Alessandra Salvatori

(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.

The introduction of universal prophylaxis with nirsevimab for all children in their first epidemic season has substantially reduced the burden of respiratory syncytial virus (RSV). However, a small number of breakthrough infections continue to occur despite immunization, mostly in previously healthy infants, and these cases remain incompletely characterized. We conducted a retrospective study across three epidemic seasons at a third-level hospital, including 536 RSV-positive children under 12 months of age hospitalised for bronchiolitis. Immunised infants with breakthrough infection showed a higher prevalence of prematurity and comorbidities than unimmunised infants, and were more frequently represented in the 9–12-month age group, with a median of 291 days since nirsevimab administration. Immunised infants had significantly lower odds of requiring supplemental oxygen (aOR 0.33, 95% CI 0.19–0.57, p < 0.001). However, once oxygen therapy was required, immunisation status did not independently predict the need for advanced ventilatory support. Severe breakthrough cases requiring invasive mechanical ventilation occurred even among infants without traditional risk factors. These findings confirm the substantial real-world impact of universal nirsevimab prophylaxis while underscoring the need for continued clinical vigilance and further research into the mechanisms underlying breakthrough disease.

Pediatric allergic and obstructive respiratory diseases are a leading cause of chronic childhood morbidity. Passive tobacco smoke exposure (TSE) is one of the most prevalent and preventable indoor pollutants affecting children, while oxidative stress is increasingly recognized as a key mechanism linking tobacco smoke exposure to airway inflammation. This systematic review critically evaluated the evidence connecting passive TSE to oxidative stress pathways in pediatric airway disease and integrated it into a “second oxidative hit” hypothesis. Following PRISMA 2020 guidelines, PubMed and MEDLINE were searched to identify studies assessing passive TSE, oxidative or antioxidant biomarkers, and respiratory outcomes in children. Of the 77 records identified, four studies met the inclusion criteria. Across the available evidence, passive TSE was associated with increased lipid peroxidation, NOX2 activation, oxidative–inflammatory signaling, depletion of antioxidant defenses, oxidative DNA damage, and impairment of redox-sensitive corticosteroid-response pathways, although findings were not uniform across studies. Clinically, passive TSE children showed persistent allergic rhinitis, greater wheezing severity, poorer asthma control and reduced corticosteroid responsiveness. Despite limited and heterogeneous evidence, the findings provide a biological rationale for a testable “second oxidative hit” hypothesis, whereby passive TSE, combined with a pre-existing inflammatory environment in the airways associated with the underlying disease, could produce an additional oxidative burden. Further prospective studies integrating standardized oxidative biomarkers and objective exposure assessment are needed to validate this hypothesis, and establish temporal and causal relationships, potentially supporting more targeted preventive and personalized strategies.

The recent implementation of preventive strategies against Respiratory Syncytial Virus (RSV) in infants has raised questions about potential changes in RSV

Background: Rapid etiological diagnosis of bacterial meningitis is crucial in children, as delays can lead to neurological sequelae. The BioFire FilmArray Meningitis/Encephalitis (ME) panel is widely used on cerebrospinal fluid (CSF), but its target spectrum may miss healthcare-associated or multidrug-resistant pathogens. We evaluated the diagnostic performance and stewardship-oriented clinical impact of off-label BioFire FilmArray Blood Culture Identification 2 (BCID2) testing on CSF from pediatric patients with suspected bacterial CNS infection and negative ME results. Methods: We retrospectively analyzed CSF samples collected between January 2023 and March 2025 at a tertiary pediatric hospital. In ME-negative cases with persistent suspicion and abnormal CSF parameters, BCID2 was performed off-label on residual CSF aliquots after routine testing, without additional sampling. We assessed pathogen detection, agreement with culture, resistance-gene identification, and documented stewardship actions. Results: Among 76 ME-negative CSF samples tested with BCID2, 23 (30.3%) were positive, all involving organisms not included in the ME panel. BCID2 was concordant with culture in 19/23 cases (82.6%); 4/23 (17.4%) were BCID2-positive/culture-negative, consistent with reduced culture sensitivity in frequently pretreated cases. Resistance genes (VIM, vanA/B, CTX-M) were detected in 30.4% of BCID2-positive samples. Overall agreement with culture was 94.7% (PPA 100%, NPA 93.0%). Escalation was documented in 13/23 episodes (56.5%), discontinuation in 2/23 (8.7%), and confirmation in 9/23 (39.1%), with no de-escalation events; clinical outcomes were not systematically available. Conclusions: In selected ME-negative pediatric cases with abnormal CSF profiles, BCID2 testing on residual CSF provided rapid, clinically meaningful microbiological information that may support antimicrobial optimization.

