ezetimibe (11.5%). Nutraceuticals were more common in children <8 years. LLT was associated with a mean LDL-C reduction of 25.7%, reaching 50.2% with statin-ezetimibe. Only 26.1% achieved LDL-C goals, with highest rates among those on combination therapy. CONCLUSIONS:Despite increased use of pharmacological therapy, therapeutic inertia remains common in paediatric FH, resulting in few children reaching recommended LDL-C targets. These findings highlight the need for earlier intervention, closer follow-up, and optimization of treatment strategies to improve long-term cardiovascular outcomes.

Over recent decades, a substantial body of research has expanded our understanding of how early-life conditions influence long-term health. These observations led to the formulation of the Barker Hypothesis, which postulates that adverse nutritional exposures during fetal life can induce persistent physiological and metabolic adaptations, thereby increasing susceptibility to chronic diseases later in life. This narrative review aims to provide a comprehensive overview of current recommendations for adequate maternal nutrition during pregnancy, with particular emphasis on key nutrients and specific dietary patterns. In addition, the effects of maternal diet on placental function and fetal growth are examined. A literature search was conducted in the following electronic databases: MEDLINE (via PubMed), Scopus, Web of Science, Embase, and the Cochrane Library. Manuscripts published between 2005 and 2025 were considered. The impact of prenatal nutritional exposures on immune development, neurodevelopment, metabolic regulation, and gut microbiota is also discussed, highlighting how these mechanisms may contribute to an increased long-term risk of non-communicable diseases, including obesity, metabolic syndrome, and neuropsychiatric disorders. Maternal nutrition during pregnancy plays a crucial role in shaping infants' and children's health, particularly regarding the development of non-communicable diseases. Therefore, ensuring adequate nutritional intake during this critical period-both quantitatively and qualitatively-is essential to optimize health outcomes for the newborn and to promote long-term well-being throughout childhood and beyond.

Background: Respiratory syncytial virus (RSV) is a leading cause of hospitalization in early infancy, with the greatest burden occurring in the first months of life. Following the COVID-19 pandemic, many countries experienced intensified RSV circulation. Nirsevimab, a long-acting monoclonal antibody providing season-long protection after a single dose, was introduced in Italy for the 2024–2025 RSV season and recommended for infants born during the period of RSV circulation. We evaluated the population-level impact of this seasonal nirsevimab strategy on RSV-related hospitalizations among young infants. Methods: We conducted a population-based observational study using regional hospital discharge records from Emilia-Romagna, Northern Italy, spanning January 2017 to April 2025. Analyses were restricted to RSV seasons (October–March) and infants aged ≤180 days. RSV-related hospitalizations were identified using ICD-9-CM codes. Hospitalization rates were calculated per 100,000 person-days. Incidence rate ratios (IRRs) were estimated using negative binomial regression models adjusted for season, age group, and sex, with clustering at the hospital level. The post-nirsevimab season (2024–2025) was compared with the immediate pre-nirsevimab season (2023–2024) and a pre-COVID reference season (2018–2019). Results: A total of 551 RSV hospitalizations occurred in the pre-COVID season, 753 in the pre-nirsevimab season, and 252 in the post-nirsevimab season. The post-nirsevimab season was associated with a substantial reduction in RSV-related hospitalization rates compared with both the pre-COVID season (IRR 0.52; 95% CI 0.41–0.66) and the pre-nirsevimab season (IRR 0.36; 95% CI 0.29–0.44). Reductions were observed consistently across epidemic months and were most pronounced during the first three to four months of life. Conclusions: Seasonal administration of nirsevimab to infants born during the RSV circulation period was associated with a marked and sustained reduction in RSV-related hospitalizations in early infancy. These findings support the effectiveness of targeted, seasonally timed infant immunoprophylaxis as a population-level RSV prevention strategy.

Childhood overweight and obesity are escalating global health challenges with conse-quences that extend across the life course. This narrative review examines the epide-miology, clinical complications, socioeconomic burden, and management of excess weight in children and adolescents across diverse socioeconomic settings. Evidence was identified through searches of MEDLINE (via PubMed), Scopus, Web of Science, Embase, and the Cochrane Library, supplemented by manual screening of reference lists. The literature indicates that excess adiposity, particularly visceral fat, promotes insulin resistance, hypertension, dyslipidemia, hepatic steatosis, and other early mani-festations of cardiometabolic disease, while also contributing to respiratory, orthope-dic, and psychosocial complications. These risks frequently persist into adulthood, in-creasing premature morbidity, mortality, healthcare utilization, and direct and indi-rect societal costs. The burden is unevenly distributed: poverty, stigma, discrimination, food and built environments, and limited access to preventive and clinical services shape both obesity risk and outcomes, with particularly severe consequences in re-source-constrained settings. Early identification of excess weight and associated risk factors, systematic screening for comorbidities, and timely, family-centered multidis-ciplinary care are therefore essential. Effective prevention and treatment must also address the broader social and commercial determinants of health through coordinat-ed action across healthcare, education, food systems, and public policy.

