Maria Paola Ronchetti

(1) Background: Respiratory syncytial virus (RSV) is the leading cause of neonatal lower respiratory tract infection. We described changes in neonatal bronchiolitis hospitalizations, RSV detection and disease severity across the transition from two seasons without systematic RSV prophylaxis to two seasons following the introduction of universal nirsevimab immunoprophylaxis (Lazio region, December 2024) in a tertiary pediatric center. (2) Methods: A retrospective, observational study was conducted at “Bambino Gesù” Children’s Hospital IRCCS (Rome, Italy) comparing four consecutive RSV seasons: pre-universal prophylaxis (2022–2024, n = 256) versus post-universal prophylaxis (2024–2026, n = 122). Term infants ≤30 days and preterm infants under term-corrected age hospitalized for acute bronchiolitis were included. RSV status was confirmed by viral testing within 72 h of admission. (3) Results: Total bronchiolitis admissions dropped by 52% (256 to 122), with RSV-positive cases decreasing from 66.8% to 43.4% (RR 0.65, 95% CI 0.52–0.81; p < 0.001). Monthly peak RSV admissions fell progressively from 56 (December 2022) to 6 (January 2026). Among all admissions, ICU rates dropped from 18.4% to 4.1% (RR 0.22, 95% CI 0.09–0.55; p < 0.001). Within RSV-positive neonates, respiratory support requirements decreased from 93.0% to 71.7% (RR 0.77, 95% CI 0.65–0.92; p < 0.001), and ICU admissions declined from 24.0% to 5.7% (RR 0.24, 95% CI 0.08–0.73; p = 0.003). Non-RSV pathogens dominated the post-campaign viral profile, with the relative prevalence of human metapneumovirus (hMPV) increasing from 3.9% to 11.5% (RR 2.94, 95% CI 1.34–6.42; p = 0.006) without increasing overall severity. In the post-campaign period, 22 of 53 RSV-positive admissions occurred in nirsevimab-immunized neonates (breakthrough infections): 7/35 in 2024–25 and 15/18 in 2025–26 (p < 0.001), reflecting higher population coverage. (4) Conclusions: Universal nirsevimab prophylaxis was associated with marked reductions in neonatal bronchiolitis hospitalizations, RSV positivity, respiratory support needs, and ICU admissions. Early, high-coverage implementation prior to seasonal RSV peaks maximizes population-level protection in highly vulnerable newborns.

Background: Enteral feeding during therapeutic hypothermia (TH) for hypoxic–ischemic encephalopathy (HIE) remains heterogeneous across centres because of concerns regarding feeding intolerance and the risk of necrotizing enterocolitis (NEC). Evidence regarding optimal feeding initiation and advancement remains limited. Methods: We performed a secondary analysis of a multicentre retrospective cohort of infants with HIE treated with TH at two tertiary neonatal intensive care units in Italy and Belgium between 2011 and 2024. We included survivors with complete nutritional data, aware that this restriction, adopted because feeding-related endpoints cannot be assessed in non-survivors, may introduce survivor bias. Feeding practices, enteral feeding progression, feeding tolerance, and gastrointestinal outcomes were evaluated. Results: Of 302 infants in the original cohort, 276 were included. Enteral feeding during TH was administered to 166 infants (60.1%). Enteral feeding volumes remained low during the first three days of life but progressively increased thereafter. Despite inter-center differences in feeding strategies (initiation and advancement), time to full enteral feeding (median 9 days; IQR 7–12) was comparable overall (Italy: median 9 days, IQR 7–12; Belgium: median 10 days, IQR 7–14; p = 0.323). Infants receiving enteral nutrition during TH were observed to achieve full enteral feeding earlier than those not fed during cooling (median 8.0 vs. 12.0 days, p < 0.001) and to have a shorter length of hospital stay (median 11.0 vs. 15.0 days, p < 0.001). Breastfeeding at discharge was also observed more frequently among infants who received enteral nutrition during TH (79.5% vs. 54.5%, p < 0.001). Feeding intolerance occurred in 47 infants (17.0%) and temporary feeding withdrawal in 31 (11.2%). Only three infants (1.1%) developed Bell stage IIA NEC, with no progression to more advanced disease or surgery. NEC was more frequent among infants with Sarnat stage III HIE than among those with stage I–II disease (8.3% vs. 0.4%, p = 0.022). Conclusions: Enteral feeding during TH was feasible, and gastrointestinal complications were uncommon. These findings support the feasibility of cautious enteral feeding during TH. The concentration of NEC events among infants with severe HIE, although based on only three cases, is hypothesis-generating and suggests that future studies should evaluate feeding strategies according to both neurological severity and physiological stability. Whether earlier initiation or faster advancement is beneficial in clinically stable infants cannot be determined from these observational data and should be addressed in prospective studies.

