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Background Lately, one of the major clinical and public health issues has been represented by Coronavirus disease of 2019 (COVID-19) during pregnancy and the risk of transmission of the infection from mother to child. Debate on perinatal management and postnatal care is still ongoing, principally questioning the option of the joint management of mother and child after birth and the safety of breastfeeding. According to the available reports, neonatal COVID-19 appears to have a horizontal transmission and seems to be paucisymptomatic or asymptomatic, compared to older age groups. The aim of this work is to describe a cluster of neonatal COVID-19 and discuss our experience, with reference to current evidence on postnatal care and perinatal management. Methods This is a retrospective observational case series of five mother-child dyads, who attended the Labor and Delivery Unit of a first-level hospital in Italy, in March 2020. Descriptive statistics for continuous variables consisted of number of observations, mean and the range of the minimum and maximum values. Results Five women and four neonates tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In one case, the mother-child dyad was separated and the neonate remained negative on two consecutive tests. Two positive neonates developed symptoms, with a predominant involvement of the gastrointestinal tract. Blood tests were unremarkable, except for a single patient who developed mild neutropenia. No complications occurred. Conclusions We agree that the decision on whether or not to separate a positive/suspected mother from her child should be made on an individual basis, taking into account the parent’s will, clinical condition, hospital logistics and the local epidemiological situation. In conformity with literature, in our study, affected neonates were asymptomatic or paucisymptomatic. Despite these reassuring findings, a few cases of severe presentation in the neonatal population have been reported. Therefore, we agree on encouraging clinicians to monitor the neonates with a suspected or confirmed infection.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic, affecting all age groups with a wide spectrum of clinical presentation ranging from asymptomatic to severe interstitial pneumonia, hyperinflammation, and death. Children and infants generally show a mild course of the disease, although infants have been observed to have a higher risk of hospitalization and severe outcomes. Here, we report the case of a preterm infant with a severe form of SARS-CoV-2 infection complicated by cerebral venous thrombosis successfully treated with steroids, hyperimmune plasma, and remdesivir.

The COVID-19 pandemic has considerably disrupted daily life and the normal functioning of hospitals. One of the clearest examples has been the drastic reduction in paediatric emergency departments visits during the pandemic (1). But we have also observed another very interesting and unexpected phenomenon in our Italian hospital. Admissions for febrile seizures from March to May 2020 were more than three times the same period in 2019. This included cases admitted via the emergency department and direct transfers from other hospitals.

— Recent evidence indicates the usefulness of lung ultrasound (LUS) in detecting coronavirus disease 19 (COVID-19) pneumonia. However, no data are available on the use of LUS in children with COVID-19 pneumonia. In this report, we describe LUS features of 10 consecutively admitted children with COVID-19 in two tertiary-level pediatric hospitals in Rome. LUS revealed signs of lung involvement during COVID-19 infection. In particular, vertical artifacts (70%), pleural irregularities (60%), areas of white lung (10%) and subpleural consolidations (10%) were the main findings in patients with COVID-19. No cases of pleural effusions were found. According to our experience, the routine use of LUS in the evaluation of children with suspected or confirmed COVID-19, when performed by clinicians with documented experience in LUS, was useful in diagnosing and monitoring pediatric COVID-19 pneumonia, reducing unnecessary radiation/sedation in children and exposure of health care workers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Introduction Children with special health-care needs are an emerging and consistent population. In a subset of children with medical complexity (CMC) a continuous access to the central vascular system is advisable to eliminate unnecessary pain and stress and to improve home management and palliative care. Methods The surgical registry of a tertiary hospital was checked in order to identify CMC who underwent totally implantable venous access device (VAD) placement. Medical records were reviewed. Results From October 2009 to August 2014, a totally implantable VAD was placed in 10 children. Seven out of 10 patients were affected by cerebral palsy while 3 presented a genetic syndrome. The median duration of the indwelling catheter was 31 months (range 5 to 77 months). Six catheters are still in place since the first placement. Infectious complications were observed in two patients, respectively, a Candida albicans and a Staphylococcus aureus colonization; in both cases the VAD was removed. In another two cases, removal was planned for reservoir dislodgment within the subcutaneous tissue. No other major complications were observed during the procedure and the follow-up period. Emergency admissions decreased from a median value of 0.4/month (range 0-1.5/month) to 0.2/month (range 0-0.6/month) after the VAD placement. Conclusions A totally implanted VAD in CMC is safe and manageable. As expected, infection seems to be the major complication with no infection-related death. Malnutrition and musculoskeletal deformities, which are frequent comorbidities in CMC, should be considered to reduce the risk of dislodgment/migration.

Coronavirus disease (COVID‐19) caused by the novel SARS‐CoV‐2 has spread worldwide since its onset in Wuhan in December 2019. In Italy COVID‐19 rapidly increased in February 2020 and by 12 May 2020, 2.0 % of the confirmed cases were under 18 years and 3.7% of those had been hospitalized. This case series report reviews the demographic characteristics, clinical course, laboratory findings, radiologic features and treatment of children admitted with COVID‐19 to a tertiary care hospital in Italy.

