Cristina Mascolo

Background: Anorexia nervosa (AN) is increasingly recognized as a multisystem disorder involving complex host–microbiota interactions, yet prospective pediatric studies with a comprehensive, longitudinal characterization of host–microbiota interactions remain scarce. Methods: In this prospective longitudinal study, 26 adolescents with severe AN were evaluated at hospital admission (T0), after one month (T1), and after three months of inpatient nutritional rehabilitation (T2). Gut microbiota composition was assessed by 16S rRNA sequencing and compared with healthy controls (HC) at the baseline; predicted functional profiling was performed using PICRUSt2. Serum and urinary biomarkers of intestinal barrier integrity and microbial metabolism, routine clinical and biochemical parameters, and psychometric scores (CDI-2, MASC-2) were evaluated longitudinally using linear mixed-effects models. Results: At the baseline, adolescents with AN showed reduced bacterial richness compared with healthy controls, with significantly lower Chao1 diversity (p = 0.00013), whereas the Shannon and Simpson indices did not differ significantly (p = 0.54 and p = 0.27, respectively). Microbial community composition differed significantly between groups based on Bray–Curtis (R² = 0.0724, FDR-adjusted p = 0.001) and unweighted UniFrac (R² = 0.0540, FDR-adjusted p = 0.001) distances. LEfSe identified 19 differentially abundant taxa; among the strongest discriminators, Blautia_A_141781, Romboutsia_B, and Clostridium_T were enriched in AN, whereas Akkermansia, Phocaeicola_A_858004, and Bacteroides_H were enriched in the healthy controls. Nutritional rehabilitation was associated with partial microbiota remodeling, alongside significant improvements in BMI and heart rate. Several host-derived biomarkers, including urinary indican, serotonin, nitric oxide, and serum occludin, changed significantly over time, whereas bile acids, short-chain fatty acids, IgA, lipopolysaccharide, and haptoglobin remained stable. Conclusions: Gut microbiota and host-derived biomarkers evolve dynamically during nutritional rehabilitation in adolescents with severe AN, supporting their potential role as complementary tools for monitoring biological recovery.

In the last years the use of digital media devices (MD) among adolescents has increased exponentially, becoming a central component of daily life for many

Background: Anorexia nervosa (AN) is a complex psychiatric disorder that requires a multidisciplinary approach. The World Health Organization recognizes the therapeutic value of expressive arts, including drama, in enhancing emotional, cognitive, and relational domains in severe mental illnesses such as AN. Expressive arts interventions may improve emotional intelligence, empathy, and self-awareness while reducing anxiety and alexithymia. This study evaluated the impact of an adjunctive expressive arts program on alexithymia in pediatric inpatients with AN. Methods: We enrolled patients aged 11–18 years hospitalized for AN, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, at the Pediatric Unit of Bambino Gesù Children’s Hospital, Rome. The study period ran from December 2024 to April 2025. Participants attended drama therapy sessions and expressive arts workshops in a dedicated recreational space integrated into a multidisciplinary treatment plan. Alexithymia was assessed at admission and discharge using the Toronto Alexithymia Scale (TAS-20), with scores ≥ 61 indicating alexithymia. At the end of the program, participants completed a semi-structured satisfaction questionnaire to evaluate subjective experiences and mood. Results: Thirty patients met inclusion criteria. The TAS-20 scores were statistically different between pre-/post-theater activity (p < 0.001). The proportion of alexithymic participants declined from 73.3% at baseline to 26.7% at discharge. Most participants reported mood improvements: 66.6% “somewhat” and 26.7% “greatly.” Additionally, 90% reported improved peer relationships. Conclusions: Expressive arts, particularly drama-based interventions, may represent an effective adjunctive therapy for adolescents with AN, supporting emotional awareness, self-regulation, and social connectedness. Arts-based interventions are associated with nonverbal avenues for emotional processing and may promote neuroplasticity, representing valuable complementary strategies for AN treatment.

Introduction: Eating disorders (EDs) are severe psychiatric disorders that significantly impact the psychological and physiological well-being of affected individuals. Despite increasing prevalence in males over the past few decades, EDs are mainly considered a female disease. This retrospective study aims to evaluate the influence of gender on the clinical, laboratory, and developmental characteristics of EDs in pediatric patients. Material and methods: A retrospective study was conducted on patients referred to the EDs between 2019 and 2024 at Bambino Gesù Children’s Hospital, Rome, Italy. Gender differences were evaluated in the whole cohort and in a sub-cohort of males and females well matched for age. Results: In the whole cohort of 501 patients (age range 8–17 years), 45 were males and 456 were females. In male patients, EDs occurred at a younger age (12.65 vs. 14.65 years, p < 0.05). When considering the matched cohort, male patients showed more severe clinical conditions, as evidenced by a tendency to a lower BMI SDS at the onset, higher inflammatory parameters (ferritin and transaminase levels), and poorer nutritional status (vitamin D levels: 23.15 vs. 26.9 ng/mL, p < 0.05). However, male patients had a shorter hospital stay (14.8 vs. 19.9 days, p < 0.05) and showed a tendency to a greater clinical improvement. Differences in therapy were also observed, with fewer males receiving pharmacological treatment or nasogastric feeding. Conclusions: The results of the current study confirm the higher prevalence of EDs in females, even though they suggest EDs are not exclusively a female disease. Male gender may represent a risk factor for a worse clinical course and a younger onset. Further studies with a longer follow-up are required to understand the significant differences between females and males in this complex disorder.