Cytomegalovirus (CMV) remains one of the most relevant congenital and early-life infections in pediatrics because of its high global seroprevalence, lifelong latency, and potential for reactivation or reinfection. Biologically, the virus poses a particular threat during pregnancy, when maternal primary infection carries a substantially higher risk of transplacental transmission than non-primary infection, with fetal and neonatal consequences that vary according to gestational timing and host vulnerability. In children, CMV infection is common in the first years of life and may contribute to a broad spectrum of outcomes, ranging from asymptomatic infection to severe multisystem disease, neurodevelopmental impairment, and sensorineural hearing loss. Clinically, the document highlights the importance of timely maternal diagnosis, differentiation between primary and recurrent infection, and integration of prenatal, neonatal, radiological, and audiological assessment. Attention is given to symptomatic and asymptomatic newborns, preterm infants, and infants exposed through breast milk. The availability of antiviral strategies in pregnancy and infancy strengthens the rationale for early identification and risk stratification. Universal newborn screening emerges as a potentially valuable approach to improve case detection, enable prompt follow-up, and reduce long-term disability. Overall, a multidisciplinary and early-intervention framework is essential to optimize prevention, diagnosis, treatment, and long-term outcomes in pediatric CMV infections.

Background: Listeria monocytogenes infection during pregnancy remains an underrecognized cause of severe neonatal disease, frequently leading to central nervous system (CNS) involvement with high mortality and long-term neurological sequelae. Case presentation: We report a case series of four neonates with confirmed neonatal listeriosis and neurological complications, managed in a tertiary neonatal intensive care unit (NICU). Clinical features, microbiological findings, neuroimaging, treatments, and outcomes were analyzed. Our cases presented with early-onset disease and severe clinical courses, including sepsis, meningitis, ventriculitis, hydrocephalus, and seizures. Neuroimaging revealed extensive CNS injury, ranging from intraventricular hemorrhage to multiloculated hydrocephalus. Outcomes varied from near-normal neurodevelopment to profound neurological impairment, despite appropriate antimicrobial therapy. A narrative review of previous cases of neonatal listeriosis was also performed to contextualize our findings. Conclusions: Neonatal listeriosis remains associated with severe neurological morbidity. Early recognition, advanced neuroimaging, multidisciplinary management, and preventive maternal strategies are essential to improve outcomes.