Early recognition of paediatric poisoning is crucial for timely intervention in emergency settings. This study aims to assess the epidemiological and clinical profiles of paediatric patients presenting with neurological features due to acute poisoning. Data from children less than 18 years of age admitted to the emergency department of a tertiary paediatric hospital in Rome between 2017 and 2023 were retrospectively reviewed. Clinical variables associated with admission were reported and analysed across the entire study sample and stratified by age group. Logistic regression models were built to assess the association between clinical and/or laboratory signs and hospitalization in the whole study sample and stratified by age. A total of 276 children developed neurological features and were included in the study. The median age was 15.6 years (IQR: 14.0-16.7 years), with most patients being female. Ethanol was the single most frequently ingested xenobiotic (39.5%). The most commonly observed neurological feature was altered consciousness (74.3%). Most patients (56.9%) were graded as minor neurologically on the International Programme on Chemical Safety/European Association of Poison Centres and Clinical Toxicologists Poisoning Severity Score. Patients more than 10 years of age were significantly (P = 0.017) more frequently females (62.6%) and were significantly (P = 0.001) more likely to have a psychiatric co-morbidity (41.0%) than patients less than 10 years of age (4.1%). In patients more than 10 years of age, 55% of patients ingested a xenobiotic for recreational reasons, whereas none did in those less than 10 years of age (P = 0.001). The main predictor of hospitalization in patients more than 10 years of age was suicidal intent (odds ratio: 10.17; P = 0.001). While no specific neurological feature predicted hospitalization, ingestion of lithium, antipsychotics, and benzodiazepines increased the likelihood of admission. Female adolescents had higher rates of intentional poisoning, often linked to suicidal intent. Altered consciousness is the most common neurological feature in paediatric poisoning but is not directly linked to hospitalisation. While neurological symptoms are important in assessment, factors such as suicidal intent, mode of emergency access, and age are stronger predictors of hospitalization and should be prioritized in the initial evaluation.

Aims: Obstructive sleep apnea (OSA) affects up to 40% of children and adolescents with obesity and is linked to hyperinsulinism. However, the mechanisms underpinning this association remain unclear. The study aims to assess the three key determinants of hyperinsulinemia: insulin clearance, secretion, and sensitivity in paediatric patients with OSA. Methods: We enrolled 70 Children with obesity and suspected OSA who performed a nocturnal polygraphy to confirm OSA diagnosis and a 3‐hour OGTT to assess glucose homeostasis. Mild OSA was defined for 1 < AHI ≤ 5, moderate–severe OSA as AHI >5. Insulin secretion rate (ISR) was estimated using C‐peptide deconvolution. Basal and total insulin clearance during OGTT were calculated. Whole‐body insulin sensitivity was evaluated with the Matsuda Index (WBISI), while hepatic insulin resistance index (HIRI) was calculated based on the AUCs of plasma glucose and insulin during the initial 30 minutes of OGTT. Results: A total of 36 children had mild OSA and 34 had moderate–severe OSA. The latter group showed reduced insulin clearance during OGTT ( p = 0.008) and higher HIRI ( p = 0.03). Basal insulin clearance ( p = 0.07), ISR ( p = 0.34), beta‐cell glucose sensitivity ( p = 0.53), and WBISI ( p = 0.56) were similar between the two groups. OSA severity negatively correlated with fasting insulin clearance ( r = −0.29, p = 0.01) and OGTT insulin clearance ( r = −0.32, p = 0.007) and positively correlated with HIRI ( r = 0.29, p = 0.02). Conclusion: Moderate–severe OSA in children with obesity is associated with impaired insulin clearance and hepatic insulin sensitivity. These factors may contribute to hyperinsulinism in paediatric OSA.

