Background Accidental hydrocarbon ingestion is a common cause of pediatric toxic exposure, particularly among those under 6 years of age, and primarily causes injury through aspiration leading to chemical pneumonitis. Clinical presentation is variable, ranging from mild symptoms to severe respiratory failure, with potential early deterioration and rare delayed complications such as pneumatoceles. Case report: We report the case of a 17-month-old previously healthy boy admitted after accidental ingestion of printer fluid containing low-viscosity hydrocarbons. He initially presented with mild respiratory symptoms and stable vital signs but developed progressive chemical pneumonitis within hours, requiring Pediatric Intensive Care Unit admission and ventilatory support. The clinical course was complicated by bilateral pulmonary consolidations and subsequent development of large pneumatoceles, with gradual radiological resolution and complete clinical recovery at 6- and 12-month follow-up, without residual sequelae. Conclusions Our case illustrates that accidental hydrocarbon ingestion may lead to severe and progressive respiratory injury even after an apparently mild initial presentation, thus warranting close in-hospital observation for at least 48 hours. Although radiological complications such as pneumatoceles may develop several days after exposure, long-term outcomes are generally favorable, highlighting the remarkable capacity for pulmonary recovery in children and the importance of structured follow-up.

To compare perioperative and long-term outcomes of lobectomy versus lung-sparing resection in children undergoing surgery for congenital pulmonary airway malformation (CPAM). A retrospective single-center study was conducted including children who underwent primary surgical resection for postnatally confirmed CPAM between 2005 and 2024. Patients with other congenital lung lesions, bilateral disease, syndromic conditions, or incomplete data were excluded. Perioperative variables, postoperative outcomes, redo surgery, and chest wall anomalies were compared between lobectomy and lung-sparing resections. Continuous variables were analyzed using the Mann–Whitney U test and categorical variables using Fisher’s exact test. Thirty-one children were included (22 lobectomies, 9 lung-sparing resections), with a median age at surgery of 8 months. Operative time (207 vs. 149 min, p = 0.0425) and anesthesia time (371 vs. 230 min, p = 0.0171) were significantly longer for lobectomy. Intraoperative complications occurred in 10

Climate change (CC) represents a serious threat for human health, through air pollution, global warming and extreme weather events. Its consequences are particularly relevant for children and their respiratory system, because of a developing immune system, higher respiratory rate and exposure to toxins and pollutants, but our understanding on this phenomenon is still lacunose. Pediatricians are crucial as clinicians, diagnosing and managing conditions CC-related, and as advocates of education and public health strategies for environmental sustainability and addressing social health disparities. In order to mitigate the effects of CC on children, several policies, public health initiative and general guidelines have been developed but rigorous application and implementation are still needed. Although concern around this topic is growing, there is still a lack in health workers educational program on the impact and mechanisms of CC-related diseases.

Adolescent nicotine dependence represents a public health challenge, driven by the rapid evolution of tobacco products and by the unique neurobiological vulnerability of the developing brain to nicotine exposure. Clinically significant dependence may emerge after brief and intermittent use, often before adolescents self-identify as users, underscoring the need for proactive and systematic screening across all nicotine and tobacco product modalities. This position paper reviews the evidence on effective cessation strategies for adolescents and provides practical recommendations for clinicians and health systems. Psychological interventions, including cognitive-behavioral therapy and shared decision-making, remain the cornerstone of treatment, given their alignment with the motivational and developmental characteristics of this age group. Educational approaches, particularly school-based and digital interventions, show promise in reducing initiation and supporting cessation among current users. Family engagement and school environment play a critical supporting role, provided that adolescent confidentiality is consistently respected. Pharmacological options are limited by the absence of approved medications for individuals under 18 years of age. However, off-label use of nicotine replacement therapy may be considered in cases of moderate-to-severe dependence under specialist oversight. Effective strategies require integrated care pathways linking primary pediatric care, school health services, and community resources, supported by policy measures that reduce product accessibility and appeal. This joint position paper, endorsed by the Italian Society of Pediatrics (SIP) and the Italian Pediatric Respiratory Society (SIMRI), provides evidence-based recommendations for adolescent smoking cessation, encompassing educational and clinical interventions.