(1) Background: Zinc is an essential micronutrient involved in immune regulation, epithelial barrier integrity, and the host response to bacterial infections. However, the clinical benefits of zinc supplementation across different age groups remain uncertain, with heterogeneous findings and variable dosing strategies reported in the literature. (2) Objectives: To map and summarize randomized controlled trials (RCTs) evaluating zinc supplementation (either as treatment or prophylaxis) for bacterial infection outcomes in neonates, children, and adults, and to identify gaps requiring further research, including the use of zinc-based nanoparticles. (3) Eligibility Criteria: We included English-language RCTs that evaluated zinc supplementation and reported clinical outcomes related to bacterial infections. Observational studies, trials without infection-related outcomes, and studies not involving human participants were excluded. (4) Sources of Evidence: A MEDLINE (PubMed) search was conducted from 2000 to 1 November 2025 using predefined keywords related to zinc supplementation, neonates, children, adults, and bacterial infections. Reference lists of eligible articles were screened to identify additional studies. (5) Charting Methods: Data were charted for each included study, including population characteristics, zinc dosing and regimen, type of supplementation (therapeutic or prophylactic), main infection-related outcomes, and key findings. Data charting was performed independently and verified within the research team. (6) Results: A total of 51 RCTs were included: 10 in neonates, 32 in children, and 9 in adults. In neonates, therapeutic zinc supplementation as an adjunct to antibiotics showed heterogeneous results, with some studies reporting reductions in morbidity, inflammatory markers or mortality, while others found no significant differences in clinical outcomes. In children, zinc supplementation consistently reduced the duration and severity of diarrheal episodes and, in several trials, improved the resolution of respiratory infections. In adults, the evidence was limited but suggested potential benefits in selected populations, such as burn patients or those with zinc deficiency or immunologic dysfunction. Variability in zinc dosage, treatment duration, and outcome definitions limits direct comparison across studies. (7) Conclusions: Zinc supplementation appears to provide benefits in neonates and children, whereas evidence in adults remains mixed and inconclusive. Standardized, well-powered RCTs are needed to define optimal dosing strategies, identify populations most likely to benefit, and clarify the mechanisms underlying zinc’s anti-infective effects. Future research should consider the use of zinc oxide nanoparticles (ZnO-NPs) demonstrated broad-spectrum antimicrobial activity and potential synergy with antibiotics, although clinical data remain still limited.

Background/Objectives: Edwardsiella tarda is a rare Gram-negative pathogen that uncommonly infects humans. Neonatal infections are extremely rare but often severe, with a high incidence of central nervous system (CNS) complications. Case presentation: We report a term neonate born via spontaneous vaginal delivery who developed systemic signs of infection within 18 h of life. Blood and cerebrospinal fluid (CSF) cultures grew Edwardsiella tarda. CSF analysis revealed severe meningoencephalitis. Maternal stool culture was also positive for E. tarda, suggesting vertical transmission. Despite initial systemic antibiotic therapy with ampicillin, gentamicin, and ceftriaxone, neuroimaging revealed progressive multifocal brain abscesses. The infant underwent a series of neurosurgical procedures, including bilateral drainage of abscesses, Rickham reservoir placement and ventriculoperitoneal shunting. A revised antibiotic regimen, including systemic meropenem and trimethoprim-sulfamethoxazole plus intrathecal gentamicin, was administered. At six months, the infant showed mild motor delay with lower limb hypertonia and was under close neurosurgical and developmental follow-up. Methods: We conducted a literature review of 12 published neonatal E. tarda infections, including our case. Results: Most infected infants presented within 72 h of life and exhibited CNS involvement. Mortality was 25%, and 44% of survivors experienced long-term neurologic sequelae. Conclusions: Edwardsiella tarda infection in neonates is rare but potentially devastating. Early suspicion, culture confirmation, aggressive antibiotic therapy, and multidisciplinary care, including neurosurgical management, are essential for improving outcomes.

Candida viswanathii has been sporadically reported in Asia and South America but not in Europe. This study reports the first European outbreak of C. viswanathii in a paediatric hospital, outlining diagnostic challenges and containment measures. Fifteen C. viswanathii isolates were recovered from blood cultures of consecutive pediatric patients admitted to intensive care units between April and August 2025. Identification was performed using MALDI-TOF MS, chromogenic media, Fourier-transform infrared (FT-IR) spectroscopy, and whole-genome sequencing (WGS). Antifungal susceptibility testing was performed by broth microdilution. All isolates were initially misidentified as C. tropicalis by MALDI-TOF MS and undetected by the FilmArray BCID2 panel. WGS confirmed C. viswanathii, and FT-IR analysis revealed clonally related strains, indicating an outbreak. Colonies displayed a distinct deep-blue color on chromogenic CHROMagar™ medium. Elevated fluconazole minimum inhibitory concentrations were observed, while isolates remained susceptible to echinocandins and amphotericin B. A multidisciplinary infection-control response halted transmission within four weeks. This investigation documents the first C. viswanathii outbreak in Europe, highlighting diagnostic limitations of current commercial tools and the need for updated databases. Integration of FT-IR spectroscopy and WGS facilitated outbreak detection and containment, underscoring the importance of advanced diagnostics and surveillance for emerging fungal pathogens.

