Erika Rigotti

Background/Objectives: Sleep-disordered breathing (SDB) is a primary concern in children’s health. Research suggests that repeated oxygen drops during sleep—common in SDB—may harm the brainstem’s breathing control centres. This damage likely occurs through oxidative stress, inflammation, and cell death, which weaken the brain’s ability to regulate breathing. Over time, these effects could lead to functional changes (e.g., disrupted chemical signalling) and physical damage in critical brain regions, creating a cycle of unstable breathing. However, much of this evidence comes from animal or lab studies, leaving gaps in our understanding of how these mechanisms work in humans. This review synthesises existing research on how breathing disruptions during sleep—particularly episodes of intermittent hypoxia—affect the brain’s ability to control respiration in children and adolescents. Methods: We analysed studies from medical databases PubMed, Scopus, and Web of Science, focusing on how SDB (obstructive or central sleep apnoea) impacts the brain’s respiratory centres in young populations. Animal studies and research involving children on mechanical ventilation were excluded to focus on natural sleep patterns. Results: After removing duplicates, 54 studies remained. Additionally, 43 record were excluded for various reasons. Ultimately, 11 articles were selected for the final analysis, including three that focused on genetic conditions, such as Down syndrome, Prader–Willi syndrome, and Pierre Robin sequence. The findings suggest that repeated oxygen dips during sleep may harm the brainstem’s respiratory control areas, especially during critical developmental stages. This damage could lead to long-term issues, such as unstable breathing, cardiovascular strain, or neurological problems. However, most studies only captured the immediate effects of low oxygen, leaving uncertainty about permanent harm due to a lack of long-term follow-up. Conclusions: Repeated oxygen deprivation during sleep appears to damage the brainstem and disrupt breathing regulation. However, small study sizes and short observation periods limit the strength of these conclusions. Future research should use advanced imaging tools to clarify long-term risks, develop effective treatments, and track children over extended periods. More significantly, longer-term studies are urgently needed to guide clinical care for vulnerable populations.

Background/Objectives: Sleep-disordered breathing (SDB) is a primary concern in children's health. Research suggests repeated oxygen drops during sleep—common in SDB—may harm the brainstem's breathing control centres. This damage likely occurs through oxidative stress, inflammation, and cell death, which weaken the brain's ability to regulate breathing. Over time, these effects could lead to functional changes (e.g., disrupted chemical signalling) and physical damage in critical brain regions, creating a cycle of unstable breathing. However, much of this evidence comes from animal or lab studies, leaving gaps in our understanding of how these mechanisms work in humans. This review synthesises existing research on how breathing disruptions during sleep—particularly episodes of intermittent hypoxia—affect the brain's ability to control respiration in children and adolescents. Methods: We analysed studies from medical databases PubMed, Scopus and WebOfScience, focusing on how SDB (obstructive or central sleep apnea) impacts the brain's respiratory centres in young populations. Animal studies and research involving children on mechanical ventilation were excluded to focus on natural sleep patterns. Results: After removing duplicates, 53 studies remained. Finally, 8 studies were reviewed, 2 focused on obstructive sleep apnea (OSA), where breathing is blocked by airway collapse; 6 examined central sleep apnea (CSA), where the brain fails to signal breathing, including studies on newborns (3) and infants (3). In addition, three studies on children with genetic conditions, like Down syndrome, Prader-Willi Syndrome and Pierre Robin sequence, were included. The findings suggest that repeated oxygen dips during sleep may harm the brainstem's respiratory control areas, especially during critical developmental stages. This damage could lead to long-term issues, such as unstable breathing, cardiovascular strain, or neurological problems. However, most studies only captured the immediate effects of low oxygen, leaving uncertainty about permanent harm due to a lack of long-term follow-up. Conclusions: Repeated oxygen deprivation during sleep appears to damage the brainstem and disrupt breathing regulation. However, small study sizes and short observation periods limit the strength of these conclusions. Future research should use advanced imaging tools to clarify long-term risks, develop effective treatments and track children over extended periods. More significant, longer-term studies are urgently needed to guide clinical care for vulnerable populations.

Background/Objectives: The field of paediatric bioethics addresses ethical issues in paediatric care, where parental authority often guides medical decisions, but children’s preferences should also be considered. Promoting ethical awareness among minors can help them understand complex issues. This study aimed to analyse how sociodemographic, educational, and experiential factors shape adult perspectives on paediatric bioethical issues, particularly concerning pain and death. Methods: A questionnaire was developed to collect adult views of bioethical issues. The online questionnaire was disseminated via e-mail or WhatsApp. It started with an initial group of known individuals and then expanded hierarchically to include contacts of friends. Participants completed an online questionnaire, and data were analysed using SPSS version 22.0 for Windows. Clustering analysis identified two distinct groups. Results: This research focused on Italian adults (N = 889) aged 18 and over. Cluster 1, predominantly female (78.3%) and more highly educated (38.6% with postgraduate degrees), exhibited greater experience with paediatric bioethical issues (81.1%). This group favoured a collaborative approach, supporting shared training among adults (92.3%) and advocating for gradually addressing bioethical issues during childhood (84.3%). Cluster 2, with a higher proportion of males (31.5%) and parents (75.1%), showed lower educational levels (3.0% with middle school education) and less experience with bioethical concerns (93.5%). This group preferred a reactive, situation-specific approach to these issues. Conclusions: This study showed two distinct adult profiles regarding how they approach paediatric bioethics. The first group adopts a preventive and collaborative strategy, while the second group is more reactive and situation-driven. These findings can guide the development of tailored educational programmes to improve discussions about sensitive topics such as pain, incurability, and death in paediatric care.

