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Bronchiolitis is the most frequent cause of hospitalization in infants younger than 1 year of age. We sought to evaluate the correlation between lymphocyte count and clinical manifestation in infants hospitalized with bronchiolitis.We performed a retrospective cohort study evaluating 1297 children hospitalized for bronchiolitis from 2004 to 2019. A nasal washing was tested for 14 respiratory viruses by PCR. A clinical severity score, ranging 0-8, was assigned at hospital admission. History and clinical course were recorded for each infant. Patients were divided in 3 groups according to lymphocyte count tertiles. Parents of enrolled patients have been phoned annually over 5 years to evaluate respiratory sequelae.A total of 433 children had 2914.2 ± 745.5/mmInfants with low lymphocyte count are more likely to have a worse clinical course of bronchiolitis.

Emergency room admissions have decreased globally during the COVID-19 pandemic, particularly for respiratory diseases. We evaluated hospital admissions for respiratory diseases in the first year of the Italian pandemic and compared them with the corresponding period in 2016-2017.The study was carried out at the Sapienza University in Rome, Italy, and covered 9 March to 28 February 2020-2021 and 2016-2017. We tested 85 hospitalised children who were negative for the virus that causes COVID-19 in 2020-2021 and compared them with 476 hospitalised children from 2016-2017, as we had also tested nasal washing samples for 14 respiratory viruses during that period.Hospitalisations for acute respiratory tract infections were 82.2% lower in 2020-2021 than 2016-2017. The respiratory syncytial virus (RSV) and several other viruses were detected less frequently during the pandemic. An extraordinary finding was that rhinoviruses remained seasonal. In 2020-2021, we detected a virus in 54.1% of the hospitalised children: rhinoviruses in 41, RSV in 4 and other viruses in 1. This was significantly lower than the 71.6% in 2016-2017: RSV in 130, rhinoviruses in 128 and other viruses in 83.Pandemic measures dramatically reduced childhood respiratory infections, particularly RSV, but were less effective at reducing rhinoviruses.

Background The heterogeneity of bronchiolitis may imply or reflect a different predisposition to respiratory sequelae. Objective Our aim was to investigate whether, among infants hospitalized with bronchiolitis, different clinical profiles extracted by latent class analysis (LCA) are associated with different risks of wheezing. Methods Over 15 consecutive epidemic seasons (2004–2019), we prospectively enrolled infants

Viral bronchiolitis is a common lower respiratory tract infection in infants. Environmental and genetic factors can favor respiratory tract infections.The aim of this study is to analyze risk factors for bronchiolitis and to investigate the predisposing factors for developing transient wheezing and asthma through a 6-year follow-up after hospitalization for bronchiolitis compared with a group of healthy controls that belonged to Piccolipiù cohort, who never had bronchiolitis.We enrolled 645 infants hospitalized with bronchiolitis. A structured questionnaire was used to obtain demographic and clinical data. At 6 years of age, 370 cases and 183 controls were investigated for the presence of asthma by the structured questionnaire, for prick test and for spirometry, and were classified to asthmatic, transient wheezing, and no wheezing/no asthma.Breastfeeding was an independent protective factor (odds ratio [OR]: 0.3, 95% confidence interval [95% CI]: 0.2-0.4, p 0.001) and tobacco smoke was a risk factor for the development of bronchiolitis (OR: 2.1, 95% CI: 1.4-3.1, p 0.001). Analyzing follow-up, bronchiolitis increased the risk of developing transient wheezing by 12.9 (95% CI: 6.3-26.1, p 0.001) and of developing asthma by 4.6 (95% CI: 1.9-10.7, p 0.001). A positive family history of atopy increased the risk of developing asthma by 3.1 (95% CI: 1.4-6.7, p = 0.005). Asthmatic patients had a lower % FEV1, a lower % flow-volume curve (FVC), and a lower FEV1/FVC value, and they had more frequently positive skin prick test.Bronchiolitis is influenced by environmental factors: tobacco smoke increases its risk and breastfeeding is a protective factor. At the end of 6 years of follow-up, bronchiolitis is a significant risk factor to have pre-school wheezing and asthma.