Background: Congenital syphilis (CS) remains a global public health concern, with rising incidence even in high-income countries. In Italy, a higher risk has been reported among primigravidae and younger mothers with late or missed prenatal screening. While neurological involvement in CS is well known, it is rarely reported in preterm infants, where it may be severe and atypical. Case presentation: A male preterm infant, delivered at 32 weeks via emergency cesarean due to abnormal fetal monitoring and breech position, was admitted to our NICU with intraventricular hemorrhage, midline shift, and hydrocephalus, requiring neurosurgery. He later developed a metaphyseal bone lesion; Staphylococcus aureus was found in blood cultures. Despite antibiotics, persistent thrombocytopenia and infectious symptoms led to further testing, revealing congenital syphilis with neurological involvement and osteomyelitis and osteochondritis of the distal ulna and radio from an undetected maternal treponemal infection during pregnancy. Penicillin therapy produced slow recovery, but the newborn developed epilepsy and spastic tetraplegia by 24 months. Genetic and metabolic tests were negative. Literature review rarely shows similar CS cases, especially in preterm infants. Conclusion: This case highlights the relevance of universal maternal syphilis screening and early neonatal evaluation. Maternal Treponema pallidum infection during pregnancy can result in preterm birth and may be associated with neurological complications, such as hemorrhages, seizures, and motor impairment, which can require multidisciplinary management and long-term follow-up.

Background: Antimicrobial therapies used for treating group B streptococcus (GBS) early-onset sepsis (EOS) provide insight into clinicians’ adherence to antimicrobial stewardship (AMS) guidelines. Methods: We reviewed antimicrobial therapies given to treat newborns with GBS-EOS. Data were obtained from an Italian surveillance network (including 35 birthing centers) and were prospectively collected from 1 January 2003 to 31 December 2024. Empiric and definitive therapies were classified as adequate and inadequate. Results: There were 967,054 live births and 200 cases of GBS-EOS, of which 43 (21.5%) were preterm and 157 (78.5%) were full-term; 35 (17.5%) out of 200 showed no signs of illness. Fourteen (7.0%) died (one full-term and thirteen preterm newborns under 34 weeks of gestation). Based on the available information, antibiotics were adequate in 106/137 (77.4%) empiric and 48/119 (40.3%) definitive therapies. The duration of antibiotic courses did not differ between severe (median 10 days, IQR 8.0–14.0) and non-severe cases (median: 10 days; IQR: 10.0–12.5; p = 0.68). Antibiotic treatments lasted ≥ 15 days in 34 (20.1%) out of 169 cases with available information. Conclusions: In this large Italian multicenter study, deviations from international recommendations in antimicrobial therapies for GBS-EOS were critical. Our findings underscore the importance of timely antimicrobial de-escalation and the need to avoid excessively prolonged courses of antimicrobials.

Sepsis remains the second cause of death among neonates after the pathological consequences of extreme prematurity. In this review we summarized knowledge about pathogens causing early-onset sepsis (EOS) and late-onset sepsis (LOS), the role of perinatal risk factors in determining the EOS risk, and the tools used to reduce unnecessary antibiotics. New molecular assays could improve the accuracy of standard blood cultures, providing the opportunity for a quick and sensitive tool. Different sepsis criteria and biomarkers are available to date, but further research is needed to guide the use of antibiotics according to these tools. Beyond the historical antibiotic regimens in EOS and LOS episodes, antibiotics should be based on the local flora and promptly modulated if specific pathogens are identified. The possibility of an antibiotic lock therapy for central venous catheters should be further investigated. In the near future, artificial intelligence could help us to personalize treatments and reduce the increasing trend of multidrug-resistant bacteria.