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Introduction: COVID-19 infection is said to be generally a milder disease in children, compared to adults, and is associated with much lower case-fatality rates. Objective of this study was to find out the clinical characteristics and outcome of COVID-19-positive children and also the differences between the first and the second waves, if any. Methodology: This was a retrospective study done in the Department of Paediatrics of a tertiary care teaching hospital. Departmental and hospital medical records were reviewed to assess the clinical characteristics, disease severity and outcome of all COVID-19-positive admitted children from May 2020 to September 2021 (the first wave from May 2020 to January 2021 and the second wave from April 2021 to September 2021). Data analyses were done in Microsoft® Excel® 2010. Results: Out of total 560 COVID-19-positive children attending the hospital during the study period, 266 children (76 in the first wave and 190 in the second wave) were admitted. The majority of the children (25%) were in the age group of 1-6 months during the first wave, while in the second wave the majority of the children (27.9%) were in the age group of 5-10 years. The most common presenting complaint was fever (51.1%), followed by cough (13.9%). Co-morbidities were present in 23.3% of cases. Asymptomatic, mild, moderate, severe and critical cases were 16.5%, 51.9%, 18.4%, 6.4% and 6.8%, respectively. The case fatality ratio was 3.75% (21/560) among all positive cases. Ventilator support was required in only 10.1% of cases. There were some significant differences between the 2 waves regarding age distribution, disease severity, outcome and some presenting complaints. Conclusions: The majority of the COVID-19 in­fections were either asymptomatic or of mild variety. Males suffered more than females. The admission rate was higher in the second wave but death was higher in the first wave, indicating higher infectiousness and milder nature of the disease in the second wave. Most of the deaths occurred within 24 hours of admission, indicating that late admission may be an important risk factor for mortality. Except for age distribu­tion, severity and outcome, other parameters were comparable between the first and the second wave.

Objectives: The ability of mothers to accurately predict the presence of fever in their children using the tactile method is still controversial. This study evaluated the accuracy of Iraqi mothers’ tactile fever detection in children under 5 during COVID-19 pandemic. Materials and methods: Interviews were conducted with 200 mothers whose children were under the age of 5 years and who assumed they had fever. Each mother was then asked to touch her child’s body for fever evaluation, while an investigator observed them, recorded their responses, and documented the places of palpation. Thereafter, the investigator determined the child’s temperature using a non-contact temple thermometer (NCTT). Statistical analysis was conducted to compare the maternal tactile approach to NCTT and single site to multiple site palpation in terms of sensitivity, specificity, and predictive values. Results: The prevalence of fever in the study sample was 72%, as 144 of the 200 children involved were confirmed to have fever by NCTT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the maternal tactile method were 96.5%, 62.5%, 86.9%, and 87.5%, respectively. Multiple child body sites were palpated by 42.5% of mothers, whereas 57.5% palpated a single site, with the forehead being the most common palpated site (31%). Multiple site palpation had a significantly lower incorrect temperature assessment rate than single site palpation (3.5% vs. 27%, p = 0.00001). Additionally, the accuracy increased significantly when the mother palpated multiple sites (96.5% vs. 73%). Conclusion: The findings of this study suggest that mothers’ use of tactile assessment is an effective screening tool when assessing their children’s fever; however, mothers’ fears can reduce the accuracy of this method, whereas instructing the mother to palpate multiple body parts can increase its reliability.

Specialist facilities for children are still unavailable in some Sub-Saharan African contexts. It is the case of pediatric urology, whose recent advances are still largely unshared. Prenatal diagnosis of urinary abnormalities (CAKUT) is largely unknown. Early recognition and referral of Undescended testis (UDT), Hypospadia, bladder exstrophy epispadias complex, ambiguous genitalia, stone disease, and tumours are uncommon in rural areas. Missed diagnosis is not uncommon and delayed management is associated with poor outcomes. We present a cross-sectional, descriptive study about the epidemiology of Pediatric urological admissions to three sub-Saharan East African Hospitals. All the urological cases between 0-18 years referred to three distinct East African Hospitals over 124 weeks were considered. Prevalence of different groups of diseases, age, and mode of presentation were reported. We found 351 cases (M/F 127/24) out of 2543 surgical referrals (13%). Seventy percent of cases were Hypospadias and UDT. Fifty percent of UDT were beyond 6, and most Hypospadias were between 4 and 7 yrs. CAKUT had a very low prevalence (4.84%), and about 50% of Wilms Tumours came too late to be resectable. In many African contexts, urology is still a tiny portion of the pediatric surgical workload compared to the 25% of European and American reports. There are also differences in the epidemiology of genitourinary conditions. A hidden burden of diseases may be presumed, remaining undiagnosed due to the shortage of specialist facilities.

Selected Lectures of the 3rd S.I.P.Ped. International Congress • QUALITY OF LIFE AND ASSISTANCE OF MINOR WITH CHRONIC DISEASE: FROM PRE-BIRTH TO ADOLESCENCE • Milan (Italy) • November 29th - December 1st, 2022 LECT 1. THE EXPERIENCE OF PEDIATRIC PSYCHOLOGY IN MATERNAL AND CHILD DEPARTMENT • G. Perricone, C. Polizzi (Palermo, Italy) LECT 2. PEER RELATIONSHIPS AND ADOLESCENTS WITH CHRONIC DISEASE • A.M. La Greca (Coral Gables, FL, USA) LECT 3. PARENTAL ETHNOTHEORIES AND CHILD CARING IN MIGRANT FAMILIES • G.G. Valtolina (Milan, Italy) LECT 4. THE CENTRALITY OF THE CHRONIC CHILD IN ACCOMPANIMENT TO TREATMENT • G. Ragni, P. Becherucci, M. Lo Giudice, M. Picca (Latina, Florence, Palermo and Milan, Italy) LECT 5. THE PEDIATRIC PSYCHOLOGIST IN DERMATOLOGICAL CHRONICITY. MULTIDISCIPLINARY WORK EXPERIENCE IN THE CLINIC OF ATOPIC DERMATITIS • A. Dattolo (Rome, Italy) LECT 6. COULD THE NUTRITION OF THE PREGNANT WOMAN PREVENT DIFFERENT FORMS OF CHRONICITY? • F. Caturano (Turin, Italy) LECT 7. QUALITY OF LIFE AND CARE OF A CHILD WITH CHRONIC PATHOLOGY: FROM PRE-NATAL LIFE TO ADOLESCENCE • F. Monti (Bologna, Italy) LECT 8. TO CARE OF THE MINOR WITH NEURODEVELOPMENTAL DISORDERS IN THE TRANSITION TO THE ADULT PHASE • M.R. Morales (Varese, Italy) LECT 9. THE POWER OF EPIGENETICS IN PERINATALITY • V. Fanos (Cagliari, Italy)

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Postoperative pain presents several challenges in pediatric Minimally Invasive Surgery. The Faces, Legs, Activity, Cry, and Consolability (FLACC) scale is a valid scale for pediatric postoperative pain. The aim of our study was to assess postoperative pain using FLACC scale and to analyze the correlation between FLACC scale score and analgesic requirement in children underwent Minimally Invasive Surgery. We retrospectively analyzed data of 153 children aged 2 months-3 years who underwent Minimally Invasive Surgery in our unit from January 2019 and December 2019. Postoperative pain assessment was established using FLACC scale. In each patient were analyzed the correlation between FLACC score and analgesic requirement. Pain evaluation was assigned immediately after surgery and at 15 and 60 minutes. 36.6% of patients (56 children) were asleep so considered pain free; 21.6% of patients (33 children) had a FLACC score more than 7 so they required analgesics and the pain assessment 15 and 60 minutes after was significantly lower. 41.8% of patients (64 children) had a postoperative FLACC score less than 3, so they didn’t require any analgesic treatment. On the basis of our results, we recommend FLACC scale for postoperative pain assessment in children underwent MIS aged 2 months-3 years. FLACC scale is an effective and precise scale in detection of postoperative analgesic requirement in children and it could be extended in different age groups with further research.

