Ospedale dei Bambini Vittore Buzzi

Reply to: Cost evaluation of mass screening of celiac disease in Italy: Prediction is very difficult

Diet during early infancy, as well as dietary patterns during childhood and parental feeding styles influence children’s eating behaviours and long-term health. While extensive data exist on the timing of complementary feeding introduction and recommended food frequencies during infancy and childhood, data on portion sizes during this period remains limited in Europe, despite their clear relevance for evaluating dietary patterns and supporting evidence-based guidance. This longitudinal study, secondary to the European Childhood Obesity Project (EU CHOP), aims to describe portion sizes consumed by infants and children aged 6 months to 8 years across five European countries. Dietary intake was recorded using 3-day food diaries and analysed by trained personnel following standardized procedures at multiple infant and childhood ages (6, 7, 8, 9, 12, 24, 36, 48, 60, 72 and 96 months). Portions sizes were calculated for 33 food groups and expressed as percentiles in the overall sample and stratified by country. A total of 1018 3-day food records were available at 6 months, with sample size gradually declining over the 11 follow-up time points to 400 records at 8 years. The results revealed a wide variation in portion sizes across food groups, ages and countries. Food portion sizes vary across food groups, age and countries. These findings provide reference percentiles representing typical portion sizes when foods are consumed. The data can support guidance provided to parents by healthcare professionals (pediatricians, nurses, and dietitian-nutritionists) and assist public health authorities in defining appropriate portion sizes and mitigating risks associated with both overeating and undereating, while respecting children’s hunger and satiety cues. These results also have practical applications in school meal planning and dietary assessment methodologies in research.

Cat Scratch Disease (CSD), caused primarily by Bartonella henselae, typically presents with regional lymphadenitis. Atypical manifestations may mimic soft tissue tumors, posing significant diagnostic challenges in pediatric patients. To describe a pediatric case of chest wall pseudotumor initially suspected to be a soft tissue neoplasm, later identified as Bartonella infection, and to highlight the role of multimodality imaging in differentiating neoplastic from infectious lesions. The patient underwent laboratory testing, ultrasound, contrast-enhanced CT, FDG PET-CT, infectious disease screening, and lesion biopsy. Clinical and radiological evolution was monitored during hospitalization. PET-CT demonstrated intense FDG uptake (SUV 6) within the chest wall lesion and mild uptake in ipsilateral axillary lymph nodes (SUV 2.1). The lesion evolved into a draining abscess with fistulous tract. Biopsy revealed infectious inflammatory tissue consistent with Bartonella spp. infection, confirmed by serology. Targeted antibiotic therapy led to complete resolution. Atypical Bartonella infections may closely mimic soft tissue neoplasms on imaging. Integration of clinical, radiological, microbiological, and histopathological data is essential to avoid unnecessary invasive procedures.

Despite continuous improvements in neonatal resuscitation and stabilization in the last decades, thermal management immediately after birth remains an unresolved issue in preterm infants. To compare 2 strategies of thermal management (plastic wrapping with or without drying) for preventing heat loss at birth in very preterm infants. This multicenter, unblinded, randomized clinical trial was conducted among very preterm infants (birth weight <1500 g and/or gestational age ≤30 weeks 6 days) at 21 tertiary care hospitals in Italy from February 21, 2023, to July 18, 2024. Eligible neonates were randomly allocated to either drying before plastic wrapping in the delivery room (intervention arm) or plastic wrapping without drying (control arm). The primary outcome was the proportion of participants with normothermia (36.5-37.5 °C) at admission to the neonatal intensive care unit (NICU). The secondary outcomes included hypothermia (<36.5 °C), moderate to severe hypothermia (<36.0 °C), and hyperthermia (>37.5 °C) at NICU admission, temperature at 1 hour after NICU admission, intraventricular hemorrhage, respiratory distress syndrome, late-onset sepsis, bronchopulmonary dysplasia, and mortality before hospital discharge. Overall, 354 very preterm infants were randomized (180 [50.8%] female; mean [SD] gestational age, 28.6 [2.5] weeks); all received the allocated intervention and were included in the analysis. Normothermia at NICU admission was achieved in 81 of 177 dried infants (45.8%) and 82 of 177 undried infants (46.3%; risk ratio, 0.99; 95% CI, 0.79-1.24). The mean (SD) neonatal temperature at NICU admission was 36.4 °C (0.8 °C) in dried neonates and 36.5 °C (0.7 °C) in undried neonates (mean difference, -0.1 °C; 95% CI, -0.2 °C to 0.1 °C). In-hospital mortality included 26 of 177 dried neonates (14.7%) and 10 of 177 undried neonates (5.6%) (unadjusted risk ratio, 2.60; 95% CI, 1.29-5.23). The other secondary outcome measures were not different between the 2 arms. In this multicenter randomized clinical trial, drying before plastic wrapping provided no benefit to very preterm infants in maintaining normothermia at NICU admission. Most deaths could be expected due to the compromised profile of the neonates, with no pathophysiological explanation related to the trial interventions. Approximately half of the infants were outside the normal thermal range at NICU admission; hence, thermal management remains a challenge requiring further investigations. ClinicalTrials.gov Identifier: NCT05740072.