Ultra-processed foods (UPFs) are industrial formulations characterized by high energy density, low nutritional quality, and the extensive use of additives, and their consumption has increased markedly worldwide. In many high-income countries, children and adolescents now derive up to 50–60% of their total daily energy intake from UPFs, raising major public health concerns. This narrative review synthesizes current evidence on UPF consumption across critical life stages, with a particular focus on pregnancy, childhood, and adolescence, and examines its potential implications for short- and long-term health outcomes. Available evidence consistently links high UPF intake in pediatric populations to excess weight gain, metabolic syndrome, and early cardiovascular risk. Additional adverse outcomes include dental caries and a higher prevalence of allergic diseases, such as atopic dermatitis and asthma. Several biological mechanisms may mediate these associations, including impaired satiety regulation, excessive intake of free sugars and saturated fats, disruption of the food matrix, and alterations in gut microbiota composition, immune function, and inflammatory pathways. Emerging research also indicates that exposure to UPFs may begin before birth, as maternal consumption during pregnancy and lactation has been associated with unfavorable offspring outcomes, including altered neurodevelopment, increased adiposity, and immune-related conditions. Familial, socioeconomic, and behavioral factors strongly influence early exposure to UPFs. Modifiable determinants such as breastfeeding duration, parental nutrition literacy, shared family meals, and screen time represent key targets for preventive interventions. Overall, the evidence highlights the urgent need for life-course–oriented nutritional strategies that promote unprocessed and minimally processed foods, reinforce family-based nutrition education, and support healthy dietary patterns from pregnancy through childhood and adolescence to reduce the long-term burden of non-communicable diseases.

Introduction: Breastfeeding plays a fundamental role in newborns’ and infants’ health. Breast milk’s protective power against malnutrition and its positive effect on neurological and physical development are well established and are reflected in the policy statements of all major pediatric health entities. However, breastfeeding also plays an important role in the prevention of so-called non-communicable diseases, such as obesity, hypertension, dyslipidemia, and autoimmune diseases. Methods: This narrative review aims to analyze the effect of breastfeeding and breast milk on the development of non-communicable diseases, with a special focus on weight excess, dyslipidemia, allergy, and gastrointestinal diseases. This narrative review was carried out through three steps: executing the search, examining abstracts and full texts, and analyzing results. To achieve this, the databases PubMed, EMBASE, Scopus, ScienceDirect, Web of Science, and Google Scholar were explored to collect and select publications from 1990 to 2024 to find pertinent studies in line with this review’s development. The search included randomized placebo-controlled trials, controlled clinical trials, double-blind, randomized controlled studies, and systematic reviews. A total of 104 manuscripts were ultimately included in the analysis. Results: Breastfeeding is associated with a decreased vulnerability to early viral infections or chronic inflammatory conditions during preschool years, a reduced incidence of weight excess, and likely lower cholesterol concentration, besides having a small protective effect against systolic blood hypertension. Conclusions: Pediatricians must promote breastfeeding, support the mother–infant dyad, and consider breast milk as a real “health voucher” that can last lifelong. However, further studies are needed to better define the extent and duration of breastfeeding’s protective power in this context.

Growing awareness of gluten-related disorders has led to a rising number of diagnoses of celiac disease (CD) and increasing adoption of the gluten-free diet (GFD), often without medical necessity. This narrative review summarizes current evidence on the main gluten-related conditions—CD, wheat allergy (WA), and non-celiac gluten sensitivity (NCGS)—and their nutritional implications, with particular focus on pediatric populations. Although these disorders share overlapping clinical features, they differ in pathogenesis, diagnostic criteria, and management. In CD, strict lifelong gluten exclusion remains essential for intestinal healing and symptom resolution, whereas in WA, wheat avoidance is the cornerstone of therapy. NCGS is characterized by gluten-related gastrointestinal and extra-intestinal symptoms in the absence of CD or WA, with notable clinical overlap with irritable bowel syndrome. Across all conditions, adherence to a GFD can lead to nutritional imbalances, including deficiencies in iron, folate, vitamin B12, vitamin D, calcium, zinc, and magnesium, as well as reduced fiber intake and unfavorable changes in gut microbiota. Overreliance on processed gluten-free foods may further increase cardiometabolic risks. In children, unmonitored GFDs may impair growth and neurodevelopment. Clinicians should ensure accurate differential diagnosis, provide nutritional counseling, and monitor long-term outcomes to balance the therapeutic benefits of GFD with potential risks.

