Respiratory syncytial virus (RSV) is a leading cause of hospitalizations among young children globally. However, the impact of RSV-associated hospitalization on subsequent wheezing episodes remains understudied in Europe. We assessed the incidence rate ratio (IRR) of wheezing in the first year after hospitalization in children hospitalized with RSV compared to those hospitalized without acute respiratory infections (ARI). We conducted a prospective matched cohort study in hospitalized children aged ≤2 years across ten hospitals in Germany, Spain, Italy, France, and England from October 2020 to May 2023. We compared the incidence rates of caregiver-reported wheezing, medically attended wheezing, and wheezing requiring medication within 12 months post-discharge in children with laboratory-confirmed RSV to matched children admitted for non-ARI. Caregivers reported wheezing episodes through bi-monthly online questionnaires. Potential confounders were adjusted using propensity scores as covariates in generalized estimating equations. A total of 300 hospitalized children with RSV and 140 with non-ARI were included, with an average 89% completion rate for the bi-monthly questionnaires. Two-thirds (66%) of children admitted with RSV experienced caregiver-reported wheezing episodes, compared to only 26% of non-ARI children; with an IRR of 3.58 (95% CI 2.87–4.46). The adjusted IRRs for caregiver-reported wheezing episodes, medically attended wheezing episodes, and use of respiratory medication were 2.51 (95% CI 1.46–4.33), 2.29 (95% CI 1.50–3.52), and 2.91 (95% CI 1.90–4.47), respectively. These associations remained consistent after imputation for missing data. Hospitalization due to RSV in children aged ≤2 years is associated with a significantly increased risk of wheezing in the year following discharge, underscoring the long-term respiratory burden of RSV infection in early childhood. Joanne G. Wildenbeest, MD, PhD, Merck & Co., Inc.: Grant/Research Support|Merck & Co., Inc.: Presentation at sponsored symposium|Sanofi: Grant/Research Support|Sanofi: participation in advisory boards, speaker at a Sanofi sponsored symposium Louis J Bont, M.D., Merck: Advisor/Consultant|Merck: Grant/Research Support Rebecca Stellato, n/a, Merck & Co., Inc.: Grant/Research Support Johannes Liese, MD MSc, Sanofi: Grant/Research Support Egbert Herting, PhD, Chiesi: Grant/Research Support Renato Cutrera, MD, Merck & Co., Inc.: Grant/Research Support Christina Calvo, MD, PhD, Merck & Co., Inc.: Grant/Research Support Chiara Azzari, Merck & Co., Inc.: Grant/Research Support Federico Martinon-Torres, MD, PhD, Assoc. Prof, Astra Zeneca: Advisor/Consultant|Astra Zeneca: Board Member|Astra Zeneca: Grant/Research Support|Astra Zeneca: Honoraria|Astra Zeneca: trial fees as PI, paid to may institution|GSK: Advisor/Consultant|GSK: Board Member|GSK: Grant/Research Support|GSK: Honoraria|GSK: trial fees as PI, paid to may institution|Merck & Co., Inc.: Advisor/Consultant|Merck & Co., Inc.: Grant/Research Support|Merck & Co., Inc.: Honoraria|Merck & Co., Inc.: trial fees as PI, paid to may institution|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Moderna: trial fees as PI, paid to may institution|Pfizer: Advisor/Consultant|Pfizer: Board Member|Pfizer: Grant/Research Support|Pfizer: Honoraria|Pfizer: trial fees as PI, paid to may institution|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Board Member|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Honoraria|Sanofi Pasteur: trial fees as PI, paid to may institution|Seqirus: Advisor/Consultant|Seqirus: Grant/Research Support|Seqirus: trial fees as PI, paid to may institution Simon Drysdale, FRCPCH, MSD: Grant/Research Support Ralph Epaud, MD, ASTRA: Advisor/Consultant|ASTRA: Board Member|GSK: Advisor/Consultant|SANOFI: Board Member Madelyn Ruggieri, MS, Merck: employee of Merck Yoonyoung Choi, PhD, MS, RPh, Merck & Co., Inc.: Grant/Research Support|Merck & Co., Inc.: Employment|Merck & Co., Inc.: Stocks/Bonds (Private Company)

