Background and Objectives: Pediatric Sjögren’s syndrome is a rare autoimmune disease with a heterogeneous clinical expression and limited pediatric-specific diagnostic criteria. Ocular involvement often represents an early manifestation, yet it may go unrecognized in children due to poor symptom reporting and the underuse of objective diagnostic tools. This retrospective study evaluated six pediatric patients with Sjögren’s syndrome, integrating systemic and ocular findings with a focus on early immunological and clinical markers. Materials and Methods: All patients underwent ophthalmological assessments, including tear break-up time, Schirmer’s test, and slit-lamp examination. Results: Tear break-up time values consistently indicated tear film instability (mean RE 7.4 ± 2.5 s; LE 7.7 ± 2.3 s), while Schirmer’s test showed greater variability. Slit-lamp examination revealed inhomogeneous tear films in all patients and blepharitis in 66.7%, consistent with Meibomian gland dysfunction. Systemic features included arthralgia, Raynaud’s phenomenon, fatigue, and frequent seropositivity for ANA and anti-SSA/Ro antibodies. Minor salivary gland biopsy confirmed lymphoepithelial sialadenitis in all cases. Conclusions: These findings highlight the importance of combining laboratory and clinical markers with ophthalmological parameters to support an early diagnosis of Sjögren’s syndrome in pediatric patients. Integrating TBUT and slit-lamp evaluation with serological and histopathological data may enhance diagnostic accuracy and guide timely, targeted intervention to prevent long-term complications.

Over the past 3 years, several kidney complications in children with severe involvement by SARS-CoV-2 have been described. However, literature data are still lacking regarding possible kidney injury in children with paucisymptomatic SARS-CoV-2 infection. Thus, we retrospectively evaluated renal function in those patients. Children between 3 and 18 years, without any renal disease, with previous paucisymptomatic SARS-CoV-2 infection from May 2020 to March 2022, were recruited at our post-COVID-19 outpatient clinic. We retrospectively collected: Glomerular filtration rate, Fractional-excretion-of-sodium (FENa), tubular-reabsorption-of-phosphate (TRP), calcium-creatinine-urine ratio (CaU/CrU); proteinuria/m2/day and microhematuria by urine cytofluorometry. A total of 148 children were enrolled after a median period of 3 (IQR 6) months after infection. Twenty-six patients (17.6%) had reduced GFR, fifty (33.9%) had hyperfiltration, eleven (7.4%) had abnormal FENa and/or TRP, twenty-two (14.9%) had hypercalciuria, seventy-eight (52.7%) had pathological daily proteinuria. Microhematuria was found in sixteen (10.9%) subjects. Hyperfiltration was more prevalent among males (38.9% vs. 22.4%, p = 0.027); CaU/CrU [median 0.08 (IQR 0.09) vs. 0.13 (IQR 0.13) p = 0.003] was significantly higher in females. Our data suggest that SARS-CoV-2 could determine, in a significant proportion of children, kidney damage characterized by hyperfiltration, proteinuria, and hematuria, warranting strict follow-up in these patients.

ObjectivesTo evaluate glomerular and tubular renal functions and analyze blood pressure in a cohort of pediatric patients with juvenile idiopathic arthritis (JIA).MethodsA total of 40 pediatric patients, 20 (50%) with JIA and 20 (50%) healthy control subjects, were studied, and performed the renal function on 24-h collection and the 24-h ambulatory blood pressure monitoring (ABPM). Moreover, we compared renal function and blood pressure trends between the groups of JIA patients with different disease activities.ResultsNo statistically significant differences were observed between patients with JIA and healthy children in terms of glomerular filtration rate (GFR), fractional excretion of sodium (FENa), tubular reabsorption of phosphate (TRP), and calcium-creatinine urine ratio (CaU/CrU). In contrast, we observed significantly higher values in JIA patients than in controls for the presence of hematuria (p < 0.0001) and proteinuria (p < 0.0001). Compared to the control group there were significantly higher values of hematuria and proteinuria/day in both groups of JIA patients with low disease activity (respectively, p = 0.0001 and p = 0.0002) and moderate disease activity (respectively p = 0.0001 and p = 0.0012). Systolic and diastolic dipping were significantly reduced in patients with JIA compared with healthy controls (p < 0.0001 and p < 0.0001, respectively).ConclusionsOur study showed that children with JIA, already in the early stages of the disease, have higher values of hematuria and proteinuria, which are early warning signs of nephropathy. Therefore, detailed screening of renal function and pressure monitoring in patients are necessary to monitor their evolution over time.