Management of pediatric Primary Spontaneous Pneumothorax (PSP) is controversial and based on guidelines on adults. Therapeutic strategies include: observation, needle aspiration, chest drain, or surgery. We aimed to assess: i) differences in the management of PSP in pediatric vs. adult departments; ii) risk of recurrence associated to each therapeutic choice; iii) management of “large” pneumothorax (i.e. >3cm at the apex on chest X-Ray); iv) role of CT scan in addressing the treatment. We reviewed all PSP treated at Pediatric Surgery Unit (PSU) and Thoracic Surgery Unit for adults (TSU) in a 10-year period (2011 to 2020). We included a total of 42 PSP: 30/42 1st episodes and 12/42 recurrences. Among the 30/42 1st episodes, 15/30 were managed in the PSU and 15/30 in the TSU. Observation was significantly most common among PSU patients (9/15, 60%) vs. TSU cases (1/15, 6.7%; p=0.005]. Chest drain placement was reduced in PSU (3/15, 20%) vs. TSU (12/15, 80%; p=0.002). Observational was associated with a reduced risk of recurrence (0/10, 0%) compared to chest drain (7/15, 46.7%; p=0.01). Management of 20/42 “large” pneumothorax was: 4/20 (20%) observation, 10/20 (50%) chest drain, 2/20 (10%) needle aspiration, 4/20 (20%) surgery. Twentythree/ 29 PSP (79.3%) underwent CT-scan after the first episode. Bullae were detected in 17/23 patients and 5/17 (29.4%) had seven episodes of recurrence. PSP patients treated by PSU were more likely to receive clinical observation. Those managed by TSU were mostly treated by chest drain. Observation seems an effective choice for clinically stable PSP, with low risk of recurrence at a mid-term follow-up. CT-scan seems not to detect those patients at higher risk of recurrence.

Background: Simple febrile seizures are a common condition among children aged 6 months to 5 years. Many studies have been conducted on the risk factors for recurrence, while few studies have investigated the risk factors for the first simple febrile seizure. Our aim was to evaluate the risk factors of the first simple febrile seizure among children in Mosul City, Iraq. Methods: This case-control study was conducted in a pediatric teaching hospital from January to May 2020 and included 120 patients who were admitted to the hospital with a first attack of simple febrile seizure; 120 age-matched children with febrile illnesses, but without seizures, were considered as controls. The cases and controls were compared to identify risk factors. A questionnaire interview with each parent/guardian, as well as necessary investigations, was performed. Odds ratios and t-tests were used for statistical analyses. Results: Upper respiratory tract infection was the most common cause of fever in patients and controls. Nearly half of the patients were less than 2 years old. Significant associations were noted between young age, family history, bottle feeding, low hemoglobin levels, low birth weight, cesarean section, prenatal exposure to paternal smoking, and the first episode of simple febrile seizure. Conclusion: Young age, artificial formula feeding, low hemoglobin levels, prenatal exposure to cigarette smoking, low birth weight, and cesarean section are likely risk factors for the first simple febrile seizure in Mosul City. To reduce the incidence of first simple febrile seizure, we recommend avoiding these possible risk factors.

Pilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative techniques are available options for the treatment of this pathology, but the ideal technique is still debatable. Analyzing the literature we found out that more recently minimally invasive approaches have been described. In particular, the mechanism of an endoscopic approach relies on the use of the endoscope without cutaneous tissue damage. Advantages include shorter operative time and time to discharge, which impact resource management in both primary and secondary care: patients undergoing endoscopic technique have a high satisfaction rate, probably due to the low level of postoperative pain and early return to daily activities. Published results of studies of newer approaches have demonstrated a lower short and long-term complication rate compared to open surgery. However, very poor reports are available in literature about pediatric population.

Importance: This systematic review could serve as a comprehensive synthesis that would benefit parents, educators, therapists, policymakers, and researchers in identifying the advantages and disadvantages of screen time (ST) on key developmental outcomes of children, specifically socio-emotional functions (SEF), executive functions (EF), cognition, language, and motor skills. Objectives: To comprehensively review the current state of literature to examine the association of the effects of ST on several developmental outcomes; to analyze the methodological quality of included studies to facilitate appraisal of evidence strength. Methods: A systematic search across EBSCO, ScienceDirect, PubMed Central, and Scopus was accomplished to identify both peer-reviewed and gray literature that reported on the association between ST and varying developmental outcomes. A chronological restriction (studies published between January 2000 and March 2020) was implemented. Inclusion criteria were studies that had participants from 0 to 9 years old, measured duration of ST, explored the effects of any of the aforementioned outcomes, and were observational studies by design (i.e., cross-sectional, cohort, case-control). Meta-analysis was not done due to clinical heterogeneity. Results: The narrative synthesis included 85 studies (from 16 countries) which had cross-sectional (n = 47), cohort (n = 36), and case-control (n = 2) designs. The majority of the studies had good (n = 16) to fair (n = 59) methodological quality. ST was generally associated with poorer SEF, EF, cognitive and motor development. Less than half of language studies supported the negative effect of ST. However, its positive effects were observed in certain conditions: (1) implementation of time limit on ST use, (2) parental co-viewing, and (3) exposure to educational content. Conclusion and relevance: The findings support the reduction of ST in children and further substantiate the American Academy of Pediatrics recommendations. The results also highlight the roles of parents and caregivers as it shows that digital media could be used as a tool to improve the development of children, given that certain conditions are met. Further research could be done on the positive effects of ST given the aforementioned conditions and the appropriate dosage of ST use.

Background: Type 1 diabetes mellitus is a chronic autoimmune endocrine and metabolic disease which frequently occurs during infancy and childhood. Self-monitoring of blood glucose (SMBG) is of utmost importance to achieve good glycemic control. Common side effects of SMBG in children are pain, discomfort, skin induration, and reduced tactile sensitivity; moreover, SMBG does not allow continuous glycemic monitoring. The more recent introduction of much less invasive devices for continuous glucose monitoring (CGM) has indeed reduced procedure-related pain and discomfort, and allowed real-time glycemic monitoring. Methods: From the beginning of May to the end of September 2019, we conducted a survey by means of a two-section (children/parents) questionnaire, aimed at assessing the impact of CGM on children affected by type 1 diabetes mellitus and their families, referring to the Pediatric Diabetes outpatient clinic at Guglielmo da Saliceto Hospital in Piacenza, Italy. Results: The vast majority (80%) of children reported that the placement of the glycemic sensor is much less painful than fingertip multiple capillary punctures, as with traditional SMBG. Likewise, 90% of parents think that the use of CGM devices allowed a remarkable improvement of glycemic control, with regard either to the reduction of hypo- and/or hyper-glycemic episodes or to glycated hemoglobin (HbA1c) level. Moreover, 89% of parents believe that the use of glycemic sensors has led to a sharp improvement in children’s quality of life. According to children, school and sport are the two areas with the most evident improvement of their quality of life; less anxiety, high comfort and better glycemic control, particularly when not at home, have been indicated as major benefits. Conclusions: According to our data, the use of CGM devices can significantly improve the quality of life of type 1 diabetic children and their families.