On March 11, 2020, the World Health Organization (WHO) declared the pandemic because of a novel coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). In January 2020, the first transmission to healthcare workers (HCWs) was described. SARS‐CoV‐2 is transmitted between people because of contact, droplets, and airborne. Airborne transmission is caused by aerosols that remain infectious when suspended in air over long distances and time. In the clinical setting, airborne transmission may occur during aerosol generating procedures like flexible bronchoscopy. To date, although the role of children in the transmission of SARS‐CoV‐2 is not clear the execution of bronchoscopy is associated with a considerably increased risk of SARS‐CoV‐2 transmission to HCWs. The aim of this overview is to summarize available recommendations and to apply them to pediatric bronchoscopy. We performed systematic literature searches using the MEDLINE (accessed via PubMed) and Scopus databases. We reviewed major recommendations and position statements published at the moment by the American Association for Bronchology and Interventional Pulmonology, WHO, European Center for Disease Prevention and Control and expert groups on the management of patients with COVID‐19 to limit transmission among HCWs. To date there is a lack of recommendations for safe bronchoscopy during the pandemic period. The main indications concern adults and little has been said about children. We have summarized available recommendations and we have applied them to pediatric bronchoscopy.

BACKGROUND Community-acquired pneumonia (CAP) represents one of the most common infectious diseases among children. Diagnosis of CAP is mainly clinical. Chest X-ray (CXR) remains the gold standard for the diagnosis in severe or controversial conditions. Recently, some authors have focused on the application of ultrasound in lung diseases but the role of lung ultrasound (LUS) in the diagnosis of CAP is still debated. We aimed to study the concordance between LUS and CXR in evaluating specific signs of CAP. As a secondary aim, we sought to determine the sensitivity and specificity of LUS in CAP diagnosis compared with CXR. Finally, we evaluated the role of LUS during the follow up. METHODS We enrolled 68 children (

During the COVID-19 pandemic, lung ultrasound (LUS) was widely used to assess SARS-CoV-2 infection. To date, there are patients with persistence of symptoms after acute infection. Therefore, it may be useful to have an objective tool to follow these patients. The aim of our study was to evaluate the presence of LUS artifacts after SARS-CoV-2 infection in children and to analyze the associations between time elapsed since infection and symptomatology during acute infection. We conducted an observational study, enrolling 607 children infected with SARS-CoV-2 in the previous twelve months. All patients performed a LUS and medical history of demographic and clinical data. We observed irregular pleural lines in 27.5%, B-lines in 16.9%, and subpleural consolidations in 8.6% of the cases. These artifacts were more frequently observed in the lower lobe projections. We have observed that the frequency of artifacts decreases with increasing time since infection. In symptomatic patients during COVID infection, B-lines (p = 0.02) were more frequently found. In our sample, some children, even after months of acute infection, have ultrasound artifacts and showed an improvement with the passage of time from the acute episode. Our study provides additional evidence about LUS in children with previous COVID-19 as a support to follow these patients in the months following the infection.

Severe Acute Respiratory Syndrome – Coronavirus – 2 (SARS-CoV-2) and its related Coronavirus Disease – 19 (COVID-19) has become a health emergency worldwide. The medical community has been concerned since the beginning of the outbreak about the potential impact of COVID-19 in children, especially in those with underlying chronic diseases. Fortunately, COVID-19 has been reported to be less severe in children than in adults. However, epidemiologic and clinical data are scarce. Children show unique features of SARS-CoV-2 involvement that may account for the low rate of infection and death in this age group. The purpose of this review is to summarize the most relevant evidence of COVID-19 in children highlighting similarities and differences with adults.

The recently discovered truncated, non-functional, ACE2 transcript (dACE2), but not the full-length ACE2 (f-lACE2), is induced by IFNs in differentiated airway cells. We measured expression of both ACE2 isoforms in SARS-CoV-2 positive and negative subjects, in relation to Interferon-stimulated genes. A significant activation of dACE2 transcript was found, in SARS-CoV-2 positive adults either hospitalized or not, showing a positive correlation with ISG15; f-lACE2 expression was weakly activated and not ISG-related. We confirmed a specific activation of dACE2 transcript in nasopharyngeal cells, related to the mucosal IFN response.

Children generally develop a mild disease after SARS-CoV-2 infection whereas older adults are at risk of developing severe COVID-19. Recent transcriptomic analysis showed pre-activated innate immunity in children, resulting in a more effective anti-SARS-CoV-2 response upon infection. To further characterize age-related differences, we studied type I and III interferon (IFN) response in SARS-CoV-2 infected and non-infected individuals of different ages. Specifically, levels of expression of type I (IFN-α, -β, -ε and -ω), type III (IFN-λ1, -λ2 and -λ3) IFNs and of the IFN-stimulated genes, ISG15 and ISG56 were quantified in nasopharyngeal cells from diagnostic swabs. Basal transcription of type I/III IFN genes was highest among children and decreased with age. Among SARS-CoV-2-infected individuals, only IFN-ε and -ω levels were significantly higher in children and young adults whereas ISGs were overexpressed in infected adults. The occurrence of symptoms in children and the need for hospitalization in adults were associated to higher transcription of several IFN genes. Starting from a pre-activated transcription level, the expression of type I and III IFNs was not highly up-regulated in children upon SARS-CoV-2 infection; young adults activated IFNs’ transcription at intermediate levels whereas older adults were characterized by higher ISGs and lower IFN-ε and -ω relative expression levels. Overall, our findings contribute to recognize components of a protective IFN response as a function of age, in the context of SARS-CoV-2 infection.