OBJECTIVES:There is little experience in implementing the WHO Standards for improving the quality of care (QOC) for children. We describe the use of 75 WHO-Standard based Quality Measures to assess paediatric QOC, using health workers (HWs) as data sources. DESIGN:Cross-sectional study. SETTING:12 Italian hospitals. PARTICIPANTS:The minimum target of 75% of HWs was reached in all facilities; answers from 598 HWs were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES:75 prioritised WHO Quality Measures were collected using a validated, and Italian-language questionnaire exploring views of HWs providing care to children. A QOC index was also calculated based on the assessed Quality Measures. RESULTS:In both the domain of resources and work organisation, most Quality Measures showed a high overall frequency of reported 'need for improvement', with high variability across hospitals. Key needs for improvement included: availability of clear and complete protocols (eg, on paediatric emergencies: 44.6%; range 10.6%-92.6%); clear hospitalisation criteria for diarrhoea (50.5%; range 30.3%-71.7%); number of hand-washing stations (13.2%; range 3.4%-37.0%); equipped working rooms with computers for HWs (66.1%; range: 32.1%-97.0%); training (eg, on pain management: 43.5%; range 17.9%-76.7%), periodic discussion of clinical cases (43.5%; range 8.1%-83.7%) audits (48.8%; range 29.7%-76.7%); and all indicators related to system to improve QOC. Factors significantly associated with a lower QOC Index included HWs working in facilities in Southern Italy (p=0.001) and absence of a paediatric emergency department (p=0.011). CONCLUSIONS:The use of the 75 prioritised Quality Measures, specific to HWs provide valuable data on paediatric QOC, which can be used to drive a quality improvement process.

Background: Pediatric rheumatic diseases (PRDs) are a group of chronic disorders that start in childhood and are characterized by periodic exacerbations and remissions of symptoms, with limitations in family, school, and social activities. The aim of this study was to detect differences in parents’ psychological adjustment and emotion regulation strategies, and parent-reported children’s adjustments in families of children with active and inactive PRDs. Methods: Fifty-four parents (38 mothers and 16 fathers) of children with PRD were recruited from a pediatric unit. Disease activity was evaluated by their pediatric rheumatologist, while parents’ depressive and anxiety symptoms, emotion regulation strategies, and children’s emotional difficulties and hyperactivity–inattention symptoms were assessed through a web-based survey. Results: Parents of children with active PRDs reported higher levels of their child’s emotional difficulties and hyperactivity–inattention symptoms. Linear regression analysis demonstrated that having a child in the active phases of PRD and lower use of cognitive reappraisal lead to higher children’s emotional symptoms, while active disease, low use of cognitive reappraisal, and greater expressive suppression were associated with higher hyperactivity–inattention symptoms. Our study highlights that children with PRDs and their parents may be at increased risk for psychological problems, especially during the active disease phase, highlighting the importance of a multidisciplinary approach.

Objectives: We compared the number of accesses, causes, and instrumental evaluations of chest pain in children between the pre-COVID-19 era and the COVID-19 period and analyzed the assessment performed in children with chest pain, highlighting unnecessary examinations. Methods: We enrolled children with chest pain admitted to our emergency department between January 2019 and May 2021. We collected demographic and clinical characteristics and findings on physical examinations, laboratory tests, and diagnostic evaluations. Then, we compared the number of accesses, causes, and instrumental assessments of chest pain between the pre-COVID-19 era and the COVID-19 era. Results: A total of 111 patients enrolled (mean age: 119.8 ± 40.48 months; 62 males). The most frequent cause of chest pain was idiopathic (58.55%); we showed a cardiac origin in 4.5% of the cases. Troponin determination was performed in 107 patients, and the value was high only in one case; chest X-rays in 55 cases and echocardiograms in 25 cases showed pathological findings, respectively, in 10 and 5 cases. Chest pain accesses increased during the COVID-19 era (p < 0.0001), with no differences in the causes of chest pain between the two periods. Conclusions: The increase in accesses for chest pain during the COVID-19 pandemic confirms that this symptom generates anxiety among parents. Furthermore, our findings demonstrate that the evaluation of chest pain is still extensive, and new chest pain assessment protocols in the pediatric age group are needed.