BACKGROUND:Respiratory tract infections (RTIs) are a leading cause of morbidity in preschool children, particularly in those with recurrent wheezing. Natural compounds such as resveratrol and carboxymethyl-β-glucan have shown immunomodulatory, antiviral, and anti-inflammatory activity, supporting their potential role in preventing pediatric airway infections. OBJECTIVE:To evaluate the efficacy, safety, and tolerability of Linfovir®, a nasal spray containing resveratrol and carboxymethyl-β-glucan, in reducing respiratory infectious symptoms in preschool children with recurrent respiratory infections and wheezing. METHODS:This multicenter, randomized, double-blind, placebo-controlled trial enrolled children aged 2-6 years with a history of recurrent respiratory infections. Participants were randomized 1:1 to receive Linfovir® or placebo once daily for 12 weeks, with follow-up at 16 weeks. Primary and secondary outcomes including days with respiratory symptoms, number of infections, antibiotic courses, and medical visits were recorded via the VIRAPP® electronic diary. RESULTS:Eighty-two children were included in the Full Analysis Set. The primary endpoint was not statistically significant. However, a numerical reduction in days with respiratory symptoms was observed in the resveratrol/β-glucan nasal spray group compared with placebo (15.0 vs. 20.4 days in the FAS population), corresponding to an approximate 26% relative difference. Similar non-significant patterns favoring the intervention were observed for infectious episodes, antibiotic courses, and medical visits. Treatment adherence was high in both groups, and no serious adverse events occurred. CONCLUSIONS:In this pilot randomized controlled trial, the resveratrol/β-glucan nasal spray was safe and well tolerated. Although the study did not show a statistically significant effect on the primary endpoint, the observed numerical differences consistently favored the intervention. These findings should be interpreted as exploratory and hypothesis-generating and require confirmation in larger adequately powered studies.

Background: Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by deficient mucociliary clearance and development of chronic lung disease. Pulmonary exacerbations (PEx) in chronic lung diseases increase morbidity and lung function decline, but their frequency in PCD has been understudied. We aimed to prospectively determine the annual frequency of PEx in PCD and identify related risk factors. Methods: In a multicentre, observational study conducted in 11 centres from seven countries, we prospectively collected data from a well-described patient cohort with genetically confirmed PCD over a year via monthly telephone questionnaires and clinical visits. We assessed the annual PEx frequency using three definitions: i) clinical definition 1 (Def-1) when three out of seven clinical items were positive; clinical definition 2 (Def-2) if the patient started or changed antibiotic treatment; self-reported PEx by the patient. For paired statistical comparisons we used the Friedman test and the Wilcoxon matched-pairs test and tested their agreement (Cohen's kappa statistics). We also determined related risk factors using a mixed-effects model. Results: We recruited 271 individuals with PCD of all ages. Among patients with complete annual records (n = 248), approximately 80% experienced at least one PEx per year, as assessed by the three definitions used. Self-reported PEx per year (median 2, interquartile range (IQR) 1-5) were higher (p < 0.0001) than the PEx assessed by Def-1 (median 2, IQR 0-4) and Def-2 (median 1, IQR 0.25-3). Self-reported PEx had a substantial agreement with Def-1 [kappa (SE) = 0.61 (0.05)] and a moderate agreement with Def-2 [kappa (SE) = 0.51 (0.05)]. Female sex and autumn season were associated with higher number of PEx, independent of the definition used. Increasing age was correlated with higher annual PEx frequency by Def-1. Conclusion: In this multicentre study, we prospectively assessed the annual PEx frequency in patients genetically diagnosed with PCD, demonstrating the importance of the definition used in capturing the exacerbation burden of PCD, as well as the influence of sex, age and season on exacerbation frequency.