Background/Objectives: Level 1 autism spectrum disorder (ASD) is a neurodevelopmental condition characterised by challenges in social and communication skills. Despite these difficulties, individuals with level 1 ASD often exhibit average intelligence and typical language development. Improving socialisation skills in this population requires tailored approaches that address their specific needs and include targeted strategies. This study aims to evaluate the effectiveness of a structured social skills training programme for adolescents and young adults with level 1 ASD. Methods: Participants diagnosed with level 1 ASD, regardless of gender, were consecutively recruited from an outpatient clinic. The intervention involved activities from the Social Skills, Autonomy, and Awareness Module, specifically designed for adolescents and young adults. Sessions were conducted fortnightly, lasting 1.5 to 3 h each, over 17 months. Adaptive behaviour was assessed using the Vineland Adaptive Behaviour Scales (VABS) at baseline and after completing the programme. Data were analysed with SPSS version 22.0 (SPSS Inc., Chicago, IL, USA). Statistical methods included automatic clustering to identify optimal clusters and Pearson’s Chi-square and Fisher’s exact tests to evaluate variable distributions among the clusters. Results: A total of 31 participants (77.4% female) with a mean age of 20.1 years (SD = 7.0) were included in the study. Two distinct clusters emerged. Cluster 1 (n = 8) had significantly higher mean ages and baseline Vineland II socialisation scores than Cluster 2 (n = 23). Both clusters demonstrated significant improvements in social skills following the intervention. Conclusions: This study highlights distinct profiles within individuals with level 1 ASD, showing a clear link between age and social skill development. The intervention improved social skills for most participants, regardless of the age at which treatment began. For some individuals, alternative or augmented treatment strategies may be necessary to achieve optimal results.

Background/Objectives: The field of paediatric bioethics addresses ethical issues in paediatric care, where parental authority often guides medical decisions, but children's preferences should also be considered. Promoting ethical awareness among minors can help them understand complex issues. This study aimed to analyse how sociodemographic, educational, and experiential factors shape adult perspectives on paediatric bioethical issues, particularly concerning pain and death. Methods: A questionnaire was developed to collect adult views of bioethical issues. Participants completed an online questionnaire, and data were analysed using SPSS version 22.0 for Windows. Clustering analysis identified two distinct groups. Results: The research focused on Italian adults (N=889) aged 18 and over. Cluster 1, predominantly female (78.3%) and more highly educated (38.6% with postgraduate degrees), exhibited greater experience with paediatric bioethical issues (81.1%). This group favoured a collaborative approach, supporting shared training among adults (92.3%) and advocating for gradually addressing bioethical issues during childhood (84.3%). Cluster 2, with a higher proportion of males (31.5%) and parents (75.1%), showed lower educational levels (3.0% with middle school education) and less experience with bioethical concerns (93.5%). This group preferred a reactive, situation-specific approach to these issues. Conclusions: The study showed two distinct adult profiles regarding how they approach paediatric bioethics. The first group adopts a preventive and collaborative strategy, while the second group is more reactive and situation-driven. These findings can guide the development of tailored educational programs to improve discussions about sensitive topics such as pain, incurability, and death in paediatric care.

Background/Objectives: Autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and Tourette syndrome (TS) are neurodevelopmental disorders (NDDs) with overlapping symptoms, suggesting a partially shared genetic origin. This study investigates the prevalence of connective tissue-related conditions in individuals with ASD, ADHD, or TS. Methods: A questionnaire was administered to families of 120 individuals with ASD, ADHD, or TS, collecting sociodemographic data and examining 10 types of disorders affecting various organs and systems. Statistical analyses were performed using STATA 16.0, with the significance level set at 5%. Results: Among the 120 patients, 48 had ASD, 36 had ADHD, and 36 had TS. Flat feet were significantly more common in individuals with ASD (52.1%; OR 7.20; p < 0.001), ADHD (52.8%; OR 6.73; p = 0.001), and TS (38.9%; OR 3.70; p = 0.034) compared to controls (13.6%). Hypersensitivity was more frequent in individuals with ASD (56.3%; OR 5.90; p = 0.001), ADHD (50.0%; OR 4.11; p = 0.011), and TS (58.3%; OR 5.35; p = 0.003) compared to controls (18.2%). Myopia and ptosis were more common in ADHD (30.6%). There was a possible trend towards orthodontic device use in TS (OR 3.20; p = 0.076). Flat feet and hypersensitivity were also common in fathers (31.0% and 36.4%, respectively), mothers (31.0% and 15.2%), and patients (43.8% and 55%). Conclusions: The findings of this study highlight the significant associations between ASD, ADHD, and TS and specific physical symptoms, such as flat feet, sensory hypersensitivity, and other connective tissue-related manifestations. The familial prevalence of these symptoms suggests a potential genetic underpinning, further supporting the hypothesis of shared aetiological pathways. These insights underscore the need for interdisciplinary research to explore the mechanisms linking neurodevelopmental and connective tissue disorders, aiming to improve diagnosis and management strategies.