In this paper, we describe the history of the 17 International Workshops on Neonatology and Pediatrics held in Cagliari, Italy, which saw the overall presence of about 11,500 participants. Some of the world’s most renowned specialists from more than 60 countries have been present in Cagliari in these years. They have created a network of scientific and human relations that have changed, improved and enriched us all. In 2019 the meeting was followed by the 40th Congress of the Union of Middle-Eastern and Mediterranean Pediatric Societies (UMEMPS), founded 60 years ago. In 2020, due to the COVID-19 pandemic, the meeting was virtual. Also this year, the meeting will be virtual. The title of this year’s Workshop, “The future is now”, underscores the trajectory that assistance, research and teaching will follow in the coming years, in an integrated way with Adult Medicine, taking into account what happened or is still going to happen. These advances are strictly related to children’s future, to their health in terms of new therapies and prevention.

Introduction: Brief resolved unexplained events (BRUE) occur during infancy. It is characterized by one or more symptoms, including skin color change, shortness of breath and unresponsiveness. Laryngomalacia is the most frequent cause of stridor in infants and results in the collapse of the supraglottic structures during inspiration and intermittent obstruction of the upper airways. To our knowledge, the relationship between BRUE and laryngomalacia has been little investigated. Methods: The medical records of 448 children (age < 12 months) treated for BRUE between July 2011 and March 2018 and followed up until March 2020 were retrospectively reviewed. Endoscopic evaluation was performed using a flexible fibrolaryngoscope. All patients underwent a brief polysomnography and 24-h cardiorespiratory monitoring. Cardiorespiratory and oxygen saturation monitoring was continued at home; 94% of patients underwent follow-up. Results: Laryngeal fiberoptic endoscopy revealed laryngomalacia in 11% of children with a clinical history of BRUE. Laryngomalacia was associated with obstructive/mixed apnea in 67%. Home cardiorespiratory monitoring showed a gradual reduction in the number of respiratory events during follow-up and complete resolution of laryngomalacia in 88% of patients. Conclusions: This is the first report that showed follow-up data from cases of BRUE with laryngomalacia. The improvement in laryngomalacia alone, although not complete, was sufficient to improve obstructive events.

Detecting the risks for hospital-acquired malnutrition in children can be performed by using nutritional screening tools. One of the screening tools that has been created is Alarm Malnutrition. This study aimed to test the sensitivity and specificity of Alarm Malnutrition in detecting the risks for hospitalacquired malnutrition in comparison to Screening Tool for the Risk on Nutritional status and Growth (STRONGkids). This study employed cross sectional design and involved 168 hospitalized children (1 month to 18 years) at pediatric ward. The data were analyzed using diagnostic approach which resulted in sensitivity and specificity values. The statistical tests showed that the sensitivity and specificity values of Alarm Malnutrition and STRONGKids were 32,2% and 81,6% respectively. These results indicated that this screening tool was not better than STRONGkids which has been previously used in Indonesia. Alarm Malnutrition needs to be developed and improved in order to achieve better performance in detecting the risks for hospital-acquired malnutrition.

COVID-19 pandemic has had deep negative impacts on mental health on both adults and children, leading to increased diagnosis of mental disorders, somatic symptoms and reactive disorders. Since emotional stress often underlies urological behavioral disorders, such as extraordinary daytime urinary frequency (EDUF), pediatricians need to be trained in “catching the symptoms” in order to achieve a proper diagnosis and to offer adequate support both to patients and their families.

The aim of the study was to investigate how Non- Pharmacological Techniques (NPT), in addition to standard pharmacological techniques, can help to manage and reduce the preoperative anxiety of children waiting for Day Surgery procedures (DS). Isola Serena activity started in 2008 to manage the preoperative time of children waiting for surgery in the playing room. The latter is run by a pedagogist. NPT includes use of games and toys, readings and drawings. A descriptive and comparative study was conducted on 50 children, aged 4 to 12 years, randomly assigned to Isola Serena group ISG and control group CG. All children received standard pharmacological techniques, while those of the ISG also received the NPT. The evaluation of the preoperative anxiety level (modified Yale Preoperative Anxiety Scale) and parent’s coping style (Coping Inventory for Stressful Situation) compared the two groups. The ISG showed a significantly lower level of preoperative anxiety than the CG. Parents’ coping style was not related to the preoperative anxiety. The activity performed in the Isola Serena Project resulted to be effective for the reduction of preoperative anxiety in children undergoing DS procedures.

We present the case of an eight-year-old boy who was referred to our Clinic with acute abdomen. After ultrasound, which showed a perforated appendix, an urgent appendectomy was initiated. When the peritoneum was opened, the abdomen was full of pus. The appendix was positioned retrocecal and subhepatic, extensively coupled with the ascendant colon. Partial omentectomy and appendectomy were performed. On the tenth postoperative day, a contrast-enhanced ultrasound (CEUS) was performed. A subcapsular lesion of the right liver lobe of 30 mm diameter was observed. It was a liver abscess. Three weeks after intravenous therapy (clindamycin/gentamicin, piperacillin/tazobactam), the abscess has completely regressed.

The ongoing pandemic is the result of the spread of a recently identified Coronavirus, named SARS-CoV-2 (Severe Acute Respiratory Syndrome – Coronavirus – 2). Since 31th December 2019, when the first cluster was reported in Wuhan (China), the global Novel COronaVIrus Disease 2019 (COVID-19) cases significantly increased, and on 12th March 2020, the WHO Director declared the disease as pandemic. As of April 28th 2020, 2.982,688 cases and 210,193 deaths were reported globally. The aim of this article is the analysis of the main epidemiological characteristics of the current pandemic: transmission, basic reproduction number (R0), incubation period, global, European and Italian confirmed cases and deaths, focusing on the paediatric population.

The dramatic and rapid widespread of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is causing millions of infected subjects and thousand of deaths worldwide. The current global goal is to mitigate or suppress the burden of COronaVIrus Disease 2019 (COVID-19) and to adopt effective targeted therapies. Laboratory tests include molecular diagnostics and viral antigens recognition for the identification of SARS-CoV-2 in human biological materials, serologic methods for detecting serum antibodies against SARS-CoV-2 and routine blood and urine tests. Many molecular tests, mainly based on real-time polymerase chain reaction (RT-PCR), have been developed after the publication of the SARS-CoV-2 full-length genome sequence; several factors may affect their accuracy, including inadequate sample collection, thermal inactivation, viral load, and cross-reactivity. In-vitro diagnostic (IVD) companies have developed serologic methods optimized on high throughput analytical platforms; however very few methods currently detect IgM and the accurate quantitative measurement of antibodies are not still ready. Sensitivity and specificity require robust validation; point of care (POC) lateral flow immunochromatographic assays are far to be highly sensitive and specific and data obtained by these methods should be evaluated with caution. The effectiveness of serologic tests depends on the appropriateness of test request too. Routine biochemical data in adults with COVID-19 reveal alterations of various tests, including lymphopenia, thrombocytopenia, hypoalbuminemia, and serum elevation of several biomarkers, including D-dimer, ferritin, C-reative protein (CRP), cytokines. Cardiac troponins and N-terminal pro-brain natriuretic peptide (NT-pro BNP) are predictors of adverse outcome and death. Vertical transmission of SARS-CoV-2 has been not yet demonstrated exhaustively. Regrettably, in pregnant women, newborns and children with COVID-19, very limited and confusing data hamper a definitive conclusion on the value of routine laboratory tests. Emerging opportunities arise from the introduction of microbiomics, metabolomics, and pharmacometabolomics for improving patient’s care and outcome.