Abstract Respiratory syncytial virus (RSV) remains a leading cause of bronchiolitis and hospitalization in infants across Italy, particularly during predictable seasonal outbreaks. With the 2023–2025 RSV seasons marking the first large-scale rollout of the monoclonal antibody nirsevimab, this study aimed to evaluate the implementation strategies, regional variability, and early clinical impact of RSV prophylaxis at the national level. We conducted a nationwide, multicenter, observational study across 19 Italian regions. Data were collected through the Italian Society of Pediatrics and the Italian Society of Neonatology, focusing on regional differences in rollout timing, organizational models, logistical challenges, and RSV-related hospitalizations and pediatric intensive care unit (PICU) admissions. The results highlighted significant regional heterogeneity. Northern and central regions such as Veneto, Lombardy, and Tuscany initiated prophylaxis earlier and experienced fewer logistical barriers, resulting in marked reductions in RSV hospitalizations - up to 83.7% in Friuli-Venezia Giulia. Conversely, southern and smaller central regions, including Molise, Marche, and Umbria, faced delayed starts, supply shortages, and bureaucratic challenges, leading to more modest decreases. PICU admissions mirrored these trends. Overall, the national introduction of nirsevimab correlated with a significant reduction in RSV-related morbidity, especially in regions with early, well-organized rollouts. Comparative international studies from France, Spain, and Luxembourg reinforce the Italian findings: timely and universal prophylaxis leads to substantial public health benefits. The study concludes that early campaign activation, consistent drug availability, and efficient organization are critical for maximizing the protective effect of RSV immunization.

Asthma is among the most common chronic childhood diseases, with inadequate control leading to substantial morbidity, impaired quality of life, and high healthcare costs. Although severe asthma affects only around 10

BACKGROUND:High-flow nasal cannula (HFNC) therapy is increasingly used for lower respiratory tract infections (LRTIs) in infants and young children, but recommendations vary, and standardised practice is lacking. OBJECTIVE:To systematically review national or international guidelines on HFNC use in children aged 1-23 months with LRTIs, focusing on initiation, administration, monitoring, discontinuation and feeding. METHODS:We searched MEDLINE, EMBASE, CINAHL, Web of Science and professional society websites (2014-2025) for guidelines on HFNC use in this age group. Four reviewers independently screened, extracted data and assessed quality with the AGREE II tool. Interguideline concordance was calculated for all guidelines and separately for those addressing bronchiolitis and for evidence-based versus consensus-based guidelines. Recommendations were synthesised narratively. RESULTS:Fifteen guidelines were included, including nine bronchiolitis guidelines. All addressed HFNC initiation, with low oxygen saturation (73%) and respiratory distress (47%) as common indications. Initial flow recommendations varied; 2 L/kg/min was most frequent (57%), and all bronchiolitis guidelines reporting it advised weight-based settings. Only two guidelines included weaning or discontinuation protocols, and seven addressed failure criteria. Monitoring typically included pulse oximetry and clinical observation; pulse oximetry was endorsed by all bronchiolitis guidelines that reported it (8/9). Enteral feeding was supported by all reporting guidelines (6/15). Guideline quality was moderate to high, though applicability and updating were frequent gaps. CONCLUSIONS:HFNC guideline recommendations for young children with LRTIs remain inconsistent, particularly regarding weaning, failure criteria and procedural details. Regular updates and greater standardisation are needed to improve care and optimise resource use. PROSPERO REGISTRATION NUMBER:CRD42024622544.

Importance Clesrovimab is a long-acting monoclonal antibody approved for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in neonates and infants who are born during or entering their first RSV season; data concerning clesrovimab from a second RSV season among children who remain at risk for severe disease are needed. Objective To evaluate the safety and tolerability of clesrovimab (105 mg) vs palivizumab in RSV season 1 in infants at increased risk for severe RSV disease. Key secondary objectives include describing the safety of 210 mg of clesrovimab in RSV season 2 in children who remain at increased risk for severe RSV disease, clesrovimab pharmacokinetics, and the incidence of RSV-associated disease. Design, Setting, and Participants SMART (MK-1654-007) was a randomized, partially masked, palivizumab-controlled, phase 3 clinical trial, conducted at 110 sites in 27 countries and territories between November 30, 2021, and November 20, 2025. The population constituted palivizumab-eligible infants, including those with prematurity, chronic lung disease of prematurity, or hemodynamically significant congenital heart disease. Interventions Participants, randomized 1:1 and stratified by region and condition, received clesrovimab (105 mg) on day 1 followed by placebo on day 28 or monthly palivizumab (15 mg/kg) up to 5 doses (1 dose per month). Eligible infants received open-label clesrovimab (210 mg) before their second RSV season. Main Outcomes and Measures The primary outcome was the observed proportions of participants experiencing adverse events (AEs) after clesrovimab or palivizumab in season 1. Results Overall, 997 infants (500 [50.2%] male; median age, 2.6 [range, 0.0-12.0] months) received clesrovimab, 105 mg (n = 498) or palivizumab (n = 499) in season 1; 276 received clesrovimab, 210 mg open-label in season 2. In season 1, the proportions of participants experiencing AEs were comparable between treatment groups. In season 2, clesrovimab, 210 mg was well tolerated. Incidence rates of RSV-associated medically attended lower respiratory infection (MALRI) were comparable between clesrovimab and palivizumab (3.2% [95% CI, 1.8%-5.2%] and 3.4% [95% CI, 2.0%-5.6%], respectively) through day 150 in season 1; total RSV-associated MALRI incidence through day 180 after a 210-mg dose in season 2 was 7.3% (95% CI, 4.4%-11.4%). Conclusions and Relevance In this randomized clinical trial, clesrovimab was well tolerated in infants at increased risk for severe RSV disease through 2 RSV seasons. These findings support the use of clesrovimab in children who remain at risk for severe RSV disease in their second RSV season. Trial Registration ClinicalTrials.gov Identifier: NCT04938830