Respiratory diseases caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV) are frequent causes of the hospitalization of children; nonetheless, RSV is responsible for the most severe and life-threatening illnesses. Viral infection triggers an inflammatory response, activating interferon (IFN)-mediated responses, including IFN-stimulated genes (ISG) expression with antiviral and immunomodulatory activities. In parallel, the reactive oxygen species (ROS) production activates nuclear factor erythroid 2-related factor 2 (NRF2), whose antioxidant activity can reduce inflammation by interacting with the NF-kB pathway and the IFN response. To clarify how the interplay of IFN and NRF2 may impact on clinical severity, we enrolled children hospitalized for bronchiolitis and pneumonia, and measured gene expression of type-I and III IFNs, of several ISGs, of NRF2 and antioxidant-related genes, i.e., glucose-6-phosphate dehydrogenase (G6PD), heme oxygenase 1 (HO1), and NAD(P)H dehydrogenase [Quinone] 1 (NQO1) in RSV- (RSV-A N = 33 and RSV-B N = 30) and HRV (N = 22)-positive respiratory samples. NRF2 and HO1 expression is significantly elevated in children with HRV infection compared to RSV (p = 0.012 and p = 0.007, respectively), whereas ISG15 and ISG56 expression is higher in RSV-infected children (p = 0.016 and p = 0.049, respectively). Children admitted to a pediatric intensive care unit (PICU) had reduced NRF2 expression (p = 0.002). These data suggest, for the first time, that lower activation of the NRF2 antioxidant response in RSV-infected infants may contribute to bronchiolitis severity.

The use of electronic cigarettes (e-cigarette) and vaping devices started as a potential aid for cessation and reducing the harmful consequences of cigarette smoking, mainly in the adult population. Today e-cigarette use is highly increasing in vulnerable populations, especially young and pregnant women, due to the misconception of its harmless use.Despite the growing acknowledgment in e-cigarette as a potential harmful device, and due to mixed information found concerning its beneficial aid for smokers, along with an insufficient clinical study done in human models, it is important to further evaluate the possible benefits and risks of non-combusting, vaping nicotine or non-nicotine delivery devices.In this review we tried to summarize the latest updated information found in the literature, concentrating mainly in the variety of adverse effects of e-cigarette use and its contribution for recent and future health concerns.

In the era of data-driven decision-making, unacceptable haziness, and inconsistency surrounds the yearlong scientific and public debate on the school closure policy in the coronavirus disease-2019 (COVID-19) pandemic mitigation efforts.The present literature review stems out of the need for a clear scaffold collecting in one place all current evidence, as well as helping to organize incoming future evidence, concerning both the role of schools in driving the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) community spread and the cost-effectiveness of school closure in containing such spread.References for this review were initially identified through searches of PubMed, Scopus, and Cochrane Library for articles published from March 2020 to March 2021 by the use of key terms "Schools," "COVID-19," "pandemic," "clusters," "outbreak," and "seroprevalence," selecting all articles from 2020 to 2021 with full-text availability. A further search was undertaken by screening citations of articles found in the original search and through Google Scholar and ResearchGate.Overall, evidence shows that opening schools and keeping them open in the context of the SARS-CoV-2 pandemic is possible, although behaviorally challenging and unfeasible if educational facilities or testing services are inadequate. Contrary to other respiratory viruses, children are not chief targets of SARS-CoV-2 infection, transmission, and disease. It also appears that the second wave of the SARS-CoV-2 virus spread in the WHO European region has been unrelated to school re-opening.A fact-based understanding of what is currently known on such a consequential policy is required to provide a basis of evidence for advocacy of either school closure or school opening at times of high-intensity community transmission of SARS-CoV-2.