Selected Abstracts of the 15th International Workshop on Neonatology and the 40th Congress UMEMPS (Union of Middle-Eastern and Mediterranean Pediatric Societies); Cagliari (Italy); October 24th-26th, 2019 • Children of the Middle-Eastern and Mediter­ranean area: we can do better! ABS 1 • THE TUBULAR DAMAGE MARKERS – NETRIN-1 IN PRETERM NEWBORNS • M. Kamianowska, M. Szczepański, N. Chomontowska, A. Wasilewska (Bialystok, Poland) ABS 2 • CYTOMEGALOVIRUS INFECTION IN THE FIRST DAYS OF LIFE: PREVALENCE IN THE SOUTH SARDINIA FROM 2016 TO 2019 • M. Loddo, A. Scano, S. Fais, G. Serreli, G. Orrù, F. Coghe (Cagliari, Italy) ABS 3 • THE EDUCATIONAL NEED FOR PEDIATRIC FOREIGN BODY AIRWAY OBSTRUCTION AMONG NURSERY AND PRIMARY SCHOOL TEACHERS. A PRELIMINARY STUDY • I. Piras, G. Piras, A. Murgia, P. Isoni, G. Melis (Cagliari and Sassari, Italy) ABS 4 • DOES LEAD (Pb) CONTENT OF LIPSTICKS POSE A HEALTH RISK TO CHILDREN? AN EXPOSURE AND RISK ASSESSMENT IN TURKISH COSMETIC MARKET • A. Berkkan, D.M. Öztaş, O.K. Ulutaş (Ankara, Turkey) ABS 5 • PRENATAL DETECTION OF CENTRAL NERVOUS SYSTEM MALFORMATIONS: OUR MULTIDISCIPLINARY APPROACH • M. Paudice, C.M. Biatta, G. Scaglione, C. Ferrari, C. Massarotti, C.R. Gaggero, L. Peñuela, E. Fulcheri, V.G. Vellone, P. De Biasio (Genoa, Italy) ABS 6 • EARLY DIAGNOSIS OF KLIPPEL-FEIL SYNDROME WITH EXTRA-SKELETAL ANOMALIES, A CASE REPORT • E. Cavallaro, F. Fordiani, S. Ferraresi, P. Amistà, C. Fanni, C. Loddo, C. Lorenzetto, F. Marino, G. Passarella, F. Rigon, D. Padrin, A. Mussari, C. Marcellino, S. Rugolotto (Padua and Rovigo, Italy) ABS 7 • SHOULD SOMATOSTATIN BE USED AS FIRST-LINE AGENT IN MANAGEMENT OF CONGENITAL CHYLOTHORAX? • T.M. William (London, UK) ABS 8 • ENAMEL HYPOPLASIA IN COELIAC CHILDREN: AN EPIDEMIOLOGICAL STUDY • A. Sinesi, S. Cefola, R. Francavilla, G. Orrù, C. Casu (Canosa di Puglia, Barletta, Bari and Cagliari, Italy) ABS 9 • METABOLOMICS IN PATENT DUCTUS ARTERIOSUS: PROPOSAL FOR A PROSPECTIVE STUDY • F. Bardanzellu, F. Mecarini, V. Fanos, P. Neroni (Cagliari, Italy) ABS 10 • LONG-TERM OUTCOMES AND VERY LOW BIRTH WEIGHT: A 16 YEARS EXPERIENCE IN THE NICU OF A.O.U FEDERICO II IN NAPLES • M. Vendemmia, G. Mansi, S. Salomè, A. Romano, L. Capasso, S. Ferraioli, C. Colinet, C. Coppola, F. Raimondi (Naples, Italy) ABS 11 • THE IMPORTANCE OF THE PRESENCE OF OLIGOSACCHARIDES IN MATERNAL MILK: METABOLOMIC RESULTS IN A CASE STUDY OF 80 SAMPLES • A. Lussu, S. Corbu, F. Cesare Marincola, V. Fanos, A. Dessì (Cagliari, Italy) ABS 12 • IMPACT OF HTST PASTEURIZATION OF HUMAN MILK ON THE KINETIC OF DIGESTION OF MACRONUTRIENTS AFTER IN VITRO DYNAMIC DIGESTION • S. Sottemano, G. Maiocco, S. Nebbia, M. Giribaldi, O. Ménard, D. Dupont, A. Deglaire, L. Cavallarin, A. Coscia, E. Bertino (Grugliasco and Turin, Italy; Rennes, France) ABS 13 • CHRONIC INTUSSUSCEPTION DUE TO INFLAMMATORY FIBROID POLYP IN CHILD: A CASE REPORT • L. Chiusaroli, F. Stefanachi, F. Marino, F. Rigon, G. Passarella, C. Loddo, C. Fanni, C. Lorenzetto, C. Ficociello, M. Cananzi, S. Rugolotto (Padua and Rovigo, Italy) ABS 14 • SUPRAVENTRICULAR TACHYCARDIA: IS IT A RISK FACTOR FOR NECROTIZING ENTEROCOLITIS? • F. Mecarini, A. Reali, F. Bardanzellu, P. Totaro, A. Dessì, P. Neroni, V. Fanos (Cagliari, Italy) ABS 15 • DRESS IN AN EPILEPTIC BOY • F. Stefanachi, E. Cavallaro, F. Marino, C. Loddo, C. Fanni, F. Rigon, C. Lorenzetto, G. Passarella, S. Rugolotto (Padua and Rovigo, Italy) ABS 16 • PLACENTAL HISTOPATHOLOGY OF DICHORIONIC DIAMNIOTIC TWIN PREGNANCIES IN RELATION TO INTRAUTERINE GROWTH RESTRICTION AND PERINATAL OUTCOME • G. Scaglione, C.M. Biatta, M. Paudice, C. Toma, C. Calcagno, C.R. Gaggero, F. Buffelli, E. Fulcheri, V.G. Vellone, P. De Biasio (Genoa, Italy) ABS 17 • RETROSPECTIVE STUDY INVESTIGATING THE MANAGEMENT OF PATENT DUCTUS ARTERIOSUS IN NEONATES BORN BEFORE 28 WEEKS OF GESTATIONAL AGE: THE CAGLIARI EXPERIENCE • R. Zucca, F. Bardanzellu, P. Neroni, F. Cau, F. Mecarini, V. Fanos (Cagliari, Italy) ABS 18 • PERSISTENT LEFT SUPERIOR VENA CAVA WITHOUT RIGHT SUPERIOR VENA CAVA IN A NEWBORN • G. Passarella, F. Stefanachi, L. Chiusaroli, F. Marino, C. Loddo, C. Fanni, F. Rigon, C. Lorenzetto, C. Ficociello, E. Reffo, S. Rugolotto (Rovigo and Padua, Italy) ABS 19 • TRAUMATIC OPEN GLOBE INJURY IN A CHILD: A CASE REPORT • B. Mangiola, A. Paratore, L. Chiusaroli, F. Stefanachi, F. Marino, F. Rigon, G. Passarella, C. Loddo, C. Fanni, C. Lorenzetto, C. Ficociello, S. Rugolotto (Rovigo and Padua, Italy) ABS 20 • A QUALITY IMPROVEMENT INTERVENTION TO DECREASE HYPOTHERMIA IN PRETERM NEONATES • S. Ferraioli, L. Capasso, J. Cerullo, M. Vendemmia, L. Lepore, C. Grande, C. Coppola, M. Palma, C. Coline, F. Wiedemann, F. Raimondi (Naples, Italy) ABS 21 • THE CURIOUS CASE OF AN UNPLANNED OUT-OF-HOSPITAL BIRTH OF A NEWBORN WHO WAS ABANDONED AFTERWARD IN A GRAVEYARD • F. Stefanachi, L. Chiusaroli, F. Marino, F. Rigon, G. Passarella, C. Loddo, C. Fanni, C. Lorenzetto, C. Ficociello, R. Mattei, S. Rugolotto (Padua, Rovigo and Adria, Italy) ABS 22 • IS RENAL SCINTIGRAPHY ACCURATE ENOUGH TO DIAGNOSE CONGENITAL SOLITARY KIDNEY? EVALUATION OF PRELIMINARY DATA • F. Guerra, M. Rossano, G. Boz, V. Manca, P. Guglielmo, M. Boero, G. Masnata (Cagliari, Italy) ABS 23 • OVERVIEW OF SOLITARY FUNCTIONING KIDNEY: ANALYSIS