In recent decades lung ultrasound (LUS) has emerged as an invaluable bedside imaging tool for the evaluation of respiratory conditions such as pneumonia, bronchiolitis, pneumothorax, and pleural effusion in pediatric age, thanks to the thin chest wall and absence of rib ossification. Despite its growing application, optimizing technique and interpretation remains crucial for reliable diagnostic performance. the present educational paper provides practical tips and tricks to enhance the accuracy, efficiency, and clinical value of LUS in pediatric patients, focusing on probe selection, patient positioning, scanning technique, common artifacts, and interpretation pitfalls.

Chronic Pseudomonas aeruginosa colonisation leads to lung deterioration and poor prognosis in people with cystic fibrosis (pwCF). Early and aggressive therapies can achieve P. aeruginosa eradication, which may recur later. Therefore, determining whether it has resisted therapy or has been newly acquired may guide subsequent treatment(s). This information is crucial also for patients treated with CFTR modulators representing P. aeruginosa after prolonged negativity and to confirm chronic infections. We evaluated the ability of Fourier-transform infrared (FT-IR) spectroscopy to determine intra-patient isoclonality for 103 P. aeruginosa strains isolated from 36 pwCF. Two were chronically and two intermittently colonised; twelve were on modulators with a past P. aeruginosa colonisation; and twenty received eradication therapy, ten of whom were also treated with modulators. FT-IR data were validated by Whole Genome Sequencing (WGS) identification of Sequence Type. FT-IR identified persistence of P. aeruginosa in 24 patients, with a WGS-confirmed positive predictive value of 100% and diagnostic accuracy of 94%. The eradication therapy success rate was 45%, and the time to P. aeruginosa reappearance was similar in both patients with failed eradication treatment and those who initially cleared the infection but later acquired a new strain. Nine patients in modulators showed persistent infections. FT-IR can rapidly determine the clonality of P. aeruginosa isolates, allowing discrimination of recurring versus new infections both in patients with established colonisations and those subjected to eradication therapy representing P. aeruginosa. By overcoming the time-based criteria used to define new infections and by providing the actual success rate of eradication therapies, FT-IR can effectively contribute to the development of efficient therapeutic strategies.

Preschool wheezing and mild asthma are among the most frequent chronic respiratory conditions in children. These conditions can significantly affect quality of life, be associated with wheeze exacerbations, and predispose to persistent airway disease. Early recognition and tailored management are crucial to prevent long-term morbidity. This Expert Opinion paper aims to translate the 2025 Global Initiative for Asthma (GINA) Strategy Report into the Italian clinical context, providing guidance for early recognition, risk stratification, and personalized management of pediatric patients with wheezing and mild asthma. The paper discusses the heterogeneity of preschool wheezing phenotypes and the emerging concept of “pre-asthma”, highlighting the prognostic role of biomarkers such as blood eosinophils, fractional exhaled nitric oxide (FeNO), and early aeroallergen sensitization in predicting disease persistence. It also addresses the impact of early-life wheezing on lung function trajectories, challenges in defining mild asthma, and the rationale for stepwise treatment strategies according to age. Particular emphasis is placed on practical aspects of care, such as the use of low dose of inhaled corticosteroids (ICS), suboptimal adherence to therapy, inhaler misuse, the benefits of dose counters to avoid pseudo-adherence, and the importance of caregiver education and shared decision-making in inhaler selection. Applying GINA 2025 principles through individualized, biomarker-informed, and education-based strategies can improve outcomes in children with early or mild asthma, bridging the gap between evidence-based recommendations and usual pediatric care in Italy.