Background: Fever and pain are among the most frequent symptoms in pediatric care, requiring timely and appropriate management. While evidence-based guidelines are available, adherence in real-world practice remains variable. This study aimed to explore the attitudes and prescribing behaviors of Italian Primary Care Pediatricians (PCPs) in the management of fever and pain, and to assess their alignment with current clinical recommendations. Materials and Methods: An anonymous, cross-sectional survey consisting of 30 multiple-choice questions was administered to 900 PCPs between 1 July and 30 October 2024. The questionnaire assessed therapeutic preferences, dosing strategies, and perceived knowledge gaps. Invitations were distributed via pediatric scientific societies and regional professional networks. Results: A total of 244 PCPs completed the survey (response rate 27.1%). The majority were aged over 55 years (72.1%), worked in urban settings (71.3%), and had more than 20 years of clinical experience (74.6%). Most respondents (77%) reported managing pediatric fever or pain on a daily basis. Paracetamol was the preferred first-line treatment for fever (95.9%), primarily due to its perceived safety (82.4%). Ibuprofen was favored by 51.6% of those who selected it for its greater effectiveness. The alternating use of paracetamol and ibuprofen for fever was never adopted by 49.6%, while 31.6% employed this strategy, believing it to be more effective. For pain, 67.6% used paracetamol and 26.2% used ibuprofen as first-line treatments; 15.2% reported alternating the two drugs. Correct dosage practices were followed by 63.9% for both medications, although 40.2% did not differentiate dosages between fever and pain management. Conclusions: While general trends showed alignment with current guidelines, notable inconsistencies were observed in drug selection, dosage, and the use of alternating therapies. These findings highlight a pressing need to improve the dissemination and implementation of pediatric fever and pain management guidelines among PCPs in order to reduce unsafe practices, avoid therapeutic errors, and prevent unnecessary strain on emergency care services.

Inflammatory Bowel Diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis (UC), have become a growing global health concern in children and adolescents. Pediatric-onset IBD presents unique challenges compared with adult-onset forms, including more extensive disease, impaired growth, delayed puberty, and psychosocial difficulties. While biologic and targeted therapies have advanced disease control, nutritional interventions remain a central component of management. Exclusive enteral nutrition (EEN) is recognized as the first-line therapy for inducing remission in pediatric CD, offering comparable efficacy to corticosteroids with additional benefits for mucosal healing, nutritional status, and growth. Modified dietary approaches, such as partial enteral nutrition and the Crohn's Disease Exclusion Diet (CDED), show promise for improving adherence and maintaining remission. However, dietary restrictions may lead to deficiencies and psychosocial stress, underscoring the importance of individualized, dietitian-supervised care. The role of nutrition in UC is less defined, but balanced, anti-inflammatory dietary patterns appear beneficial. This narrative review summarizes current evidence on nutritional strategies in pediatric IBD, highlighting their therapeutic potential, limitations, and integration with pharmacologic treatment within a multidisciplinary framework aimed at optimizing outcomes and quality of life.

Background: Awareness, diagnosis, and treatment of familial hypercholesterolemia (FH) starting from childhood are a cornerstone of cardiovascular disease prevention. The LIPIGEN Paediatric Group, a network of specialised centres for the diagnosis and management of familial genetic dyslipidemia, is an active part of this mission. Materials and Methods: This is the second exploratory survey organised within the LIPIGEN (LIpid transPort disorders Italian GEnetic Network) paediatric centres. A digital questionnaire consisting of 16 questions was proposed to the principal investigators of 35 LIPIGEN centres in September 2023. We analysed the main FH screening strategies implemented in Italy, which are the referral characteristics to the lipid clinics and clinical and biochemical criteria considered to diagnose FH in paediatric patients. Results: Centres frequently reported conducting cascade screening (88.6%) and reverse screening (57.1%), whereas 28.6% of respondents indicated using selective screening and only 5.7% reported employing child–parent screening. We documented a detailed biochemical characterisation of paediatric patients (62.9% of respondents usually perform full lipoprotein profile and 80% determine lipoprotein(a) for each patient) and a high percentage of genetic analysis (82.9%). We have also highlighted a quite low awareness of FH as a genetic condition involving paediatric patients among primary care paediatricians and general practitioners. Conclusions: The results of our survey show that specialised lipid centres usually have good diagnostic competence when dealing with paediatric patients with hypercholesterolemia. However, FH awareness and the importance of early diagnosis and treatment initiation in childhood still need to be further improved.