OF SARDINIAN POPULATION • F. Guerra, G. Boz, M. Rossano, V. Manca, P. Guglielmo, M. Boero, G. Masnata (Cagliari, Italy) ABS 24 • USE OF VACUUM ASSISTED THERAPY IN LLA INFANT WITH ECTIMA: A CASE REPORT • L. Cara, A. Nonnis, A.B. Aru, P. Pistis, R. Mura (Cagliari, Italy) ABS 25 • CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT (CAKUT): POSTNATAL MANAGEMENT OF URINARY TRACT DILATION • M.L. Giua Marassi, V. Manca, G. Masnata (Cagliari, Italy) ABS 26 • BAD PLACENTA, BAD BRAIN: MATERNAL CHORIOAMNIONITIS ASSOCIATED WITH PRETERM DELIVERY AND INTRAVENTRICULAR HEMORRHAGE • F. Mecarini, C. Gerosa, R. Pintus, V. Marinelli, G. Faa, M. Testa, V. Fanos, C. Betti (Cagliari, Italy) ABS 27 • USE OF ACID SUPPRESSIVE DRUGS IN CHILDREN AND ADOLESCENTS: A SINGLE CENTER EXPERIENCE • G. Cheri, C. Locci, M.G. Clemente, G. Sotgiu, R. Antonucci (Sassari, Italy) ABS 28 • ROTAVIRUS ACUTE GASTROENTERITIS IN HOSPITALIZED CHILDREN: A SINGLE CENTER EXPERIENCE • A. Spano, A.M. Oggiano, M.G. Clemente, G. Sotgiu, R. Antonucci (Sassari, Italy) ABS 29 • URINARY METABOLOMICS IN TERM NEWBORN RELATED TO NUTRITION AND BIRTH WEIGHT: CLINICAL RECORDS • L. Deriu, F. Cesare Marincola, S. Corbu, V. Fanos, A. Dessì (Cagliari, Italy) ABS 30 • OCT-4 IS HIGHLY EXPRESSED IN STEM/PROGENITOR CELLS AND PRIMORDIAL FOLLICLES OF THE HUMAN FETAL OVARY • F. Cau, D. Fanni, M.C. Botta, C. Gerosa, S. Aversa, E. Sorrentino, F. Ronchi, C. Bellan, G. Faa, M. Castagnola (San Gavino Monreale, Cagliari, Siena and Rome, Italy) ABS 31 • CDX2 EXPRESSION IN THE DEVELOPING HUMAN GUT: AN IMMUNOHISTOCHEMICAL STUDY • V. Aimola, C. Gerosa, G. Cerrone, M.S. Piga, G. Senes, R. Murru, M. Scartozzi, G. Faa (Cagliari, Italy) ABS 32 • PLACENTAL MESENCHYMAL DYSPLASIA IN BECKWITH-WIEDEMANN SYNDROME: A CASE REPORT • C. Rossi, M.L. Lai, C. Gerosa, E. Di Felice, V. Fanos, I. Murgianu, F. Birocchi, G. Faa, A. Ravarino (Cagliari, Italy; Philadelphia, PA, USA) ABS 33 • OVERVIEW OF FEDERATED FACILITY TO HARMONIZE AND ANALYZE DATA IN COHORTS • H.S.M. Rajula, V. Odintsova, M. Manchia, V. Fanos (Cagliari, Italy; Amsterdam, the Netherlands; Moscow, Russia; Halifax, NS, Canada) ABS 34 • TUBULAR ADENOMA OF THE BREAST IN A 15-YEAR-OLD GIRL • G. Cerrone, V. Aimola, D. Fanni, C. Gerosa, G. Faa, A. Ravarino (Cagliari, Italy) ABS 35 • PULMONARY CAPILLARY HEMANGIOMATOSIS IN A NEWBORN: A CASE REPORT • G. Cerrone, V. Aimola, G. Masnata, V. Marinelli, M. Testa, F. Coghe, G. Faa, V. Fanos, C. Gerosa (Cagliari, Italy) ABS 36 • HYDROPS DUE TO FETAL TACHYCARDIA: A CLINICAL CASE • D.A. Agostino, R. Thomasset, B. Minervini, A. Di Paolo (Rome, Italy) ABS 37 • ADMISSION LABORATORY TESTING ON UMBILICAL CORD BLOOD HELPS TO REDUCE BLOOD TRANSFUSIONS IN VERY PREMATURE INFANTS • N. Mense-Dietrich, N. Wonko, K. Kalaniti, S. Daspal, V.M. Samedi (Saskatoon, SK, Canada) ABS 38 • COMPATIBILITY OF DEXMEDETOMIDINE AND TOTAL PARENTERAL NUTRITION AT NEONATAL INTENSIVE CARE UNIT: SINGLE CENTRE EXPERIENCE • V. Samedi, H. Hodqson, S. Daspal, L. Givelicheian, W. Bingham, K. Kalaniti (Saskatoon, SK, Canada) ABS 39 • NOTCH ACTIVATION IN BILIARY ATRESIA • M.G. Clemente, F. Parolini, R. Frassetto, N. Muresu, G. Boroni, G. Satta, V. Doneddu, M.A. Pinna, G. Galleri, R. Manetti, A. Dessanti, L. Bercich, V. Villanacci, A. Piana, F. Tanda, K.B. Schwarz, R. Antonucci, D. Alberti (Sassari and Brescia, Italy; Baltimore, MD, USA) ABS 40 • ACYL-COENZYME A BINDING PROTEIN (ACBP) EXPRESSION IN HUMAN FETUSES • G. Pinna, C. Gerosa, M. Piras, M. Piludu, J.S.A. Zanda, G. Senes, M. Murru, F. Cau, T. Congiu, Y. Gibo, M. Castagnola, G. Faa (Cagliari and Rome, Italy; Matsumoto, Japan) ABS 41 • STEM/PROGENITOR CELLS IN THE DEVELOPMENT OF THE INTERVERTEBRAL DISC FROM THE HUMAN NOTOCHORD: AN IMMUNOHISTOCHEMICAL STUDY • M. Piras, M. Piludu, C. Betti, M. Castagnola, G. Faa, A. Maleci, P. Van Eyken, T. Congiu (Cagliari and Rome, Italy; Leuven, Belgium) ABS 42 • FROM TWO-DIMENSIONAL TO THREE-DIMENSIONAL: OBSERVATION OF HISTOLOGICAL PREPARATIONS THROUGH SCANNING ELECTRON MICROSCOPY • T. Congiu, M. Piras, M. Piludu, C. Gerosa, G. Faa (Cagliari, Italy) ABS 43 • ACYL COA BINDING PROTEIN IS HIGHLY EXPRESSED IN THE HUMAN FETAL BRAIN DURING DEVELOPMENT • J.S.A. Zanda, G. Pinna, C. Gerosa, G. Senes, R. Murru, A. Ravarino, F. Coghe, G. Faa, M. Castagnola (Cagliari and Rome, Italy) ABS 44 • PLACENTAL CHANGES DUE TO KLEBSIELLA PNEUMONIAE INFECTION: A CASE REPORT • V. Vallascas, A. Pintus, M. Angiolucci, V. Fanos, B. Pinna, D. Gariel, F. Cioglia, G. Faa, F. Coghe (Cagliari, Italy) ABS 45 • MORNING FRACTIONAL EXHALED NITRIC OXIDE IN CHILDREN WITH RECURRENT DESATURATION IN SLEEP • L. Nosetti, M.V. Cairati, M. Agosti, G. Piacentini, M. Zaffanello (Varese and Verona, Italy) ABS 46 • SERUM VITAMIN D, AGE, AND PHYSICAL CHARACTERISTICS ARE PREDICTORS OF ACUTE BRONCHIOLITIS IN INFANTS • M. Zaffanello, M. Piazza, L. Tenero, G. Lippi, G. Piacentini (Verona, Italy) ABS 47 • THE PANAYIOTOPOULOS SYNDROME • M. Vendemmia, G. Parisi, S. Vendemmia (Naples, Vasto and Aversa, Italy) ABS 48 • THE ENGEL’S LEGACY, A GENTLE REVOLUTION IN MEDICINE: FROM THE BIOMEDICAL MODEL TO THE PRECISION MEDICINE • G. Parisi, V. Fanos, S. Vendemmia, R. Pintus, M. Vendemmia (Vasto, Cagliari, Aversa and Naples, Italy) ABS 49 • PERINATAL OUTCOMES AMONG REFUGEES IN A TERTIARY