Trisomy 18 was once considered a fatal diagnosis due to the presence of cardiac and extracardiac lesions. However, with the increasing use of therapeutic management, 3

Introduction: Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by an impaired ventilatory response to hypercapnia and hypoxia, particularly during sleep, and frequently associated with autonomic dysfunction. It is caused by pathogenic variants in the PHOX2B gene. Although CCHS is typically diagnosed in the neonatal period, milder forms may present later in infancy or childhood, often triggered by respiratory infections. Case presentation: We report the case of 16-month-old male diagnosed with CCHS following an episode of hypoxemic-hypercapnic respiratory failure during respiratory syncytial virus (RSV) infection. His medical history included neonatal respiratory distress requiring oxygen therapy and recurrent wheezing. At 15 months, he developed acute respiratory distress with severe hypercapnia (PaCO2 70 mmHg), requiring admission to the Pediatric Intensive Care Unit and invasive mechanical ventilation. Persistent sleep-related hypercapnia and hypoxemia prompted evaluation for central hypoventilation, confirmed by means of transcutaneous capnography and nocturnal pulse oximetry. Genetic testing revealed a de novo nonsense mutation in exon 1 of PHOX2B (p.Tyr14Ter). Brain magnetic resonance imaging showed diffuse white matter changes suggestive of gliosis. Further investigations identified early-onset systemic hypertension, requiring antihypertensive therapy. The patient was discharged on nocturnal non-invasive ventilation and enrolled in a neurodevelopmental rehabilitation program. Conclusions: This case highlights the phenotypic variability of CCHS and the importance of considering this diagnosis in children presenting with unexplained hypercapnia and sleep-related hypoxemia. It underscores the need for comprehensive autonomic evaluation, including blood pressure monitoring. The p.Tyr14Ter variant may allow partial protein function, potentially accounting for the relatively mild phenotype.

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.

IntroductionAsthma is often treated with oral corticosteroids (OCS), despite their association with significant adverse effects. While guidelines recommend minimizing OCS use through alternative therapies and patient-centered approaches, discrepancies between recommendations and real-world practices persist. This study evaluates OCS usage patterns and barriers to adherence to asthma treatment guidelines in Italy, using surveys conducted with healthcare professionals (HCPs) and patients.MethodsTwo cross-sectional surveys were administered between January and March 2024 to HCPs and asthma patients. The surveys assessed OCS prescription practices, treatment adherence, patient involvement, adverse event management, and perceptions of OCS use. Descriptive analysis was performed to identify patterns and highlight gaps in current practices.ResultsThe surveys revealed considerable variability in OCS prescribing practices, treatment duration and daily dosages. Over 80% of patients reported using OCS and 18% of HCPs believed that the maximum daily doses of OCS are higher than the guideline-recommended doses. Patients did not feel fully involved in treatment decisions, with over 40% of patients reporting unsatisfactory communication about treatment alternatives or adverse effects. Barriers to optimal care included inadequate access to specialists, inconsistent monitoring protocols, and a lack of multidisciplinary approaches. Both HCPs and patients highlighted the need for clearer definitions of OCS dependency and enhanced tools for tracking treatment adherence.DiscussionThe findings underscore the urgent need for systemic reforms to align clinical practice with guidelines. These include establishing pragmatic definitions for OCS dependency, promoting multidisciplinary care, and leveraging technology for monitoring. Addressing psychosocial factors and empowering patients through education and shared decision-making are also critical.