Background: Respiratory syncytial virus (RSV) bronchiolitis remains a leading cause of hospitalization in infants, particularly those with risk factors such as prematurity or chronic diseases. Nirsevimab, a long-acting monoclonal antibody, has recently been approved for RSV prevention. However, parental acceptance of this novel immunoprophylaxis is crucial for effective implementation. The aim of this study was to investigate parental acceptance of nirsevimab prophylaxis for RSV among eligible neonates in Emilia-Romagna, Italy, and to identify factors influencing decision making. Methods: A prospective, multicenter observational study enrolled 1042 parents of neonates eligible for nirsevimab prophylaxis according to regional criteria. Parents completed a semi-structured questionnaire during pre-immunization counseling, exploring knowledge, attitudes, perceived risks, information sources, and willingness to accept prophylaxis. Statistical analysis assessed associations between parental characteristics and acceptance rates. Results: Among the 1042 respondents, 87.0% (n = 907) expressed willingness to administer nirsevimab to their child, while 2.2% (n = 23) refused and 8.8% (n = 92) were undecided. Higher acceptance was significantly associated with awareness of RSV risks (72.1% vs. 41.7%, p < 0.01), belief in nirsevimab’s high efficacy (46.2% vs. 18.3%, p < 0.01), and lower concern over side effects (10.6% vs. 27.8%, p < 0.01). Trust in primary care pediatricians and the healthcare system was also notably higher among accepting parents (p < 0.001). Willingness to pay declined with a hypothetical EUR 250 cost but remained higher among the acceptance group (71.0% vs. 50.4%, p < 0.001). Conclusions: Parental acceptance of nirsevimab in Emilia-Romagna was high, though significant gaps in knowledge and concerns about safety persist. Targeted educational strategies that clarify the nature, efficacy, and safety of nirsevimab—alongside maintaining cost-free access—are essential to support the successful implementation of RSV prophylaxis programs.

Background: Antibiotic-associated diarrhea (AAD) is a common adverse effect of pediatric antibiotic therapy, often linked to gut microbiota disruption. Probiotics may help prevent AAD when appropriately selected and dosed. Methods: We conducted a cross-sectional survey to assess the attitudes and prescribing habits of Italian Primary Care Pediatricians (PCPs) regarding the use of probiotics during antibiotic treatment. A digital questionnaire comprising 23 mandatory multiple-choice items was distributed to 980 PCPs across Italy between July and October 2024. The survey explored probiotic prescribing frequency, indications, strains used, dosage, duration, and sources of information. Descriptive statistics and subgroup analyses by years of clinical experience were performed. Results: A total of 279 PCPs (response rate: 28%) completed the survey; 66.7% were female, and 77.1% had over 20 years of clinical experience. Probiotics were prescribed primarily to restore microbiota balance (81.1%) and prevent AAD (47.3%). The most common barriers included additional cost (35.1%) and perceived lack of evidence (26.5%). Lactobacillus rhamnosus GG (91.8%) and Saccharomyces boulardii (41.9%) were the most frequently recommended strains. Daily doses of 5-10 billion CFU were preferred by 44.4% of respondents, with typical durations of 1-2 weeks (40.1%) or one week (31.2%). Conclusions: Probiotics are widely used by Italian PCPs during antibiotic therapy, especially for microbiota support and AAD prevention. However, variability in practice underscores the need for clearer, evidence-based guidelines regarding probiotic strain selection, dosing, and treatment duration.