Point-of-care thoracic ultrasound at the patient's bedside has increased significantly recently, especially in pediatric settings. Its low cost, rapidity, simplicity, and repeatability make it a practical examination to guide diagnosis and treatment choices, especially in pediatric emergency departments. The fields of application of this innovative imaging method are many and include primarily the study of lungs but also that of the heart, diaphragm, and vessels. This manuscript aims to describe the most important evidence for using thoracic ultrasound in the pediatric emergency setting.

BACKGROUND:infectious mononucleosis is very common during childhood and neurological manifestations are extremely rare. However, when they occur, an appropriate treatment must be undertaken to reduce morbidity and mortality as well as to ensure appropriate management.METHODS:we describe the clinical and neurological records of a female patient with post-EBV acute cerebellar ataxia, whose symptoms rapidly resolved with intravenous immunoglobulin therapy. Afterwards, we compared our results with published data.RESULTS:we reported the case of an adolescent female with a 5-day history of sudden asthenia, vomiting, dizziness, and dehydration, with a positive monospot test and hypertransaminasemia. In the following days, she developed acute ataxia, drowsiness, vertigo, and nystagmus with a positive EBV IgM titer, confirming acute infectious mononucleosis. The patient was clinically diagnosed with EBV-associated acute cerebellitis. A brain MRI showed no acute changes and a CT scan showed hepatosplenomegaly. She started therapy with acyclovir and dexamethasone. After a few days, because of her condition's deterioration, she received intravenous immunoglobulin and demonstrated a good clinical response.CONCLUSIONS:although there are no consensus guidelines for the treatment of post-infectious acute cerebellar ataxia, early intervention with intravenous immunoglobulin might prevent adverse outcomes, especially in cases that do not respond to high-dose steroid therapy.

The COVID-19 pandemic could be a threat for the health status of children with a chronic condition. The present study aimed to explore parents’ and children’s psychological adjustment during the current pandemic, pursuing a triple objective: to compare the psychological adjustment of parents of children with pediatric rheumatic diseases (PRDs) and parents of healthy children; to analyze children’s psychological symptoms (emotional problems and hyperactivity) before and during the COVID-19 pandemic, and with or without a PRDs diagnosis; to explore the associations of children’s emotional problems and hyperactivity with parents’ psychological adjustment, parent–child interactions and belonging or not to families with PRDs. This cross-sectional study involved 56 parents of children with PRDs and 53 parents of healthy children. Self-report questionnaires about parents’ depression, anxiety, parenting stress, and children’s emotional symptoms and hyperactivity-inattention were administered. No differences were detected on psychological adjustment between parents of children with PRDs and parents of healthy children. Parents of children with PRDs reported statistically significant higher levels of children’s emotional problems and hyperactivity before the pandemic, compared to parents of healthy children; during COVID-19 pandemic, emotional symptoms increased for both groups, while hyperactivity-inattention symptoms increased only in the group of healthy children. Children’s emotional difficulties were associated with higher levels of parental anxiety, worse parent–child interaction and having PRDs; children’s hyperactivity symptoms were related to parent–child difficult interaction and higher levels of parental depression. Findings suggest the importance to target the children in relation to their parents, when approaching the psychological aspects of PRDs.

X-linked hypophosphatemia is a genetic condition that leads to fibroblast-growth-factor 23 (FGF23) increase, causing phosphate renal wasting. Since 2018, burosumab, an anti-FGF23 antibody, has been used for this disease with different dosage in children and adults. We report the case of burosumab administration every 2 weeks, as usually done in children. We retrospectively evaluated parathormone (PTH), alkaline phosphatase, serum phosphate, tubular reabsorption of phosphate (TRP), and 25OH vitamin D every 2 weeks in a 29-year-old man with nephrocalcinosis and tertiary hyperparathyroidism who did not respond to standard treatment with burosumab nor to maximum dosage and was treated with burosumab 90 mg every 2 weeks. His serum phosphate and TRP increased with this regimen compared with 4 weeks frequency (respectively 1.74 ± 0.26 mg/dL vs. 2.3 ± 0.19 mg/dL [p 0.0004] and 71.3% ± 4.8% vs. 83.9% ± 7.9% [p 0.01]) with decrease in PTH (183 ± 24.7 pg/mL vs. 109 ± 12.2 pg/mL [p 0.04]). Burosumab may be a good choice in adult patients with X-linked hypophosphatemia; new data are needed regarding the increase in dosage and/or frequency of administration as usually done in children, to achieve disease control.