Background: Anorexia nervosa is a serious eating disorder that mainly affects children and adolescents. Most patients present with extreme body dissatisfaction and an obsessive focus on body weight and food. Anorexia nervosa is a complex and multifactorial condition characterised by biological, psychological, and social factors. However, studies that have explored the cumulative risk that predisposes to anorexia nervosa are limited. This study aims to explore the potential risk factors for a severe form of the disease in patients affected by anorexia nervosa and to identify whether they may interact and reinforce each other, contributing to the severity of the disorder. Methods: For this study, we enrolled children and adolescents under 18 years of age hospitalised at IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy, for anorexia nervosa from 1 December 2022 to 31 August 2024, identifying and analysing potential risk factors. Elevated shape and weight concerns were found in all patients. Psychiatric and neurodevelopment comorbidities were identified in 76 patients (51.35%), life stress events in 69 (46.62%), and a family history of eating and weight control behaviours in 39 (26.35%). Out of the sample size, 20.27% of patients did not live in a traditionally structured family. This study used the Kiddie-SADS-Present and Lifetime Version interview, the Coddington Life Events Scales, and the Trauma Symptom Checklist for Children questionnaires. Results: Patients with an extreme or severe index of anorexia nervosa are more likely to have multiple predisposing factors. In detail, four predisposing factors were found in 18.6% of patients with an extreme severity index, in 15.5% of those with a severe score, and in 10.3 and 10.6% of those with a moderate and mild score, respectively. Conclusions: Cumulative potential risk factors are more likely to be found in cases of severe course disease and patients hospitalised for anorexia. Prompt identification of predisposing factors and an effective plan of action are required to avoid a severe course disorder.

Nutritional rehabilitation with weight restoration is an important step in patients hospitalised for anorexia nervosa (AN). Naso-gastric feeding (NGF) should be considered when oral nutrition (OF) and oral nutritional supplementation (ONS) are insufficient. We evaluated the role of NGF on short- and long-term outcomes, considering weight gain, the length of hospitalisation (LOS) and the time to relapse. We report on the characteristics of patients under 18 years of age with AN admitted to the Department of Emergency and Acceptance of the Bambino Gesù Children’s Hospital, IRCCS, Rome, between March 2019 and August 2022. Three hundred and fifteen patients were enrolled. We compared patients treated with NGF (group A) and patients without NGF (group B). Group A was characterised by a significantly lower BMI on admission and discharge, more frequent use of inpatient psychotropic therapy (IPDT) and longer hospital stay. The time to relapse was significantly longer in group A compared to group B. An early NGF setting correlates with a longer time to relapse and may be associated with a shorter LOS. A high caloric intake with a balanced nutritional formula provided by NGF allows an earlier recovery. The main advantages of this approach could be the rapid discharge of patients and a more effective psychological and social recovery.

Background: Acute Cerebral Nervous System Infections (ACNS) may cause death or severe complications even to promptly treated children. The role of the immune system in influencing the course and the outcome of meningitis has been studied but it is not yet completely understood. The aim of the research is to ascertain whether children who experienced ACNS infection had a normal immune system. Methods: Patients under 18 years of age admitted at Bambino Gesù Children from January 2006 till June 2016 for meningitis were asked to participate to the follow-up study. The immune status was evaluated both clinically and by laboratory investigations. Results: Most of the patients over 3 years at follow up had at least one immunological alteration at follow-up evaluation (74%). Considering ACNS infection etiology, certain pathogens were almost exclusive of patients affected by some immunological alteration, regardless of their age. Discussion: Our preliminary results indicate that sub-clinical immunological defects may be associated to ACNS pediatric infections. Moreover, to the best of our knowledges, this is the first study correlating pathogens to immune evaluation in ACNS infections. It is, however, important to underline the high frequency of persistent immunological alterations in the analyzed patients. Further studies are needed to confirm our conclusions. Conclusions: We recommend an immunological assessment at follow up evaluation in children who experienced an ACNS infection.

Background: Post-Infectious Neurological Syndromes (PINS) are heterogeneous neurological disorders with post or para-infectious onset. PINS diagnosis is complex, mainly related to the absence of any recognized guidelines and a univocal definition. Aim of the study: To elaborate a diagnostic guide for PINS. Materials and methods: We retrospectively analysed patients younger than 14 years old admitted to Bambino Gesù Children’s Hospital in Rome for PINS from December 2005 to March 2018. Scientific literature using PubMed as research platform was analysed: the key words “Post-Infectious Neurological Syndromes” were used. Results: A polysymptomatic presentation occurred in a percentage of 88% of the children. Motor signs and visual disturbances the most observed symptoms/signs were the most detached, followed by fever, speech disturbances, sleepiness, headache and bradipsychism. Blood investigations are compatible with inflammation, as a prodromal illnesses was documented in most cases. Normal cerebral spinal fluid (CSF) characteristics has been found in the majority of the study population. Magnetic resonance imaging (MRI) was positive for demyelinating lesions. Antibiotics, acyclovir and steroids have been given as treatment. Discussion: We suggest diagnostic criteria for diagnosis of PINS, considering the following parameters: neurological symptoms, timing of disease onset, blood and CSF laboratory tests, MRI imaging. Conclusions: We propose criteria to guide clinician to diagnose PINS as definitive, probable or possible. Further studies are required to validate diagnostic criteria.