HOSPITAL IN GREECE • G. Mitsiakos, D. Gialamprinou, F. Chatzigrigoriou, A. Karagkiozi, E. Lazaridou, I. Chatziioannidis, E. Papacharalampous, V. Soubasi (Thessaloniki, Greece) ABS 50 • NECROTIZING ENTEROCOLITIS IN VERY LOW BIRTH WEIGHT INFANTS (VLBWI): A CASE CONTROL STUDY • E. Papacharalampous, I. Chatziioannidis, E. Lazaridou, P. Karagianni, G. Katsaras, V. Soubasi, G. Mitsiakos (Thessaloniki, Greece) ABS 51 • CHORIOAMNIONITIS ASSOCIATED WITH IMMATURITY OF THE LUNG, KIDNEY, AND ABORTION. A CASE REPORT • A. Pintus, C. Betti, V. Marinelli, V. Zurrida, G. Palmas, M. Angiolucci, G. Faa (Cagliari, Italy) ABS 52 • 1H-NMR METABOLOMICS ANALYSIS OF CONVENTIONAL AND ORGANIC FORMULA MILK: PRELIMINARY RESULTS • S. Corbu, R. Pintus, A. Dessì, M. Puddu, V. Fanos, F. Cesare Marincola (Cagliari, Italy) ABS 53 • CAN NATURE HELP US IN THE AUTISM SPECTRUM DISORDERS? • S. Vendemmia, G. Parisi, A.M. Basilicata, M. Vendemmia (Aversa, Vasto, Benevento and Naples, Italy) ABS 54 • PERSISTENCE AND COARCTATION OF THE V AORTIC ARCH, ATRESIA OF THE IV ARCH • P. Neroni, F. Bardanzellu, A. Andronache, A. Giamberti, F. Cioglia, D. Manus, V. Fanos, M. Chessa (Cagliari and San Donato Milanese, Italy) ABS 55 • OVERVIEW OF CAPICE – CHILDHOOD AND ADOLESCENCE PSYCHOPATHOLOGY: UNRAVELING THE COMPLEX ETIOLOGY BY A BROAD INTERDISCIPLINARY COLLABORATION IN EUROPE – AN EU MARIE SKŁODOWSKA-CURIE INTERNATIONAL TRAINING NETWORK • H.S.M. Rajula, M. Manchia, K. Agarwal, W.A. Akingbuwa, A.G. Allegrini, E. Diemer, S. Doering, E. Haan, E.S. Jami, V. Karhunen, M. Leone, L. Schellhas, A. Thompson, M. Mauri, V. Fanos, M. Bartels, C.M. Middeldorp (Cagliari, Italy; Halifax, NS, Canada; Enschede, Amsterdam and Rotterdam, The Netherlands; London and Bristol, UK; Gothenburg, Solna and Stockholm, Sweden; Brisbane, Australia) ABS 56 • SARDINIAN MUTATION T338I: A "MILD" FORM OF CYSTIC FIBROSIS • D. Congiu, D. Manunza, F. Mascia, C. Angioni, M. Zanda (Cagliari, Italy) ABS 57 • ANALYSIS OF CARDIOTOCOGRAPHIC PATTERNS AND NEONATAL OUTCOMES IN VACUUM DELIVERY AND EMERGENCY CESAREAN SECTION • E. Corvetto, S. Sorrentino, A. Daniilidis, D. Deiana, M.N. D’Alterio, S. Angioni (Cagliari, Italy; Thessaloniki, Greece) ABS 58 • INCIDENCE AND INDICATION FOR SURGERY IN RELATION WITH ROBSON’S CLASSIFICATION IN A SINGLE TERTIARY HEALTH CARE CENTER: A PROSPECTIVE COHORT STUDY • M.N. D’Alterio, G. D’Ancona, S. Sannia, A. Daniilidis, C. Giuliani, M. Russo, S. Angioni (Cagliari, Italy; Thessaloniki, Greece) ABS 59 • IS SPORTOMICS USEFUL TO EVALUATE METABOLIC RESPONSES AND TO PREVENT INJURIES IN PROFESSIONAL SOCCER PLAYERS? POTENTIAL INTEREST IN PEDIATRICS • T. Bongiovanni, R. Pintus, F. Cesare Marincola, S. Corbu, A. Dessì, A. Noto, V.C. Francavilla, G. Corsello, V. Fanos (Parma, Cagliari and Palermo, Italy) ABS 60 • AN EARLY DIAGNOSIS OF CLASSIC CONGENITAL ADRENAL HYPERPLASIA • V. Esposito, M. D’Anna, L. Bufalo, A. Verde, V. Gaeta, E. Scarpato, M. Vendemmia, F. Raimondi (Naples, Italy) ABS 61 • EFFECT OF NONINVASIVE RESPIRATORY SUPPORT ON FEEDING TOLERANCE IN PRETERM VLBW INFANTS • C. Colinet, L. Capasso, M. Vendemmia, M. Palma, L. Lepore, S. Nardecchia, C. Coppola, S. Ferraioli, F. Wiedemann, F. Raimondi (Naples, Italy) ABS 62 • TISSUE OXYGENATION AND SPONTANEOUS CLOSURE OF PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECTS • P.P. Bassareo, R. Savage, E. Doran, C. O’neill, K. Walsh (Dublin, Republic of Ireland) ABS 63 • FROM TRIALS TO RESEARCH BASED ON BIOBANKING. THE PATH LAUNCHED IN ASL LECCE • P. Paladini, E. Pitotti, M. Maffia, F. De Robertis, S. Leo, N. Di Renzo, A. Tornesello, R. Rollo (Lecce, Italy) ABS 64 • FROM THE US TO THE MEDITERRANEAN REGION, THROUGH THE UK: BORN TO READ AND LOW-VOICE READING • M.G. Gregorio (Cagliari, Italy) ABS 65 • A CASE REPORT OF PANS AND MYCOPLASMA PNEUMONIAE INFECTION: A METABOLOMICS APPROACH • C. Piras, R. Pintus, D. Pruna, A. Dessì, L. Atzori, V. Fanos (Cagliari, Italy) ABS 66 • METABOLOMICS AND VITAMIN D IN PRETERM NEWBORNS: CLINICAL RECORDS • A. Laconi, S. Corbu, F. Cesare Marincola, M. Puddu, V. Fanos, A. Dessì (Cagliari, Italy) ABS 67 • DISSEMINATION OF THE MUSICAL CULTURE DEDICATED TO THE NEONATES ACCORDING TO THE MUSIC LEARNING THEORY • M. Murru, R. Pintus, A. Dessì (Paris, France; Cagliari, Italy) ABS 68 • THE FIRST 1,000 DAYS: A UNIQUE OPPORTUNITY TO UNDERLINE THE ROLE AS A PREVENTION OF UNCOMMUNICABLE DISEASES • A. Pietrobelli, C. Tosi, L. Pecoraro (Verona, Italy; Baton Rouge, LA, USA) ABS 69 • SYSTEMIC PERSPECTIVE FOR THE FRAMING OF THE NEURODEVELOPMENTAL DISORDERS: GLIA (GRUPPO DI LAVORO INTERDISCIPLINARE PER L’AUTISMO, MEANING "THE INTERDISCIPLINARY GROUP FOR AUTISM") • C. Panisi, E. Burgio, R. Pintus, S. Vendemmia, E. Grossi, V. Fanos (Varese, Cagliari, Aversa and Como, Italy; Bruxelles, Belgium) ABS 70 • A STRANGE DROWSINESS IN A 20-MONTH-OLD CHILD • C. Gagliardo, I. Pezone, R. Mormile, M.P. Capasso, G. Bottigliero, C. Fusco, A. Coronella, C. Cioffi, R. Coppola, G. Della Corte, A. Colella, D. Perri (Aversa, Italy) ABS 71 • AN UNUSUAL CASE OF PERSISTENT HYPERTRANSAMINASEMIA IN AN INFANT • I. Pezone, C. Gagliardo, B. Gaetano, C. Amalia, G. Della Corte, D. Perri (Aversa, Italy) ABS 72 • NEVER FORGET PERTUSSIS • I. Pezone, A. Stabile, S. Cioffi, C. Cioffi, A. Colella, D. Perri (Aversa, Italy)