Background: We previously demonstrated an 81% reduction in pediatric Emergency Rooms (ER) admissions in Italy during lockdown, from March 9 to May 3, 2020 (doi: 10.3390/ijerph17238753.). Since May 2020 lockdown measures were mitigated allowing the reopening of schools in September 2020. Aim: To evaluate pediatric ER admissions during schools reopening in Italy. Methods: We performed a retrospective multicenter study involving 11 Italian pediatric ERs. We compared total ER admissions from September 24, 2020 to November 6, 2020 with those during the corresponding timeframe in 2019. We evaluated 16 ER specific diagnoses grouped in Air communicable and Non-air communicable. Finally, we recognized four different triage categories: white, green, yellow and red. Results: In 2020 total ER admissions reduced by 51% compared to 2019 (8744 vs 17080, respectively). The decrease in Air communicable diseases was significantly higher compared to Non-air communicable diseases (-60% vs -41%, respectively). ER admissions in each triage category decreased in 2020 compared to 2019 but, in percentage, yellow codes increased and green codes decreased. Conclusions: We can speculate that social distancing and simple hygiene measures drastically reduced the circulation of air communicable diseases even during the reopening of schools. The increase in yellow codes during the lockdown period may be related to a lack of primary care and, consequently, a delay in ER admissions.

In recent decades, scientific studies of chemical processes involving metabolites have been steadily increasing, indicating that we are well into the metabolomics era. This has resulted in numerous studies that explore the field of biomarkers. One of the medical areas most concerned with these innovations is certainly that of childhood respiratory disorders, including asthma and cystic fibrosis. This current study is a review of the literature about biomarkers used or studied in the field of pediatric pulmonology, including asthma and cystic fibrosis.

Pulmonary surfactant is a heterogeneous combination of lipids and proteins, which prevents alveolar collapse at the end of expiration cycle by decreasing the alveolar surface tension at the air-liquid interface. At birth, the expression of surfactant is very important for normal lung function and it is strictly correlated to gestational age. The best known genetic mutations associated with the onset of respiratory distress in preterm and full-term newborns and with interstitial lung disease later in childhood are those involving the phospholipid transporter (ABCA3) or surfactant proteins C and B (SP-C and SP-B) genes. In particular, mutations in the SP-B gene induce respiratory distress in neonatal period, while alterations on gene encoding for SP-C are commonly associated with diffuse lung disease in children or in adults. Both clinical phenotypes are present, if genetic mutations interest even the phospholipid transporter ABCA3 ambiguity in the sentence. Interstitial lung disease in children (chILD) is defined as a mixed category of mainly chronic and rare respiratory disorders with increased mortality and morbidity. Although genetic alterations are mainly responsible for the onset of these diseases, however, there are also other pathogenic factors that contribute to increase the severity of clinical presentation. In this review, we analyze all clinical features of these rare pulmonary diseases in neonatal and in pediatric age.

The COL2A1 gene consists of 54 exons spanning over 31.5 kb and encodes for type II collagen. Type II collagen is the main component of hyaline cartilage extracellular matrix, nucleus pulposus of intervertebral discus, vitreous humor of the eye and inner ear structure. Molecular defects in COL2A1 gene cause a wide variety of rare autosomal-dominant conditions known as type II collagenopathies. A clear genotype-phenotype relationship is not yet known. However, some correlations are described. Spondyloephyseal dysplasia congenita was suggested for a short-trunk dwarfing condition affecting primarily the vertebrae and the proximal epiphyses of the long bones.

In the last twenty years, despite high vaccination coverage, epidemics of pertussis are occurring in both developing and developed countries. Many reasons could explain the pertussis resurgence: the increasing awareness of the disease, the availability of new diagnostic tests with higher sensitivity, the emergence of new Bordetella pertussis (B. pertussis) strains different from those contained in the current vaccines, the asymptomatic transmission of B. pertussis in adolescents and adults and the shorter duration of protection given by the acellular pertussis (aP) vaccine. New preventive strategies have already been implemented, such as booster doses of aP vaccine in adolescents and adults, maternal immunisation during pregnancy and the "cocooning" strategy, but more are still needed. Knowing what is new about this old disease is necessary to reduce its incidence and to protect infants too young to be vaccinated, which have the highest risk of complications and death.

The use of electronic cigarettes (e-cigarette) and vaping devices started as a potential aid for cessation and reducing the harmful consequences of cigarette smoking, mainly in the adult population. Today e-cigarette use is highly increasing in vulnerable populations, especially young and pregnant women, due to the misconception of its harmless use. Despite the growing acknowledgment in e-cigarette as a potential harmful device, and due to mixed information found concerning its beneficial aid for smokers, along with an insufficient clinical study done in human models, it is important to further evaluate the possible benefits and risks of non-combusting, vaping nicotine or non-nicotine delivery devices. In this review we tried to summarize the latest updated information found in the literature, concentrating mainly in the variety of adverse effects of e-cigarette use and its contribution for recent and future health concerns.