At present, the vaccine authorized in children aged 5 years and older is the BNT162b2 messenger RNA COVID-19 vaccine. Unlike adults, there is limited data available in the pediatric age describing adverse events after vaccine. We report a case of adenomesenteritis in a young girl following the first dose of vaccine.

OBJECTIVE:To evaluate whether the use of a surgical and N95 mask for overweight and obese children was associated with respiratory distress.METHODS:We enrolled 15 healthy and 14 overweight or obese children. We performed two sessions: one wearing a surgical, the other an N95 mask. We tracked changes in partial pressure of end-tidal carbon dioxide (PETCO2), oxygen saturation (SaO2), pulse rate (PR), and respiratory rate (RR) during a 72 min test: 30 min without a mask, 30 min wearing a mask, and then during a 12 min walking test.RESULTS:In healthy children, there was no significant change in SaO2 and PETCO2 during the study; there was a significant increase in PR and RR after the walking test with both the masks. In overweight or obese children, there was no significant change in SaO2 during the study period; there was a significant increase in PETCO2 as fast as wearing the mask and an increase in PETCO2, PR, and RR after walking test. After the walking test, we showed a significant correlation between PETCO2 and body mass index.CONCLUSION:Overweight or Obese children who wear a mask are more prone to developing respiratory distress, which causes them to remove it frequently. In a crowded environment, they are at greater risk of infection. For this reason, it is desirable that they attend environments where everyone uses a mask.

Objective: Our aim was to evaluate the safety of COVID-19 vaccine in children resident in the Latina Local Health Authority. Methods: We conducted a telephone survey among children aged 5–11 years receiving BNT162b2 mRNA COVID-19 vaccine between December 15 and 21. The main outcomes included the presence of allergic reactions or anaphylaxis, adverse events after 24–48 h, 7 and 20 days of taking the first and second doses of medications, and documented SARS-CoV-2 infection after vaccination. The information obtained was automatically linked to a spreadsheet and analyzed. Results: 569 children were enrolled. The mean age was 114 ± 4.24 months; there were 251 males in the study. The vaccine showed a favorable safety profile; no anaphylaxis or serious adverse events were reported. The most common symptoms both after the first and second dose were injection site reactions, asthenia, and headache. Injection site reactions were more frequent after the first dose (p = 0.01), while systemic symptoms were more frequent after the second dose (p = 0.022). These symptoms were more frequent in patients with comorbidities (p = 0.0159). Conclusion: Our findings confirm the safety of COVID-19 vaccine in children younger 11 years and could be useful to promote its diffusion in pediatric ages in order to achieve “herd immunity” and prevent the virus’s circulation.

Abstract Background SARS-CoV-2 infection in the pediatric age group has a milder course than in adults, but in some cases even children may present with severe forms or develop long-term consequences. The aim of this study was to analyze the clinical features, long-term effects, lifestyle changes and psychological effects of SARS-CoV-2 infection in a pediatric sample of the Italian population. Methods We conducted a telephone survey among 3075 children infected with SARS-CoV-2 in the Latina Local Health Authority. Outcomes included: clinical features of infection, long-term symptoms, lifestyle changes and emotional symptoms during the illness. The information obtained was automatically linked to a spreadsheet and analyzed. Results One thousand four hundred thirteen children agreed to participate in the study; the mean age was 112.8 ± 21.9 months. Children were infected mainly inside familial clusters (59.6%; n = 842); 99% (n = 1399) of children were asymptomatic or exhibited mild symptoms. 20% (n = 259) of children experienced long-term symptoms; risk factors were: older age, higher body mass index and longer duration of infection. Throughout the period of infection, children spent most of the time on devices like tv-video, social media and mobile phone for non-educational activities. 58.8% (n = 620) of parents expressed a negative opinion about distance learning. Finally, we observed that 49,6% (n = 532) of children experienced psychological symptoms during quarantine period. Conclusion Despite a lower susceptibility to COVID-19 in children, it is important to keep the focus high in children, both because of the possible long symptoms after infection and the impact on a children’s mental and physical health due to pandemic. We believe that the return to school or other extracurricular activities are important to correct some of the risk factors for the long COVID syndrome, as obesity, and to limit the cultural damage generated by distance learning and psychological effects related to restrictive measures.