Background/Objectives: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition requiring personalised therapeutic approaches. This study evaluated the effectiveness of Equine-Assisted Activities and Therapies (EAATs) in 86 children with varying ASD severity levels (levels 1–3). Methods: Vineland Adaptive Behaviour Scales and the Parenting Stress Index were used. Between May 2022 and October 2023, participants completed 20 weekly sessions of 45 min each, tailored to their individual needs. Results: Children with level 3 ASD demonstrated greater challenges in communication (level 1: 67.1 ± 29.0 vs. level 3: 30.0 ± 12.6; p < 0.001), daily living skills (81.0 ± 26.8 vs. 42.6 ± 18.1; p < 0.001), and socialisation (72.2 ± 23.2 vs. 37.3 ± 14.2; p < 0.001). Parental distress was higher in cases of greater ASD severity. Nevertheless, significant improvements were observed across the entire cohort in daily living skills (58.3 ± 25.5 vs. 67.8 ± 29.0; p = 0.023), with particularly notable outcomes in children with level 1 ASD (65.7 ± 26.9 vs. 81.0 ± 26.8; p = 0.010). While increases in socialisation were noted among children with level 1 ASD, these were not statistically significant (p = 0.073). Conclusions: EAAT fosters improvements in daily living skills, particularly in children with level 1 ASD, and has a positive impact on socialisation. For children with more severe ASD, targeted interventions are required.

Background/Objectives: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition requiring personalised therapeutic approaches. This study evaluated the effectiveness of Equine-Assisted Activities and Therapies (EAAT) in 86 children with varying ASD severity levels (levels 1–3). Methods: Vineland Adaptive Behaviour Scales and the Parenting Stress Index were used. Between May 2022 and October 2023, participants completed 20 weekly sessions of 45 minutes each, tailored to their individual needs. Results: Children with level 3 ASD demonstrated greater challenges in communication (level 1: 67.1 ± 29.0 vs. level 3: 30.0 ± 12.6; p < 0.001), daily living skills (81.0 ± 26.8 vs. 42.6 ± 18.1; p < 0.001), and socialisation (72.2 ± 23.2 vs. 37.3 ± 14.2; p < 0.001). Parental distress was higher in cases of greater ASD severity. Nevertheless, significant improvements were observed across the entire cohort in daily living skills (58.3 ± 25.5 vs. 67.8 ± 29.0; p = 0.023), with particularly notable outcomes in children with level 1 ASD (65.7 ± 26.9 vs. 81.0 ± 26.8; p = 0.010). While increases in socialisation were noted among children with level 1 ASD, these were not statistically significant (p = 0.073). Conclusions: EAAT fosters improvements in daily living skills, particularly in children with level 1 ASD, and has a positive impact on socialisation. For children with more severe ASD, targeted interventions are required.

Background/Objectives: Autism Spectrum Disorders (ASD), attention deficit hyperactivity disorder (ADHD), and Tourette Syndrome (TS) are neurodevelopmental disorders (NDD) with overlapping symptoms suggesting a partially shared genetic factor. This study investigates the prevalence of connective tissue-related conditions in individuals with ASD, ADHD, or TS. Methods: A questionnaire was administered to families of 120 individuals with ASD, ADHD, or TS, collecting sociodemographic data and examining 10 types of disorders affecting various organs and systems. Statistical analyses were performed using STATA 16.0, with a significance level set at 5%. Results: Among the 120 cases, 48 had ASD, 36 had ADHD, and 36 had TS. Flat feet were significantly more common in individuals with ASD (52.1%; OR 7.20; p<0.001), ADHD (52.8%; OR 6.73; p=0.001), and TS (38.9%; OR 3.70; p=0.034) compared to controls (13.6%). Hypersensitivity was more frequent in individuals with ASD (56.3%; OR 5.90; p=0.001), ADHD (50.0%; OR 4.11; p=0.011), and TS (58.3%; OR 5.35; p=0.003) compared to controls (18.2%). Myopia and ptosis were more common in ADHD (30.6%). There was a possible trend towards orthodontic device use in TS (OR 3.20; p=0.076). Flat feet and hypersensitivity were also common in fathers (31.0% and 36.4%, respectively), mothers (31.0% and 15.2%), and patients (43.8% and 55%). Conclusions: These results suggest common aetiopathogenetic factors, with connective tissue anomalies potentially underlying different clinical phenotypes. Further studies are warranted.