Background: Community-acquired pneumonia (CAP) is an acute bacterial or viral inflammation of the lung parenchyma. Worldwide it is one of the most common infectious diseases among children. Diagnosis of CAP is clinical, but chestX-ray (CXR) is used in special clinical situation or severe cases. The role of lung ultrasound (LUS) to diagnose and manage CAP is still debated. Aim: 1) To evaluate concordance between LUS and CXR in evaluating specific signs of CAP (Cohen’s Test). 2) To determine sensitivity and specificity of LUS in the diagnosis of CAP compared to CXR. 3) To evaluate the role of LUS during the follow-up of patients hospitalized for CAP. Methods: We enrolled 68 patients younger than 16 years: 41 cases with clinical and radiological diagnosis of CAP and 27 controls with no respiratory diseases who performed a LUS during hospitalization. Nine-teen cases were re-evaluated 30 days after discharge with both LUS and CXR. Results: LUS confirmed CAP diagnosis in 40/41 cases, showing the presence of single or multiple consolidations. Concordance (K) between LUS and CXR was 0.88 in the right hemithorax and 0.70 in the left hemithorax. Moreover, LUS showed 97% of sensitivity and 96% of specificity in the diagnosis of CAP compared to CXR. During the follow-up, LUS sensitivity and specificity were 100% and 94%, respectively. Conclusion: Our study showed the potential benefit of LUS in the diagnosis and follow-up of children with CAP, possibly avoiding the need to take CXR.

Introduction Acute bronchiolitis is the most common respiratory illness and the main cause of respiratory failure in infant. Effective therapy is not available. A relatively new, safe and promising method of non-invasive respiratory support is oxygen delivery by high-flow nasal cannula (HFNC), but several questions concerning HFNC clinical practice remain unanswered. Aim The main aim of our study is to analyse the clinical course of infants hospitalized for bronchiolitis who underwent HFNC in order to identify clinical, laboratory or radiological findings that can have an impact on HFNC failure, which is defined as requirement for mechanical ventilation (MV). Methods We conducted a retrospective data analysis of case records of 130 patients less than 12 months hospitalized for bronchiolitis who underwent HFNC and clinical epidemiological laboratory and radiological data were collected. Results Only 11 (8.5%) out 130 infants required invasive mechanical ventilation for clinical deterioration. Patients who needed to switch from HFNC to MV because of a progressive respiratory failure showed more frequently a complete upper lobe consolidation on CXR (90.9%) than infants exclusively supported by HFNC (14.9%). They were younger with a lower admission weight and they had a lower lymphocyte count than patients who underwent HFNC only. Discussion Our study suggests that a complete upper lobe consolidation in young infants is a significant risk factor for HFNC failure. Further studies are needed to understand if an early identification of consolidation following by an adequate follow-up and proper therapeutic strategies may reduce the number of children who require mechanical ventilation.

To date, the diagnosis of mediastinal teratoma and mediastinal masses relies on the use of chest X-ray and CT. Lung and thoracic ultrasound is becoming increasingly used in the diagnosis and follow-up of many lung and thoracic diseases. Here, we report the case of a mature cystic teratoma in which the performance of lung ultrasound allowed to speed up the diagnostic workup and to provide the indication for the execution of CT of the thorax allowing the diagnosis.

Background We aimed to study respiratory syncytial virus (RSV) genotype distribution, clinical presentation, and disease severity in infants with bronchiolitis from RSV subtypes and new RSV genotypes. Methods We prospectively enrolled previously healthy term infants less than 1 year old hospitalized for bronchiolitis in an Italian university hospital over 12 epidemic seasons. In 312 nasopharyngeal washings positive for RSV, we sequenced the viral genotype and analyzed this according to patient data. Strain-specific RSV loads were quantified for 273 specimens. Results From 2005-2006 to 2011-2012, the RSV-A genotype NA1 predominated, and was replaced in 2012 by the novel ON1. All infants infected with RSV subtype B were genotype BA. Stratifying data according to genotypes NA1, ON1, and BA showed that NA1-infected infants were the youngest and had the most severe clinical course. Conversely, BA-infected infants had less severe symptoms and more frequently had eosinophilia and a family history of asthma. Infants with the ON1 genotype had a milder clinical course than those with NA1 and more risk factors for asthma, despite having the highest viral loads. Conclusion The disease course in infants hospitalized for acute RSV bronchiolitis may depend on the RSV genotype.

The ERS International Congress 2018 represented the theatre, for researchers with an interest in respiratory medicine, to feature their work to the researchers’ community. In this article, we provide the insight from the paediatric assembly, summarizing the results of the highest quoted abstracts presented at the meeting. We grouped the reviewed abstract in different categories as follows.