INTRODUCTION:Preterm birth is a major cause of neonatal respiratory morbidity and increases the risk of bronchopulmonary dysplasia (BPD). Tidal-breathing flow-volume loops (TBFVL) enable non-invasive early detection of respiratory abnormalities. While there is extensive data on TBFVL in preterm infants with BPD, data in those without BPD are limited. This prospective cohort study evaluates TBFVL and the impact of prematurity-related variables in preterm infants without BPD. MATERIALS AND METHODS:Subjects were recruited from the Neonatology Unit of Buzzi Children's Hospital in Milan, Italy, from 1st February to 31st December 2025. TBFVLs were performed during natural sleep at term-equivalent postmenstrual age. Time-to-peak expiratory flow to total expiratory time (tPTEF/tE, measuring airway size), respiratory rate, tidal volume/kg and minute ventilation/kg were analysed, comparing them with reference values for term subjects and stratifying the sample by gestational age (GA) (≤32 vs > 32 weeks). Several perinatal variables were collected, to identify potential associations with respiratory outcomes. RESULTS:38 infants (mean GA 32.76 weeks) were included. The mean tPTEF/tE was significantly lower compared to a previously published cohort of healthy term infants (p < 0.001). Infants born ≤32 weeks had significantly lower values than those born >32 weeks (p < 0.001). Gestational age at birth was the only variable significantly associated with tPTEF/tE. CONCLUSIONS:Preterm infants, even without BPD, show greater signs of airway obstruction at term corrected age. GA at birth emerges as the main determinant of respiratory performance, suggesting a key role for intrauterine lung maturation. Longitudinal studies are needed to define its long-term clinical significance.

INTRODUCTION:Bronchiolitis is the leading cause of infant hospitalizations worldwide, primarily driven by respiratory syncytial virus (RSV). METHODS:This multicenter retrospective comparative study assessed the impact of immunoprophylaxis with nirsevimab against RSV on bronchiolitis-related hospitalizations in Italy during the 2024-2025 winter season. RESULTS:Data from nine Italian hospitals showed a substantial 48% decrease in bronchiolitis admissions compared to the previous season (438 vs. 832 admissions). Among hospitalized infants, only 23% had received immunoprophylaxis. RSV positivity dropped significantly among immunized patients (48%) versus non-immunized (73%, p < 0.0001), with fewer RSV-related coinfections. DISCUSSION:While indicators of illness severity-such as ICU admission, respiratory support needs, and complications-were generally lower, no statistically significant differences in disease course were observed between immunized and non-immunized hospitalized infants. A shift in viral epidemiology was noted, with a reduction in RSV dominance and increased detection of rhinovirus and enterovirus, suggesting a pathogen replacement effect. The 2024-2025 season also saw a lower intubation rate (< 0.5%), pointing to an overall milder disease course. CONCLUSIONS:This study supports the effectiveness of nirsevimab in reducing RSV-associated hospitalizations and reshaping the virological landscape of bronchiolitis in Italy. Early and widespread implementation of immunoprophylaxis is recommended to maximize public health benefits.

Background: Paediatric-to-adult transition represents an unmet need in many chronic conditions. Data and ­outcomes on pulmonary transition clinics (PTC) are limited. Methods: We report the structure, organization, and patients’ characteristics of a multidisciplinary outpatient PTC started in 2022 by two secondary level academic hospitals in Milan, Italy. Consecutive adult patients (≥18 years old) that entered the PTC from January 2022 until January 2023 and completed ≥2 follow-up visits were asked to answer a custom designed, anonymized, online questionnaire to test improvement in disease perception, self-confidence, and evaluate their experience with the clinic. Results: Out of thirty-three patients, twenty-one completed the survey (62% males, median age 19 years). The most common diagnoses included asthma (57%) and bronchiectasis (19%). The disease control rate was optimal, only <2% of visits were unscheduled emergency visits. 100% of patients rated the presence of a dedicated service, a direct relationship with the treating physician and the possibility to improve self-management extremely useful. Conclusions: Our questionnaire revealed that transitioning from caregiver-based disease management to patient-based disease management was perceived as more arduous. PTCs are an impactful resource for patients transitioning to adult care, but our knowledge on disease specific management strategies in transitioning patients remains limited.