SummaryBackground In infants, post-thoracotomy analgesia traditionally consists of systemic opiates, while regional techniques have gained more favor in recent years. We compare the two techniques for thoracotomy in infants. Methods All consecutive patients below 6 months of age who underwent thoracotomy for congenital pulmonary malformations in the study period were retrospectively divided according to the chosen postoperative analgesia: Group S systemic opiates, Group R continuous regional (epidural or extrapleural paravertebral) block. We studied the following outcomes: need for NICU and mechanical ventilation, pain score, requirement for additional analgesics, heart rate 1 h postsurgery, time to pass first stool and to full feed, complications, and duration of hospitalization. Results Forty consecutive patients were included, 19 in Group S and 21 in Group R. Median age at surgery was 89 days (40–110) and 90 days (46–117), respectively. Five of 19 patients in Group S vs none in Group R required postoperative intensive care (P = 0.017). Patients in Group R had significantly lower postoperative heart rate (145 [138–150] vs 160 [152–169] b·min−1, P = 0.007), earlier passage of first stools (24 h [12–24] vs 36 h [24–48] P = 0.004), and earlier time to full feed (36 h [24–48] vs 84 h [60–120] P = 0.0001) than those in Group S. The only observed complication was one catheter dislocation. Conclusion In infants undergoing thoracotomy, loco-regional analgesia is effective and associated with a reduced intensity of postoperative care and earlier full feeding than systemic analgesia; it should therefore be considered a better option.

Objective – To underline the fetal kidney toxicity of losartan, an angiotensin receptor blocker (ARB), administered to a woman during pregnancy. Case report – We describe a male infant, prenatally exposed to losartan from week 32 of gestation, born at term by cesarean section due to maternal hypertension and oligohydramnios. The baby was admitted to the NICU of our hospital for anuria; he required peritoneal dialysis and survived the neonatal period. Presently, the child is 24 months old and is affected by severe chronic renal failure, failure to thrive and persistent hypertension. Conclusions – Although ARBs are recommended as first line antihypertensive agents, their administration should be avoided during pregnancy, especially from the second trimester onward. Most fetuses, affected by ARB toxicity, progress to death. The few that survive show serious outcomes. If a pregnant woman is under antihypertensive treatment with ARB, this has to be discontinued and replaced as soon as possible, and especially within the second trimester of pregnancy. Obstetricians should also be alerted of the potential risks of ARB administration beyond the first trimester of gestation.

Objectives – To investigate the dose of enoxaparin required in neonates to achieve target therapeutic ranges of anti factor Xa 48 hours after starting therapy, and compare this dose to recommended guideline dosages for neonates. Methods – We retrospectively reviewed 19 records of newborns who received enoxaparin at different doses for the treatment of thrombosis and evaluated how many among them reached the target anti-factor Xa level after 48 hours. Results – Only 1/5 neonates (20%) treated with 150 UI/kg twice a day, but 100% (6/6) of those treated with 175 UI/kg twice a day reached therapeutic levels of anti-factor Xa at 48 hours. Of the 8 neonates treated with lower starting doses none reached the therapeutic range after 48 hours and these required the highest number of dose changes. Conclusions – Our results reinforce the need to increase in neonates the dosage of enoxaparin suggested in published guidelines, in order to shorten the time-delay in achieving a therapeutic level of anti-factor Xa, and also reducing the number of blood tests necessary for dosing anti-factor Xa.

Objective To review the clinical and molecular genetic characteristics of 16 patients presenting a suspected diagnosis of Kabuki syndrome (KS) in the first year of life, to evaluate the clinical handles leading to a prompt diagnosis of KS in newborns. Clinical diagnosis of KS can be challenging during the first year of life, as many diagnostic features become evident only in subsequent years. Methods All patients were clinically investigated by trained clinical geneticists. A literature review was performed using the Pubmed online database and diagnostic criteria suggested by DYSCERNE–Kabuki Syndrome Guidelines (2010) were used (a European Network of Centres of Expertise for Dysmorphology, funded by the European Commission Executive Agency for Health and Consumers (DG Sanco), Project 2006122). Molecular analysis of the known causative genes of KS, KMT2D/MLL2 and KDM6A , was performed through MiSeq-targeted sequencing platform. All mutations identified were validated by Sanger sequencing protocols. Results Mutations in KMT2D gene were identified in 10/16 (62%) of the patients, whereas none of the patients had KDM6A mutations. Facial dysmorphisms (94%), feeding difficulties (100%) and hypotonia (100%) suggested the clinical diagnosis of KS. No significative differences in terms of facial features were noticed between mutation positive and negative patients of the cohort. Brachydactyly, joint laxity and nail dysplasia were present in about 80% of the patients. Other congenital anomalies were most commonly present in the mutated group of patients, including left-sided cardiac abnormalities, skeletal, renal and anorectal malformations and hypertricosis. Conclusions We present an overview of patients with KS diagnosed during the first year of life. Early diagnosis is serviceable in terms of clinical management and for targeted genetic counselling.

Scurvy is the clinical consequence of chronic vitamin C deficiency. It is the oldest known nutritional disease, with the first report being in the 1550 BC Papyrus of Ebers, which includes a clear recommendation to eat some vegetables.1 Today, scurvy is rare and almost exclusively associated with malnutrition, malabsorption or psychiatric disease. Recently, in the paediatric population neurological impairment or autistic spectrum disorders have also emerged as risk factors for scurvy owing to food selectivity leading to a potentially fresh fruit- and vegetable-free diet.2 ,3 In view of these recent observations, we checked our database to evaluate the prevalence of scurvy in a subset of disabled children who are cared for …

NIRS has been used as a key device with the aim to evaluate the impact of surgery and anesthesia on cerebral and splanchnic oxygenation in neonatal population. The main applications has been in cardiac surgery, congenital diaphragmatic hernia and esophageal atresia. In this report we summarized the results published on the application of NIRS in neonatal surgery with particular respect to cerebral and splanchnic oxygenation, presenting also some future prospective.