Pediatrics InternationalVolume 64, Issue 1 e15095 Clinical NotesOpen Access Lung ultrasound in children drowning victims in pediatric emergency department Silvia Bloise, Corresponding Author Silvia Bloise silvia.bloise1989@gmail.com orcid.org/0000-0002-2853-8318 Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, Italy Correspondence: Silvia Bloise, MD, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia, Ospedale Santa Maria Goretti, Polo di Latina, Rome, Italy. Email: silvia.bloise1989@gmail.comSearch for more papers by this authorVanessa Martucci, Vanessa Martucci Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, ItalySearch for more papers by this authorAlessia Marcellino, Alessia Marcellino Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, ItalySearch for more papers by this authorMariateresa Sanseviero, Mariateresa Sanseviero Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, ItalySearch for more papers by this authorRiccardo Lubrano, Riccardo Lubrano Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, ItalySearch for more papers by this author Silvia Bloise, Corresponding Author Silvia Bloise silvia.bloise1989@gmail.com orcid.org/0000-0002-2853-8318 Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, Italy Correspondence: Silvia Bloise, MD, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria e Neonatologia, Ospedale Santa Maria Goretti, Polo di Latina, Rome, Italy. Email: silvia.bloise1989@gmail.comSearch for more papers by this authorVanessa Martucci, Vanessa Martucci Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, ItalySearch for more papers by this authorAlessia Marcellino, Alessia Marcellino Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, ItalySearch for more papers by this authorMariateresa Sanseviero, Mariateresa Sanseviero Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, ItalySearch for more papers by this authorRiccardo Lubrano, Riccardo Lubrano Sapienza Università di Roma, Dipartimento Materno Infantile e di Scienze Urologiche, UOC di Pediatria e Neonatologia - Polo Pontino, Rome, ItalySearch for more papers by this author First published: 06 April 2022 https://doi.org/10.1111/ped.15095AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Drowning, defined as the process of respiratory difficulty caused by submersion/immersion in liquid, is a leading cause of accidental death among infants and toddlers.1 The most frequent manifestations observed in drowning victims are pulmonary complications. These include: non-cardiogenic pulmonary edema, acute respiratory distress syndrome and pneumonia. In particular, it is important to maintain a high index of suspicion for pulmonary infections caused by water-borne pathogens, such as Aeromonas, Pseudomonas, and Proteus that may cause complicated pneumonia. In order to diagnose all these conditions a chest x-ray is recommended at baseline. However, this can be negative or underestimate the severity of lung injury and therefore a radiological follow up is necessary. In the case of children, this implies that the child is exposed to a high dose of ionizing radiation. This aspect should not be underestimated, in fact children are considered to have an increased risk of morbidity and mortality from radiation compared with their adult counterparts, both because of organ sensitivity and longer life expectancy. Therefore, to reduce the dose of ionizing radiation and speed up diagnostic times, the thoracic ultrasound could represent a reliable diagnostic tool for management and follow up in drowning victims in pediatric emergency department and in the ward. We present a case report of a 4-year-old girl that was brought to hospital after accidental near-drowning in swimming pool. Informed consent was obtained from the patient's parents. On admission, the patient was found alert and only mildly distressed. The oxygen saturation was 91% in air; respiratory frequency was 48/min; Blood pressure was 90/65 mmHg and pulse 130/min. The skin was cold, but dry; crackles were present on lung auscultation. We performed immediately a lung ultrasound that showed an initial small right basal consolidation and some lines B, hyper echoic comet-tail artifacts, perpendicular to the pleural line, caused by the thickening of interlobular interstitium of secondary lobules (Fig. 1a). Therefore, we started an antibiotic therapy with amoxicillin and low-flow oxygen therapy. After 24 h we repeated lung ultrasound that confirmed the consolidation previously seen and showed another anterior left consolidation (Fig. 1b). Fig. 1Open in figure viewerPowerPoint (a) First lung ultrasound performed on arrival in the emergency department. The probe was placed vertically to the ribs in the right hemithorax and showed initial subpleural consolidation with lines (b) confluent in the right basal area; (b) Second lung ultrasound performed after 24 h of hospitalization. The probe was placed orizzontaly to the ribs in the left hemithorax and showed a structure consolidation in the left mid-basal area. Considering the possibility of unusual organisms as cause of drowning pneumonia, ultrasound findings, the occur of fever and the increase of inflammation indices, we modified the therapy with broad-spectrum antibiotics, with defervescence after 72 h after starting the new therapy. Inflammation indices progressively decreased until normalization on day 10. After 14 days we performed a lung ultrasound that showed almost complete resolution of the inflammatory process. This case report is a further proof of the usefulness of lung ultrasound as point-of-care in Pediatric emergency department. Lung ultrasound is rapidly becoming a valuable tool in the hands of the pediatrician2 and has multiple fields of application: in traumatic pathology, cardiac diseases and lung diseases.3-5 Currently, there are no data in literature that describe the use of lung ultrasound in the evaluation of children victim of a near-drowning accident. In particular, different reports showed the accuracy of Lung Ultrasound in the diagnosis and monitoring of pulmonary edema and especially in defining the degree of severity of the edema. Furthermore, many studies demonstrated high sensitivity and specificity of Lung ultrasound in diagnosis and follow-up of pneumonia compared to chest x-ray and the 2020 consensus established at least the same diagnostic value of lung ultrasound to chest x-ray in detecting pneumonia, suggesting ultrasound as the method of choice in children with suspected pneumonia requiring diagnostic imaging. Both these conditions are frequent complications in case of drowning and it is necessary their investigation through clinical examination and instrumental investigations. Given the high frequency of the phenomenon, especially in in the United States where drowning represents one of the most common injury-related cause of death in children 1–4 years of age, with almost 1,000 child deaths due to drowning in the year 2017, on basis of these considerations an imaging method, simple, easily reproducible and without ionizing radiations as lung ultrasound, could be a valid tool for the initial assessment and follow up of children victim of drowning. This clinical case highlights the clinical value of lung ultrasound in the evaluation of a near-drowning victim. Lung ultrasound performed by clinicians could be an easy and quick tool to assess early the child with drowning syndrome and for the follow-up, contributing to a better use of the economic resources of the health system and to a more prudent management of children. However, further studies are needed to assess whether this methodic can be included in the diagnostic pathway of the child drowning victim. Disclosure The authors declare no conflict of interest. Author contributions RL designed the study and revised the manuscript. SB, AM, VM, MS enrolled patient and acquired data. SB performed lung ultrasound. SB, AM, VM, MS drafted the manuscript. All authors read and approved the final manuscript. References 1Denny SA, Quan L, Gilchrist J et al. Prevention of drowning. Pediatrics 2019; 143: e20190850. CrossrefPubMedWeb of Science®Google Scholar 2Iovine E, Nenna R, Bloise S et al. Lung ultrasound: its findings and new applications in neonatology and pediatric diseases. Diagnostics (Basel) 2021; 3: 652. CrossrefGoogle Scholar 3Bloise S, Martucci V, Marcellino A, Mallardo S, Lubrano R. Possible role of thoracic ultrasound in the diagnostic pathway of infant abuse in the pediatric emergency department. J. Ultrasound Med. 2021; 40 (8): 1705– 7. Wiley Online LibraryPubMedWeb of Science®Google Scholar 4Bloise S, La Regina DP, Pepino D et al. Lung ultrasound compared to chest X-ray for the diagnosis of CAP in children. Pediatr. Int. 2021; 63: 448– 53. Wiley Online LibraryPubMedWeb of Science®Google Scholar 5La Regina DP, Bloise S, Pepino D et al. Lung ultrasound in bronchiolitis. Pediatr. Pulmonol. 2021; 56: 234– 9. Wiley Online LibraryPubMedWeb of Science®Google Scholar Volume64, Issue1January/December 2022e15095 FiguresReferencesRelatedInformation