Bronchiolitis is the first lower respiratory tract viral infection manifesting in infants younger than 12 months of age. Our aim was to evaluate clinical and serological differences in infants with bronchiolitis from a single or from multiple viruses. Our secondary aim was to investigate differences in recurrent wheezing episodes after 12‐24‐36 months of follow‐up. We reviewed the clinical records for 486 full‐term infants hospitalized for bronchiolitis with at least one virus detected in the nasopharyngeal aspirate. In 431 (88.7%) patients one virus was detected and in 55 (11.3%) infants more than one virus was found. No differences were observed in the length of hospitalization, clinical severity score, O2 supplementation or admission to the intensive care unit. Single virus was associated with higher serum C‐reactive protein (C‐RP) than infants with multiple viruses and higher blood neutrophil counts. Respiratory syncytial virus (RSV) was the most frequently detected virus. RSV alone was associated with higher C‐RP (P = 0.007), compared to RSV coinfection. Infants with human rhinovirus (hRV) alone had higher white blood cell counts, higher blood neutrophils, and higher serum C‐RP levels than hRV co‐infection (P = 0.029, P = 0.008, P = 0.008). RSV + hRV, the most frequent co‐infection, was associated with lower neutrophil count and lower C‐RP levels (P = 0.008, P = 0.016) and less fever (P = 0.012), when comparing RSV versus hRV versus RSV + hRV. No differences were found in the frequency of recurrent wheezing between single versus multiple viruses after bronchiolitis. Our findings suggest that in infants with bronchiolitis multiple viral co‐infections can occur, without influence in the clinical severity of the disease. Infants with co‐infection seems to mount a lower inflammatory response.

Background: We sought to clarify possibly modifiable risk factors related to pollution responsible for acute bronchiolitis in hospitalized infants. Methods: For this observational study, we recruited 213 consecutive infants with bronchiolitis (cases: median age: 2 months; age range: 0.5–12 months; boys: 55.4%) and 213 children aged Results: In the 213 hospitalized infants the questionnaire identified the following risk factors for acute bronchiolitis: breastfeeding ⩾3 months (OR: 2.1, 95% confidence interval [CI]: 1.2–3.6), presence of older siblings (OR: 2.8, 95% CI: 1.7–4.7), ⩾4 cohabitants (OR: 1.5, 95% CI: 1.1–2.1), and using seed oil for cooking (OR: 1.7, 95% CI: 1.2–2.6). Having renovated their home in the past 12 months and concurrently being exposed daily to smoking, involving more than 11 cigarettes and two or more smoking cohabitants, were more frequent factors in cases than in controls ( p = 0.021 and 0.05), whereas self-estimated proximity to road and traffic was similar in the two groups. Conclusions: We identified several risk factors for acute bronchiolitis related to indoor and outdoor pollution, including inhaling cooking oil fumes. Having this information would help public health authorities draw up effective preventive measures – for example, teach mothers to avoid handling their child when they have a cold and eliminate exposure to second-hand tobacco smoke.

We describe the case of a boy with spondyloepiphyseal dysplasia congenita. At birth, he experienced severe respiratory distress necessitating tracheotomy. Endoscopy done because mechanical ventilation failed to resolve desaturations disclosed severe tracheo-bronchomalacia. A Polyflex silicone stent was placed in the trachea (replaced by Y-Dumon stent) and 2 Palmaz metallic stents in the mainstem bronchi (overlapped with 2 Jomed stents 5 years later). Airway stenting guaranteed a suitable respiratory status and allowed a child who was expected to die at birth, to reach 13.5 years old in good conditions.

Today, the term “study” is very frequently used in quite a broad sense: survey, clinical trial, analysis, research and other terms with deeply different meanings are often generally indicated as “studies”. A “study” can be generally defined as a process composed of several actions aimed to verify one or more hypotheses (objectives), with the ultimate goal of sharing the answers (results) with a target audience, in the form of a scientific paper, presentation or poster., The key for the success of a study lies in the careful design of all its different phases, from the statement of the objectives to the dissemination of the results http://ow.ly/5NbG30kHEnQ

Background: Respiratory Syncytial Virus (RSV) is the leading cause of bronchiolitis. The local bacterial ecosystem may influence RSV disease severity and the immune response. Aim: To evaluate the association between RSV infection, nasal microbiota composition (NMC) and patients’ immune response in infants with bronchiolitis. Materials and Methods: We characterized the NMC of 47 hospitalized infants Results: NMC differed among RSV and non RSV groups. In RSV-positive nasal samples alfa-diversity was reduced and NMC differed between RSV-A and RSV-B. Discriminant bacterial species were Clostridium indolis for RSV-A group and Hemophilus haemolyticus for RSV-B. In infants with RSV, there was a significant cross-correlation among NMC (evaluated as β diversity) and white blood cells level, expression of Lambda3 and Beta IFN genes and Th1/Th2 response. Conclusions: This preliminary study showed differences in the NMC in relation to the aetiological cause of bronchiolitis and the type of immune response, that are worthy of further examination in larger groups.