Background: Allergy to Alternaria alternata (Alt a), although often underdiagnosed, is a significant global health issue. In the allergen immunotherapy (AIT) field, novel therapeutic strategies are emerging, particularly with the advent of polymerized allergoids. This study aims to evaluate the efficacy of subcutaneous immunotherapy (SCIT) based on these innovative molecules in children with respiratory allergies, assessing clinical and functional parameters. Methods: We enrolled 42 patients aged between 6 and 16 years, all of whom had allergic rhinitis (AR) and concomitant asthma and all of whom were monosensitized to Alt a. Between December 2020 and December 2021, 17 patients initiated SCIT with Modigoid^® for Alt a1, while 25 patients continued with standard therapy. At the initial visit (T0), all the patients underwent nasal and bronchial evaluation, including exhaled nitric oxide (eFeNO) measurement and spirometry. The Asthma Control Test (ACT) was used to evaluate the control of asthma symptoms. Patients were followed up every 6 months, with a comprehensive re-evaluation at 24 months (T1) replicating the initial assessments. Results: After 24 months of SCIT with the new polymerized molecular allergoid Alt a1 (Modigoid^®), children showed a statistically significant reduction in eFeNO levels, improved FEV1 values, and enhanced ACT scores. Conclusions: SCIT with the new molecular allergoid Alt a1 significantly improves functional parameters (FEV1 and eFeNO) and subjective asthma symptoms (ACT scores) in children with AR and objective asthma signs. This treatment represents an effective preventive strategy that can be used to halt the progression of the classic atopic march from AR to asthma and potentially reverse the atopic march.

Background. Allergy toward the dust mite is steadily increasing on the European continent. This sensitization may be a risk factor for developing sensitization to other mite molecules such as tropomyosin Der p 10. This molecule often correlates with food allergy and the risk of anaphylaxis after ingesting mollusks and shrimps. Materials and Methods. We analyzed the sensitization profiles by ImmunoCAP ISAC of pediatric patients from 2017 to 2021. The patients under investigation were being followed for atopic disorders such as allergic asthma and food allergies. The study aimed to analyze the prevalence of sensitization toward Der p 10 in our pediatric population and assess the related clinical symptoms and reactions after ingestion of foods containing tropomyosins. Results. This study included 253 patients; 53% were sensitized toward Der p 1 and Der p 2; 10.4% were also sensitized to Der p 10. Assessing patients sensitized to Der p 1 or Der p 2, and Der p 10, we observed that 78.6% were affected by asthma ( ) and had a history of prior anaphylaxis after ingestion of shrimp or shellfish ( ). Conclusion. The component-resolved diagnosis gave us a deeper understanding of patients’ molecular sensitization profiles. Our study showed that a fair proportion of children sensitive to Der p 1 or Der p 2 are also sensitive to Der p 10. However, many patients sensitized to all three molecules had a high risk of asthma and anaphylaxis. Therefore, the assessment of Der p 10 sensitization should be considered in atopic patients with sensitization to Der p 1 and Der p 2 to avoid encountering possible adverse reactions after ingesting foods containing tropomyosins.

The prevalence of allergic rhinitis is rising, and it is impacting children’s growth and quality of life. To uncover unconventional treatment modalities, research was carried out to clarify the significance of novel components in the pathophysiology of allergic rhinitis. One of these elements was gut microbiota, which plays a crucial role in the development and evolution of allergic disorders. Specifically, dysbiosis, defined as impaired microbiota composition, characterizes allergic disorders. In light of this concept, probiotics (beneficial bacteria) may restore gut dysbiosis, rebalance the immune response, and indirectly influence the clinical course of allergic diseases. In this article, we discussed the role of the gut–lung axis in children and reported on new findings. We also reviewed the most relevant studies about probiotics in patients with allergic rhinitis.