Selected Lectures of the 15th International Workshop on Neonatology and the 40th Congress UMEMPS (Union of Middle-Eastern and Mediterranean Pediatric Societies); Cagliari (Italy); October 24th-26th, 2019 • Children of the Middle-Eastern and Mediter­ranean area: we can do better! LECT 1 • THE FUTURE OF PREMATURITY • T. Boggini, M. Fumagalli, F. Mosca (Milan, Italy) LECT 2 • NEONATAL ARTERIAL ISCHEMIC STROKE: REVIEW OF THE CURRENT GUIDELINES • E. Saliba (Tours, France) LECT 3 • CEREBRAL WHITE MATTER: A COMMON DENOMINATOR OF PRETERM BABIES • L.A. Ramenghi (Genoa, Italy) LECT 4 • EUROPEAN FOUNDATION FOR THE CARE OF NEWBORN INFANTS – PAST, PRESENT, FUTURE • S. Mader (Munich, Germany) LECT 5 • OVERVIEW ON NEONATAL ANEMIA • S. Barella (Cagliari, Italy) LECT 6 • THE PLACENTA: AN IMPORTANT BUT OFTEN NEGLECTED TOOL FOR NEONATOLOGISTS • S. Rossi, S. Perrone, G. Buonocore (Siena and Parma, Italy) LECT 7 • VITAMINS TODAY: FOCUS ON NEONATOLOGY • S. Rezzi (Epalinges, Switzerland) LECT 8 • PERSISTENT DUCTUS ARTERIOSUS: THE ITALIAN EXPERIENCE AND MORE • C. Dani (Florence, Italy) LECT 9 • NATURE OR NURTURE? THE ANSWERS FROM THE INTERGROWTH-21ST PROJECT • E. Bertino, G. Maiocco, F. Giuliani (Turin, Italy) LECT 10 • NEONATAL JAUNDICE: WHEN TO WORRY? • E. Koç (Ankara, Turkey) LECT 11 • NEONATAL VENTILATION IN THE THIRD MILLENNIUM • C. Moretti, C. Gizzi (Rome, Italy) LECT 12 • METABOLOMICS AND MICROBIOMICS IN INFECTIONS • V. Fanos, M. Mussap (Cagliari, Italy) LECT 13 • HUMAN BREAST MILK METABOLOMICS • F. Cesare Marincola (Cagliari, Italy) LECT 14 • HUMAN MILK MICROBIOME • D. Peroni (Pisa, Italy) LECT 15 • GROWTH FACTORS IN MATERNAL MILK • A. Malamitsi-Puchner (Athens, Greece) LECT 16 • MOTHERS’ QUESTIONS ON MATERNAL MILK • A. Dessì (Cagliari, Italy) LECT 17 • THE ROLE OF THE MIDWIFE • L. Kuqi (Tirana, Albania) LECT 18 • LONG-TERM BENEFICIAL EFFECTS ON MOTHERS OF BREASTFEEDING • A.M. Paoletti, M. Neri, V. Vallerino (Cagliari, Italy) LECT 19 • OBSTETRICAL MONITORING TO PREVENT PERINATAL ASPHYXIA • S. Angioni, M.N. D’Alterio (Cagliari, Italy) LECT 20 • PERINATAL ASPHYXIA IN TERM NEWBORNS • R. Antonucci, C. Locci, L. Antonucci (Sassari and Rome, Italy) LECT 21 • MITOCHONDRIA ASPHYXIA: THE ATP SYNTHASE AS A TARGET FOR ISCHEMIA AND REPERFUSION INJURIES • M. Bonora, G. Morciano, A. Tarocco, G. Campo, G. Garani, C. Giorgi, P. Pinton (Ferrara and Ravenna, Italy) LECT 22 • PERINATAL ASPHYXIA: MEDICAL-LEGAL ASPECTS • E. d’Aloja, G. Bazzano, M. Ciuffi, M. Nioi, R. Demontis, E. Locci (Cagliari, Italy) LECT 23 • PERINATAL ASPHYXIA: PATHOLOGICAL ASPECTS • C. Gerosa (Cagliari, Italy) LECT 24 • IMPACT OF THE ECONOMIC CRISIS ON PERINATAL PARAMETERS AND LONG-TERM EFFECTS • A. Malamitsi-Puchner (Athens, Greece) LECT 25 • UNRAVELED MYSTERIES OF THE NEONATAL KIDNEY • V. Fanos, G. Faa (Cagliari, Italy) LECT 26 • MANDATORY VACCINATIONS IN EUROPEAN COUNTRIES, UNDOCUMENTED INFORMATION, FALSE NEWS, AND THE IMPACT ON VACCINATION UPTAKE • A. Villani, E. Bozzola, R. Russo, L. Nicolosi, A. Grandin (Rome and Benevento, Italy) LECT 27 • CHRONIC COUGH IN CHILDREN: DIAGNOSTIC AND MANAGEMENT APPROACH • D.A. Plesca (Bucharest, Romania) LECT 28 • BRONCHIOLITIS TODAY • D. Peroni, G. Nuzzi, I. Trambusti (Pisa, Italy) LECT 29 • THE CHILD WITH SEVERE ASTHMA: INFECTIONS AND MORE • G. Piacentini (Verona, Italy) LECT 30 • RESPIRATORY INFECTIONS IN THE FIRST YEAR OF LIFE AND DEVELOPMENT OF CHRONIC LUNG DISEASES • E. Baraldi (Padua, Italy) LECT 31 • NUTRITION IN PEDIATRICS: PREVENTION OF NONCOMMUNICABLE DISEASES • E. Verduci (Milan, Italy) LECT 32 • OVERVIEW ON CHRONIC NEONATAL DIARRHEA • E. Aramouni (Beirut, Lebanon) LECT 33 • PROBIOTICS IN PEDIATRICS: WHERE WE ARE HEADING • F. Savino (Turin, Italy) LECT 34 • PEDIATRIC GASTROESOPHAGEAL REFLUX CLINICAL PRACTICE GUIDELINES • K. Gargary (Duhok, Iraq) LECT 35 • SYRIANS, PALESTINIANS AND IRAQI REFUGEES IN LEBANON • R. Sacy, Y. Nassif, D. Hamod, K. Pia (Beirut, Lebanon) LECT 36 • GUT MICROBIOTA AS A TARGET FOR PREVENTION AND TREATMENT OF FOOD ALLERGY • R. Berni Canani (Naples, Italy) LECT 37 • PRECISION