To perform a comprehensive clinic, laboratory, and instrumental evaluation of children affected by coronavirus disease (COVID‐19).

IMPORTANCE Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older. OBJECTIVE To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged <= 24 months, and group B, aged >24 months to <= 144 months). Data were analyzed from May through June 2020. INTERVENTIONS All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes whilewearing a face mask. Children aged 24 months and older then participated in awalking test for 12 minutes. MAIN OUTCOMES AND MEASURES Changes in respiratory parameters during the use of surgical masks were evaluated. RESULTS Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (PETCO2; 33.0 [32.0-34.0] mmHg; P for Kruskal Wallis =.59), oxygen saturation (SaO(2); 98.0%[97.0%-99.0%]; P for Kruskal Wallis =.61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min; P for Kruskal Wallis =.99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min; P for Kruskal Wallis =.69) or for group B in median (IQR) PETCO2 (36.0 [34.0-38.0] mm Hg; P for Kruskal Wallis =.97), SaO(2) (98.0%[97.0%-98.0%]; P for Kruskal Wallis =.52), PR (96.0 [84.0-104.5] pulsations/min; P for Kruskal Wallis test =.48), or RR (22.0 [20.0-25.0] breaths/min; P for Kruskal Wallis =.55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min; P <.02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min; P <.05). CONCLUSIONS AND RELEVANCE This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in SaO(2) or PETCO2, including among children aged 24 months and younger.