BACKGROUND:"Bronchiectasis" is a clinical syndrome characterized by chronic wet cough associated with chronic mucus production and abnormal bronchial dilatation. This condition is currently diagnosed through high resolution chest tomography in both adults and children. Bronchiectasis continues to be underdiagnosed -especially in childhood- but this age group should be considered of particular importance since the progression from chronic bronchitis to bronchiectasis may take many years. METHODS:In this paper we analyze the barriers to a timely diagnosis of non-CF bronchiectasis in childhood and discuss new options to improve the diagnostic algorithms as well as new opportunities for patients. CONCLUSIONS:Bronchiectasis diagnosis should be done as early as possible in children, since interrupting the infection/inflammation cycle is critical to reverse and/or stop the disease progression and structural lung injury. Further studies are required to establish transition programs from pediatric to adult bronchiectasis care.

BACKGROUND:No standardized guidelines exist for the management of isolated congenital bronchial atresia (CBA), particularly in asymptomatic cases. This systematic review analyzes both pediatric and adult cases to inform future treatment recommendations. METHODS:A systematic review was conducted following PRISMA guidelines, including studies of pediatric (<15 years) and adult (≥15 years) patients with CBA. RESULTS:Out of 3686 screened studies, 85 met the inclusion criteria, encompassing 275 patients (169 children, 106 adults). Surgical intervention was reported in 69.8 % of cases, including 31.2 % of asymptomatic patients, with a particularly high rate of lobectomy in children (83.8 %). CONCLUSIONS:Management of CBA remains contentious. While symptomatic are generally treated surgically, a notable proportion of asymptomatic patients also underwent surgery, with a particularly high rate of lobectomy in children. No evidence supports an increased risk of complications in untreated cases, suggesting a potential role for conservative management.

Electronic nicotine delivery systems (ENDS), heated tobacco products (HTP), and nicotine pouches have rapidly gained popularity among adolescents, driven by appealing flavors, targeted marketing strategies, and widespread misperceptions of reduced harm. This joint position paper, endorsed by the Italian Society of Pediatrics (SIP) and the Italian Pediatric Respiratory Society (SIMRI), considers current evidence on patterns of youth use and outlines potential prevention strategies. We examine industry tactics, including social-media influencer campaigns and product design features that disproportionately attract adolescents, and discuss the influence of peer, family, and environmental factors on product uptake. Parents and caregivers play a pivotal role through open dialogue, modeling nicotine-free behaviors, and monitoring access. Pediatricians and primary-care providers should incorporate routine screening for all nicotine products into well-child visits, deliver brief motivational counseling, and connect families with cessation resources tailored to teens. Continuous surveillance of youth consumption patterns and systematic evaluation of intervention effectiveness will ensure strategies remain responsive to evolving product designs and marketing practices. Through coordinated policy changes, healthcare support, community action, and education, it is possible to prevent nicotine initiation among adolescents and foster a generation free from smoke and vaping addiction.

Background: In pediatric age, the central airways are more flexible and mobile, with tracheal and bronchial walls easily tending to collapse, allowing partial or complete occlusion of the lumen: a situation described as tracheobronchomalacia (TBM). This is a condition that causes an increase in intrathoracic pressure that may accentuate airway collapse, and a biphasic or barking cough appears. Objectives: Although TBM is relatively frequent in pediatric age, the diagnostic criteria and subsequent treatment do not follow well-standardized criteria and often vary from pediatric center to center. Therefore, there is a need to standardize diagnostic procedures and the resulting medical or surgical treatments. Methods: We therefore organized a day of meetings to talk about TBM, inviting all Italian pediatricians and pediatric surgeons who diagnose and treat patients with this pathology on a daily basis. Results: This work, collecting all the meeting interventions, is a compendium that deals with all aspects of TBM, emphasizing the most correct criteria to diagnose and therefore best treat each pediatric patient with this clinical condition. We give particular emphasis to the need to perform static and dynamic videobronchoscopy (S/DVBS) to verify the patency of the tracheal lumen, so as to evaluate the severity of TBM. Conclusions: this work deals with TBM in all its diagnostic and treatment aspects and can be a valid help for all pediatricians who treat these patients.