An early lung ultrasound score (eaLUS) predicts surfactant administration in neonates of any gestational age with respiratory distress syndrome stabilized on CPAP. Whether this is also true for more unwell infants, non invasively and invasively ventilated, is not known. To assess whether an eaLUS may predict surfactant replacement in infants on different respiratory support modes (CPAP, nasal ventilation and mechanical ventilation). We also investigated eaLUS as a potential marker of unfavorable respiratory outcomes. Prospective, international, multicenter diagnostic study conducted from March 2024 to March 2025 in seven, level III Italian and Spanish neonatal intensive care units. Participants: neonates of any gestational age presenting with respiratory distress, enrolled within 2 h of birth and before the administration of surfactant. Intervention: eaLUS calculated within the first 2 h of life masked to attending physician evaluating both the type of respiratory support and the need for surfactant administration. Main outcome: prognostic accuracy of eaLUS to predict surfactant administration overall and in three subgroups based on early respiratory stabilization strategy (CPAP, NIV and MV). As secondary outcomes we investigated the accuracy of oxygen inspiratory fraction (FiO2) > 0.3 by mode of respiratory support to predict surfactant need. Additionally, logistic regression analysis was used to investigate the link between eaLUS with prolonged mechanical ventilation and death or BPD as secondary outcomes. We enrolled 229 infants stabilized on CPAP (n = 117), nasal ventilation (n = 58) and mechanical ventilation (n = 54). eaLUS had good prognostic accuracy in the total population (AUC, 0.86; 95% CI, 0.81–0.91). Despite the wide gap of mean airway pressure (MAP) across the population, eaLUS and MAP were only moderately correlated (rho = 0.39; p < 0.001). Optimal thresholds for surfactant replacement were slightly different (LUS ≥ 8 for CPAP; LUS ≥ 9 for nasal ventilation; LUS ≥ 10 for mechanical ventilation). FiO2 > 0.3 was a less accurate predictor of surfactant replacement. eaLUS was significantly associated to prolonged mechanical ventilation beyond both 72 and 168 h. Finally, eaLUS emerged as an independent predictor of BPD or death. An early LUS accurately predicts surfactant replacement in neonates non invasively and invasively ventilated and it is a noninvasive imaging prognostic marker of disease severity and adverse respiratory outcomes in this population. ISRCTN Registry (number ISRCTN10205806).

Abstract Background Cumulative evidence supports the use of dietary approaches for the treatment of Crohn’s disease (CD)1–4. This study aims to compare the macro and micronutrient intakes provided by exclusive enteral nutrition (EEN) and Crohn’s disease exclusion diet (CDED) combined with partial enteral nutrition (PEN), in order to identify nutritional deficiencies and suggest the need for nutritional supplementation. Methods A retrospective single-center cohort study was performed among paediatric CD patients treated with EEN or CDED combined with PEN between 2020 and 2025. The patients were divided into four categories (14 patients on EEN, 21 on CDED1, 15 on CDED2, and 16 on CDED3), with the same patients potentially being included in multiple categories. Macronutrient (carbohydrates, proteins, lipids) and micronutrient (calcium, iron, magnesium, vitaminD) intakes were collected at baseline for each category and compared with the Dietary Reference Intakes (DRIs) for age. Results The energy intakes of all patients were adequate to their total energy expenditure (TEE). In terms of macronutrient intake, carbohydrates were below the recommended levels in the EEN group, whereas lipids exceeded these references. Conversely, macronutrient intakes were within recommended ranges for CDED1, CDED2, and CDED3. Regarding micronutrient intake, calcium was adequate in all patients in the EEN group, whereas deficiencies were observed in 7/21 (33%) CDED1 patients, 15/15 (100%) CDED2, and 7/15 (44%) CDED3. VitaminD intake was adequate in the EEN group, but insufficient in 15/21 (71%) CDED1 patients, and in all those on CDED2 and CDED3. Magnesium intake was adequate in all EEN patients and in the majority of patients on CDED, specifically in 20/21 (95%), 15/15 (100%), and 15/16 (94%) patients on CDED1, CDED2, and CDED3, respectively. Finally, iron intake was adequate in all groups. Conclusion This study shows that calcium and vitaminD intakes may be inadequate in patients on CDED, with significant declines between CDED1 and CDED2. These findings emphasize for the first time the importance of addressing calcium and vitaminD supplementation across the different phases of CDED, with particular attention to CDED2.