Since the outbreak of SARS-CoV-2 among the population has occurred quite recently, there is a lack of evidence on the long-term duration of antibody response, especially in children. It is therefore crucial to clarify this aspect, considering its implications in the development of successful surveillance strategies, therapies, and vaccinations. The aim of this study was to assess the antibody response in a children group after SARS-CoV-2 infection, and to compare it with that of their parents affected by SARS-CoV-2 infection. We enrolled 12 children and their parents, both groups being affected by COVID-19 in April 2020. In the children’s group, we collected real-time RT-PCR cycle threshold (Ct) values and gene characterization of first nasal-throat swab at the time of diagnosis (T0); 30 days after the diagnosis (T30), we performed blood tests to detect anti-SARS-CoV-2 IgM and IgG. Finally, 180 days after the diagnosis (T180), we measured anti-SARS-CoV-2 IgG in both children and parents. In children, antibody levels declined significantly at 180 days (T180) after first measurement (T30). There were no significant differences in IgG level related to age, sex, and clinical manifestations. We found a significant correlation between IgG titers at T30 and Ct value of gene N. Children showed a lower level of antibodies against SARS-CoV-2 at T180 compared to their parents. Conclusion : Antibody responses in children waned 180 days after SARS-CoV-2 infection, and at the same time, their parents showed a different antibody response to the virus. These results highlight that serological tests should be used with caution in surveillance strategies among the general population. What is known: • Currently is not known how long antibody response will be maintained or if it protects from reinfection .• Recent reports in adults suggest that antibodies to SARS-CoV-2 declined several months after infection, but data are missing in pediatric age . What is new: • We showed that antibody responses to SARS-CoV-2 wane several months after infection also in children with quantitative differences in antibody levels between children and adults .• In this context, serological tests should be used with caution in surveillance strategies .

OBJECTIVE:To evaluate how the restrictive measures implemented during the SARS-CoV-2 pandemic have influenced the incidence of the most common children's diseases and the consumption of medications in 2020 compared to 2019.METHODS:We involved all family pediatricians of the local health authority of Latina, from which we requested data of monthly visits in 2019 and 2020 for six common diseases disseminated through droplets and contact, and the territorial and integrative pharmaceutical unit of the area, from which we requested data of the net expenditure regarding the most commonly used drugs at pediatric age.RESULTS:There was significant reduction in the incidence of the evaluated diseases and in the consumption of investigated drugs between 2019 and 2020 in the months when the restrictive measures were in place, with an attenuation of this effect during the months of the gradual loosening of those measures.CONCLUSION:Nonpharmaceutical intervention measures have caused changes in the diffusion of common pediatric diseases. We believe that the implementation of a reasonable containment strategy, even outside of the pandemic, could positively influence the epidemiology of infectious and allergic diseases in children, and healthcare system spending.

In response to the current COVID-19 pandemic, universal face masking represents one of the most important strategies to limit the spread of infection. However, their use in children is still highly debated (Esposito and Principi, 2020; Esposito et al., 2020) and there are few data (Lubrano et al., 2021a, 2021b) describing their possible effects on respiratory function in children. A dataset in this paper presents a comparison of the data related to the effects on respiratory function of children wearing a filtering facepiece 2 (N95 mask) with or without exhalation valve. 22 healthy children were randomly assigned to two groups, both groups wearing an N95 mask: one without an exhalation valve (group A), another with an exhalation valve (group B). Children were subjected to a 72 min test: the first 30 min without mask, then 30 min wearing face mask while practiced their usual play activity; finally, 12 min, with face mask in place, while they walked as in a walking test. They were monitored through to microstream capnography system (Rad-97TM with Nomo-Line Capnography, Masimo, Irvine, CA, USA) to log oxygen saturation (SpO2) and respiratory rate (RR). We use the Wilcoxon test to analyzed the differences between the parameters recorded during the study in group A and B. Data analysis was performed using JMP14.3.0 program for Mac by SAS Institute inc.