Background: Risk factors for bronchiolitis and for long term respiratory sequelae remain unclear. Aim: To study the occurrences of asthma and allergic sensitization after bronchiolitis. Materials: 622 children hospitalized for bronchiolitis (cases) during 9 consecutive seasons and 65 healthy children enrolled in “Piccolipiu” cohort with negative history for bronchiolitis (controls) were followed for 6 years. A structured questionnaire was used to obtain demographic information from all children. Parents were interviewed 5 years after hospitalization to check whether their children experienced recurrent wheezing. At 6 years of age 253 cases and all controls performed prick test. Results: Cases had lower gestational age (p=0.001), lower birth weight (p=0.016), higher smoking exposure during their first year of life (p Conclusions: Environmental factors seems to have an important role in bronchiolitis. Bronchiolitis is a risk factor or asthma but not for allergic sensitization.

Rationale: We aimed to study wheezing recurrence after bronchiolitis from different RSV genotypes: RSVA NA1 and ON1, and RSVB BA. Methods: We prospectively enrolled term infants Results: 125 infants had NA1, 49 ON1, and 41 BA bronchiolitis. At 3 years, we registered wheezing in 65.6% NA1, 77.6% ON1 and 75.6% BA bronchiolitis children. Patients with wheezing had a higher RSV load when hospitalized with bronchiolitis (6.3±1.6 vs 5.6±1.5; p=0.015 copies/ml), particularly in ON1 infants (7.3±1.1vs 6.3±1.3; p=0.026). Among NA1 infants, wheezing was more frequent in children who had a severe bronchiolitis comparing to those children who had a mild bronchiolitis (75.9% vs 56.7%; p=0.025). The logistic regression analysis adjusted for sex, family history of asthma, passive smoking exposure, RSV genotype and eosinophils count, found severe bronchiolitis (OR: 2.9; 95% CI: 1.3, 6.6; p=0.01) and high viral load (OR:1.3; 95% CI: 1.0, 1.6; p=0.04) as risk factors for wheezing at 3 years. Conclusion: Viral factors (genotype specific-viral load) and clinical factors (severity score) contribute to the occurrence of respiratory sequelae after hospitalization for RSV sole bronchiolitis.

Background: Respiratory syncytial virus (RSV)-A genotype ON1 caused a less severe bronchiolitis course than the previously circulating RSV-A genotype (Midulla, F et al JID 2018;219:526-534). However, ON1 continued to circulate worldwide and to differentiate in new strains. Aim: to study the variability of the viral glycoprotein G in relation to clinical severity in bronchiolitis cases. Methods: From prospectively enrolled previously healthy term infants hospitalized for bronchiolitis in 2012-13 to 2017-18 epidemic seasons, cases positive to RSV-A ON1 only were selected. After sequencing the second half of the G gene of about 70 samples, a phylogenetic analysis was performed. Demographic and clinical data were compared among divergent ON1 clades. Results: The phylogenetic analysis of the G gene identified genomic variants appearing since 2012; some of them were not maintained in the following seasons. All sequences did not present polymorphisms in the conserved tract of the G protein that binds the cellular receptor and in the heparin-binding domain. Nonetheless, most strains sequenced in the 2017-18 season set well apart from those of the previous epidemic seasons, in two distant branches of the phylogenetic tree. The two more divergent branches were characterized by patterns of aminoacid changes never reported before, some of which located in antigenic sites. Moreover, substitutions may have altered N- and O-glycosilation sites. Patients infected with divergent strains presented higher severity scores. Conclusions: The aminoacid changes detected in the hypervariable part of the G protein may have altered functions and/or changed its immunogenicity determining an impact on disease severity.

Background: Positive serology for cytomegalovirus (CMV) has been associated with all-cause mortality risk in previous studies. Aims: We sought to determine the relation of CMV serology to COPD mortality. Methods: We analyzed data from 806 participants in the TESAOD cohort who at enrollment in 1972 were aged 28–70 yrs and completed lung function tests. CMV serology in serum samples from enrollment was categorized as low, medium, and high tertiles. Date and cause of death were assessed through death certificates and linkage to the National Death Index up to January 2017. The association of CMV serology to all-cause and cause-specific mortality was tested in Cox models adjusted for age, sex, level of education, BMI, smoking status, and pack-years. Results: CMV serology was associated with subsequent all-cause mortality, but the effect was strongly dependent on age at enrollment. Among subjects Conclusions: High CMV serology is a novel and potentially modifiable risk factor for COPD mortality.