Pulmonologists may be involved in managing pulmonary diseases in children with complex clinical pictures without a diagnosis. Moreover, they are routinely involved in the multidisciplinary care of children with rare diseases, at baseline and during follow-up, for lung function monitoring. Lysosomal storage diseases (LSDs) are a group of genetic diseases characterised by a specific lysosomal enzyme deficiency. Despite varying pathogen and organ involvement, they are linked by the pathological accumulation of exceeding substrates, leading to cellular toxicity and subsequent organ damage. Less severe forms of LSDs can manifest during childhood or later in life, sometimes being underdiagnosed. Respiratory impairment may stem from different pathogenetic mechanisms, depending on substrate storage in bones, with skeletal deformity and restrictive pattern, in bronchi, with obstructive pattern, in lung interstitium, with altered alveolar gas exchange, and in muscles, with hypotonia. This narrative review aims to outline different pulmonary clinical findings and a diagnostic approach based on key elements for differential diagnosis in some treatable LSDs like Gaucher disease, Acid Sphingomyelinase deficiency, Pompe disease and Mucopolysaccharidosis. Alongside their respiratory clinical aspects, which might overlap, we will describe radiological findings, lung functional patterns and associated symptoms to guide pediatric pulmonologists in differential diagnosis. The second part of the paper will address follow-up and management specifics. Recent evidence suggests that new therapeutic strategies play a substantial role in preventing lung involvement in early-treated patients and enhancing lung function and radiological signs in others. Timely diagnosis, driven by clinical suspicion and diagnostic workup, can help in treating LSDs effectively.

Multisystem inflammatory syndrome is a severe complication of SARS-CoV-2 infection in children (MIS-C). To date, data on long-term sequelae mainly concern cardiac outcomes. All ≤ 18 year olds consecutively admitted to the Buzzi Children’s Hospital with a diagnosis of MIS-C between October 1, 2020, and May 31, 2022, were followed up for up to 12 months by a dedicated multidisciplinary team. They underwent laboratory tests, multi-organ clinical and instrumental assessments, and psychosocial evaluation. 56/62 patients, 40 M, mean age 8.7 years (95

Background: Asthma is a common chronic disease in pediatric patients, and perimenstrual asthma (PMA), refers to the worsening of asthma symptoms during the perimenstrual period, mainly reported in adult women. However, there is limited information regarding the exacerbation of symptoms in the presence of premenstrual disorders (PMDs) in adolescents. The aim of this pilot observational study was to investigate the frequency and potential association of PMA and PMDs in a clinical sample of adolescents with asthma. Patients and Methods: The study included 50 adolescents (aged 12-18 years, mean 16.08 +/- 2.35) with asthma and at least 2 years of gynecological age. The participants completed the Asthma Control Test (ACT) to assess asthma control (considered pathological if ACT score < 20) and the modified Premenstrual Symptoms Screening Tool for Adolescents (PSST-A) to evaluate PMDs. Results: A total of 75.5% of adolescents reported PMA. The prevalence of premenstrual symptoms did not significantly differ between the PMA and no-PMA group. Among the study sample, 38.7% experienced symptoms indicative of moderate/severe premenstrual syndrome, and 8.1% exhibited symptoms of premenstrual dysphoric disorder. Compared with the no-PMA group, patients with PMA showed a significant impairment in daily and home activities ( P = .03 and P = .02, respectively) and exhibited a difference in the frequency of asthma symptoms ( P < .001) and medication use ( P <= .01). Conclusion: Perimenstrual worsening of asthma symptoms may be common in adolescents with a severe form of asthma. Prospective data collection through menstrual diaries is necessary to further explore the association between PMA and PMDs. Identifying early risk factors for PMA could facilitate the development of preventive strategies and early interventions for adolescents with asthma.