Background:The extent to which changes in lung function are due to natural variability in patients with primary ciliary dyskinesia (PCD) is unknown. We aimed to assess intra-individual variability in forced expiratory volume in 1 s (FEV1) derived from spirometry to define the extent to which the observed changes were due to test variability in clinically stable PCD patients. Methods:PROVALF-PCD (Prospective Observational Multicentre Study on Variability of Lung Function in Stable PCD Patients) was a large international prospective cohort conducted in 2017-2019. We included patients aged ≥5 years who were clinically stable at two or more consecutive visits and provided spirometry-derived lung function measurements. To calculate the upper limit of normal (ULN), we fitted an unadjusted multilevel mixed-effect model, and to determine the absolute change in FEV1 z-scores, we calculated the coefficient of repeatability (CR). We performed sensitivity analyses by stratifying relative change by age (adults versus children), number of measurements (at least four), and time between measurements (<4 months apart). Results:We included 252 participants from 12 countries with confirmed or highly likely PCD. We included 1028 FEV1 measurements from patients in stable state. The ULN for relative change between two measurements of FEV1 was 25%. Test variability remained high in all sensitivity analyses. The CR was 1.88 FEV1 z-score. Conclusions:Changes in intra-individual FEV1 >25% between visits in stable PCD patients lie beyond the expected test variability and therefore could be considered physiologically relevant. These findings inform the selection of end-points for pulmonary intervention trials in PCD, as they suggest that FEV1 is not a sensitive test for monitoring lung health in PCD.

Respiratory syncytial virus (RSV) is a leading cause of hospitalizations in young children globally. We evaluated direct medical costs, caregiver work loss, and child quality of life (QoL) impairment associated with RSV hospitalization. Children ≤ 2 years with laboratory-confirmed RSV infection were prospectively identified between October 2020 and May 2023 at ten hospitals in Germany, Spain, Italy, France, and England. Direct costs were calculated based on country-specific unit costs per hospital day. Productivity loss and QoL impairment were ascertained by two validated, caregiver-administered instruments: 1) Work Productivity and Activity Impairment Questionnaire: Child’s Hospitalization for Respiratory Illness (WPAI:CHRI), administered before discharge and 2) TNO AZL Child Quality of Life (TAPQOL), administered at baseline (shortly after admission) and before discharge. Among 382 hospitalized children, 261 (69

BACKGROUND: Telemedicine and tele monitoring represent an emerging-study area in several and chronic diseases. Tele-rehabilitation during COVID-19 disease became an essential tool to promote physical activity in total safety. In fact, for pwCF physical activity was fundamental not only for the respiratory program but also. The aim of the study was to evaluate the feasibility of home web-based program of home exercise training program in patients with cystic fibrosis (CF) during COVID-19 pandemic. METHODS: Thirty-two patients (12 M/ 20 F) age 20.52 (+/- 9.3); FEV1 mean was 84.88% (+/- 21.1) and Ph angle mean at T0 was 6.11 (+/- 0.83). Patients performed at the beginning spirometry, CF questionnaire-revised, bioimpedance analysis and handgrip-test. At the end of study, patients replaced the same examinations with also satisfaction and utility Likert Scales. RESULTS: Adherence average rate was 61.5%. Satisfaction and utility scores were respectively 4.5 and 4.3(Likert Scale); about QoL the Body-domain had a statistically significant increase (P value <0.05). CONCLUSIONS: Web-based rehabilitation could be a good tool but more studies are needed to confirm optimal values of adherence. Although data are based on a small sample size and longer periods of treatment are requested to analyze especially the physiological answer about heart rate and lung volumes.

BACKGROUND:Mycoplasma pneumoniae (MP) is a common cause of lower respiratory tract infections in children. During the COVID-19 pandemic, a marked decline in MP infections was observed, with a delayed resurgence reported in some European countries. This study aimed to assess the epidemiologic trends and clinical features of MP infections in a pediatric tertiary care academic hospital in Italy from 2017 to 2024. METHODS:We conducted a retrospective, single-center study including immunocompetent patients 30 days to 17 years of age, hospitalized with confirmed MP infection. Clinical, laboratory, and radiologic data were analyzed across 3 periods: prepandemic (2017-2019), pandemic (2020-2022) and postpandemic (2023-2024). Statistical analyses were performed to compare incidence and clinical characteristics over time. RESULTS:Of 303 included patients, 130 were hospitalized prepandemic and 148 postpandemics. The proportion of MP among acute respiratory infection hospitalizations nearly doubled, from 3.2% in 2019 to 6.1% in 2024. Despite the higher incidence, the need for respiratory support remained stable (25.7% overall; P = 0.3), the pediatric intensive care admissions were rare and unchanged (2.0% vs. 2.0%, P = 1.0) and median hospital stay was consistent across both periods (5 days, interquartile range 4-8; P = 0.803). CONCLUSIONS:MP incidence increased significantly postpandemic, and clinical severity remained comparable to prepandemic levels. Ongoing epidemiologic surveillance is essential to better understand infection dynamics and to guide effective clinical management strategies.