Introduction: Respiratory syncytial virus (RSV) A ON1, firstly detected in 2010, has progressively replaced the previous circulating subtype RSV A NA1. Aims and Objectives: The aim of our study was to compare the clinical severity of RSV A ON1 bronchiolitis in hospitalised children over six epidemic seasons. Methods: We enrolled 497 patients younger than 12 months, hospitalised for RSV bronchiolitis, through the epidemic seasons 2005/2006-2017/2018. We analyzed the genotype in 391 samples and selected the RSV A ON1 positive patients. For each patient, demographic and clinical data were collected from clinical records. A severity score (range 0-8) was calculated based on respiratory rate, peripheral oxygen saturation, presence of withdrawals and feeding difficulty. Furthermore, we retrospectively collected the number of bronchiolitis visiting the Emergency Department and the number of hospitalised bronchiolitis through the epidemic seasons 2012/2013-2017/2018. Results: From the epidemic season 2012/2013, when RSV A ON1 was first detected, the rate of bronchiolitis hospitalised per bronchiolitis visited in the Emergency Department progressively increased (from 51.3% in 2012/2013 to 66.9% in 2017/2018). The severity score showed the same trend: β coefficient 0.52 (95% confidential interval: 0.38-0.66), p-value Conclusions: During the last six seasons (from 2012/2013) the severity of RSV A ON1 bronchiolitis has progressively increased. This phenomenon could be explained by the variability of the virus or by the host immune response.

Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality eitherviaa face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.

Bronchiolitis is the leading cause of hospitalization in infants under 12 months. Our aims were to analyze epidemiological characteristics of infants with bronchiolitis over 10 consecutive seasons and to evaluate whether there are any clinical differences between infants hospitalized for bronchiolitis during epidemic peak months and infants in non-peak months. We enrolled consecutive enrolled 723 previously healthy term infants hospitalized at the Paediatric Emergency Department, "Sapienza" University of Rome over the period 2004-2014. Fourteen respiratory viruses were detected from nasopharyngeal aspirates by molecular methods. Clinical and demographic data were extracted from clinical charts. Viruses were detected in 351 infants (48.5%): RSV in 234 (32.4%), RV in 44 (6.1%), hBoV in 11 (1.5%), hMPV in 12 (1.6%), co-infections in 39 (5.4%), and other viruses in 11 (1.5%). Analyzing the 10 epidemic seasons, we found higher incidence for bronchiolitis every 4 years with a peak during the months December-January. Infants hospitalized during peak months had lower family history for asthma (P = 0.003), more smoking mothers during pregnancy (P = 0.036), were slightly higher breastfed (0.056), had lower number of blood eosinophils (P = 0.015) and had a higher clinical severity score (P = 0.017). RSV was detected mostly during peak months, while RV was equally distributed during the seasons. We found some variations in bronchiolitis incidence during epidemics, and discriminative characteristics in infants hospitalized for bronchiolitis during peak months and in non-peak months, that might reflect two different populations of children. Pediatr Pulmonol. 2016;51:1330-1335. © 2016 Wiley Periodicals, Inc.

Background The clinical picture of celiac disease is changing with the emergence of subclinical forms and growing evidence reporting associated neurological disorders. Aims To establish the prevalence of celiac disease in children suffering from recurrent headache. Methods In our retrospective study we collected charts from 1131 children attending our tertiary care Centre for Paediatric Headache over the period 2001–2012. They were screened for celiac disease and positive patients were referred to our Operative Unit for Coeliac disease and confirmed positive children underwent upper endoscopy with multiple duodenal biopsies. Celiac children started a gluten-free diet. Results 883 children (481 females; median age, 9.8 years, range 3–19) performed celiac disease screening, and among them, 11 children (7 females; median age, 8.2 years, range: 4.8–13.9) were diagnosed with celiac disease. Seven children (5 females, median age, 11.9 years, range: 10.3–13.9) had been diagnosed as celiac prior to the neurological evaluation. The prevalence of celiac disease in our sample is 2.04% vs. 1.2% of the general population (p = 0.034). Conclusions Our study demonstrates, on a large series, that celiac disease prevalence is doubled in patients with chronic headache. Screening for celiac disease could be advised as part of the diagnostic work-up in these paediatric patients, particularly among pharmacological non-responders.