Dietary fiber is present in many food categories (fruits, cereals, vegetables, legumes), and is considered a beneficial component of adult and children’s diets. It is now well-established that dietary intervention is the first line of treatment for childhood dyslipidemia, both as a curative intervention (Familial Hyperchylomicronemia Syndrome, Sitosterolemia) and as an appropriate lifestyle aimed at improving the lipid profile in dyslipidemia, which is associated with early atherosclerosis and an increased risk of cardiovascular disease in adulthood (Familial Hypercholesterolemia, overweight- and obesity-related dyslipidemia). In this paper, we reviewed the main consensus documents to determine the current indications for its use in children and adolescents, and analyzed the few specific papers on the subject in the literature to assess how fiber is currently used in the treatment of pediatric dyslipidemia, what precautions should be taken, and what the main benefits of fiber are on the lipid profile and cardiovascular risk.

Familial hypercholesterolemia (FH) is a common genetic disorder with a fairly constant worldwide prevalence of 1 case per 311 individuals worldwide. It is characterized by severe hypercholesterolemia from birth, early atherosclerosis and death from cardiovascular disease at a young age. Diagnosis and treatment from childhood are essential to reduce cardiovascular mortality. Many countries have developed a strategy of implementing pediatric screening, which has led to an increase in diagnoses. This paper evaluates the screening strategies implemented in different countries worldwide. First, we examined which schemes were preferred in various national contexts in Europe. Next, we evaluated the screening methods used in the US, Canada, Australia and Japan. Finally, we researched the screening strategies proposed in some low-resource countries, discovering the difficulties and limitations they face. We have highlighted a wide range of realities, from small-scale pilot studies to cutting-edge proposals. We have also emphasized that, while the topic is certainly of interest, it is burdened by multiple difficulties and unresolved questions.

Familial hypercholesterolemia is a genetically determined disease characterized by elevated plasma total and LDL cholesterol levels from the very first years of life, leading to early atherosclerosis. Nutritional intervention is the first-line treatment, complemented with nutraceuticals and drug therapy when necessary. Nutraceuticals with a lipid-lowering effect have been extensively studied in the past few decades, and have been recently included in international guidelines as a complement to nutritional and pharmacological treatment in subjects with dyslipidemia. In this review, we explore current nutritional interventions for dyslipidemia in childhood, with a specific focus on the main nutraceuticals studied for treating severe dyslipidemia in pediatric patients. Additionally, we briefly describe their primary mechanisms of action and highlight the advantages and risks associated with the use of lipid-lowering nutraceuticals in childhood.

According to WHO, “complementary feeding (CF) is the process starting when breast milk alone or infant formula alone is no longer sufficient to meet the nutritional requirements of infants, and therefore, other foods and liquids are needed, along with breast human milk or a breastmilk substitute”. CF is one of the most important “critical and sensitive periods” in human life: indeed, timing and approaches to solid foods introduction in an infant’s nutrition are of utmost importance as potential epigenetic factors from infancy to adulthood. CF is also deeply influenced by each country and single-family traditions, culture, and beliefs. The aim of our narrative review is to analyze traditional CF practices, including innovative and alternative ones that emerged in the last decades, such as baby-led weaning or plant-based weaning, and to evaluate their effects on the risk of developing non-communicable diseases. Moreover, we will discuss pitfalls and misunderstandings that pediatricians frequently have to face when dealing with complementary feeding. Health care professionals must not have prejudices against parents’ wishes or traditions about CF; rather, they should support and educate them in case of any alternative CF choice, always pursuing the infant’s adequate growth, neuro- and taste development, and the achievement of correct eating behavior as the primary goal.

The evaluation of serum Lp(a) values in childhood and adolescence has been widely debated, and in the last few years, many authors have tried to better define Lp(a) role in atherosclerosis pathogenesis, starting from childhood. In our narrative review, we have evaluated the main historical stages of Lp(a) studies in childhood, trying to focus on pathogenic mechanisms linked to elevated serum Lp(a) values, starting from ischemic stroke and vascular damage, and to its possible direct involvement in premature atherosclerosis from childhood onwards. Historic manuscripts on Lp(a) in pediatric patients have mainly focused on serum Lp(a) values and increased stroke risk. More recently, many studies have evaluated Lp(a) as a coronary vascular disease (CVD) risk factor starting from childhood, especially related to a positive family history of premature CVD. Finally, only a few studies evaluated the role of Lp(a) in premature atherosclerotic processes and endothelial and vascular damage in pediatric patients. Lastly, we have hypothesized a future perspective, with the hope that plasma Lp(a) levels will be treated with a tailored pharmacologic approach, and Lp(a) will become a precocious therapeutic target to control the atherosclerotic pathways from the first years of life.