NUTRITION IN PEDIATRICS • A. Staiano (Naples, Italy) LECT 38 • FEW RULES FOR PEDIATRIC NUTRITION • G.V. Zuccotti, V. Fabiano (Milan, Italy) LECT 39 • RECURRENT WHEEZING AND GASTROESOPHAGEAL REFLUX IN CHILDREN – 5 YEAR REPORT • V.V. Lupu, I. Miron, C. Gavrilovici, A. Lupu (Iasi, Romania) LECT 40 • GASTROINTESTINAL INVOLVEMENT IN AUTISTIC CHILDREN: THE METABOLOMICS LESSON • A. Noto, C. Fattuoni, M. Mussap, L. Barberini, M. Siracusano, L. Mazzone, R. Francavilla, P. Curatolo, V. Fanos (Cagliari, Rome and Bari, Italy) LECT 41 • NEONATAL HYPOXIC-ISCHEMIC ENCEPHALOPATHY; GOLDEN HOUR • R. Falsaperla, M.G. Aguglia (Catania, Italy) LECT 42 • HYPOXIC ISCHEMIC ENCEPHALOPATHY: MANAGEMENT FROM DELIVERY ROOM TO NEONATAL INTENSIVE CARE UNIT – “IDEAL TIMING FOR IDEAL BRAIN PROTECTION” • E. Gitto (Messina, Italy) LECT 43 • NEONATAL CARDIAC EMERGENCIES • P. Neroni, F. Bardanzellu, D. Manus, M.A. Farina, V. Fanos (Cagliari, Italy) LECT 44 • STABILIZATION AND TRANSPORT OF NEWBORNS WITH CARDIAC DISEASE • D. Manus, P. Neroni, M.A. Farina, R. Pintus, V. Fanos (Cagliari, Italy) LECT 45 • INTERVENTIONAL PROCEDURE IN NEWBORNS • M. Chessa, F. D’Aiello, D. Negura, D. Basile, A. Micheletti (San Donato Milanese, Italy) LECT 46 • THE NEONATAL ECG: HOW TO APPROACH THE ECG OF THE NEWBORN AND WHAT TO BE ABLE TO IDENTIFY FROM IT • C. Cavalli, A. Garavelli, A. Mani (Cremona, Italy) LECT 47 • CONGENITAL HEART DEFECT AND GENETIC SYNDROMES • M.A. Farina, P. Neroni, D. Manus, V. Fanos (Cagliari, Italy) LECT 48 • CONGENITAL HEART DISEASE: WHAT PAEDIATRICIANS SHOULD KNOW • P.P. Bassareo (Dublin, Ireland) LECT 49 • ANESTHESIA AND THE DEVELOPING BRAIN • G. Finco, S. Sardo, M. Musu (Cagliari, Italy) LECT 50 • END-OF-LIFE MANAGEMENT: ETHICS VERSUS REALITY • Y. Nassif, S. Slim (Beirut, Lebanon) LECT 51 • MEDICAL RESPONSIBILITY: THE ITALIAN SITUATION • E. d’Aloja, M. Ciuffi, A. Chighine, M. Nioi, R. Demontis (Cagliari, Italy) LECT 52 • MEDICAL RESPONSIBILITY: THE SPANISH SITUATION • M. Lorente (Granada, Spain) LECT 53 • CLINICAL APPROACH TO THE DYSMORPHIC CHILD • K. Boduroğlu (Ankara, Turkey) LECT 54 • SLEEP-DISORDERED BREATHING IN A PEDIATRIC SETTING • M. Zaffanello, L. Tenero, M. Piazza, G. Piacentini (Verona, Italy) LECT 55 • HEART AND PERINATAL PROGRAMMING • P.P. Bassareo (Dublin, Ireland) LECT 56 • CYSTIS ECHINOCOCCUS BOTH IN HEART AND LUNG, THE FIRST CASE IN ALBANIA • N. Maliqari, A. Koja, D. Cela, A. Baboci, A. Veshti, V. Vanini, L. Teneqexhi (Tirana, Albania) LECT 57 • YOUNG ADULTS WITH CONGENITAL HEART DISEASE • M. Chessa, F. D’Aiello, D. Negura, D. Basile, S. Flocco, A. Micheletti (San Donato Milanese, Italy) LECT 58 • METABOLIC EMERGENCIES IN NEONATES • H. Mansour (Beirut, Lebanon) LECT 59 • THE BLEEDING NEONATE: OLD DIAGNOSTIC AND OLD THERAPEUTIC APPROACHES IN A NEW ERA • G. Mitsiakos (Thessaloniki, Greece) LECT 60 • RETINOPATHY OF PREMATURITY: PAST, PRESENT, AND FUTURE • E. Koç (Ankara, Turkey) LECT 61 • EVALUATION AND OUTCOME OF NEUROLOGICAL DAMAGE IN NEWBORNS • M. Vendemmia (Naples, Italy) LECT 62 • THE INFANT OF DIABETIC MOTHER • A. Dessì (Cagliari, Italy) LECT 63 • MENTAL HEALTH IN CHILDREN WITH NEOPLASMS • A. Godo, E. Nastas, M. Xhafa, D. Bali, M. Kapllanaj, M. Kreka, I. Shira (Tirana, Albania) LECT 64 • GYNECOLOGICAL PROBLEMS IN CHILDREN AND ADOLESCENTS • A.M. Fulghesu, C. Succu (Cagliari, Italy) LECT 65 • THE SCHOOL OF PEDIATRICS IN EMERGING COUNTRIES: THE ROLE OF ITALIAN INTERNATIONAL COOPERATION • G.B. Parigi (Pavia, Italy) LECT 66 • CARDIOSURGERY IN EMERGING COUNTRIES • A. Giamberti (Milan, Italy) LECT 67 • PEDIATRIC FELLOWS IN AFRICA • F. Pistolesi (Cagliari, Italy; Chiulo, Angola) LECT 68 • AUTISM: PATHOGENESIS, PREVALENCE, AND COMORBIDITY • S. Lundström (Gothenbürg, Sweden) LECT 69 • OMICS IN AUTISM • M. Mussap (Cagliari, Italy) LECT 70 • PANDAS SYNDROME: WHAT IS NEW? • D. Pruna, S. Cossu, M. Asunis, S. Dettori, N. Ronzano (Cagliari, Italy) LECT 71 • SUBSTANCE USE AND MISUSE IN ADOLESCENTS • N. Kanbur (Ankara, Turkey) LECT 72 • CHILDHOOD AND ADOLESCENCE PSYCHOPATHOLOGY? THE CAPICE PROJECT • M. Manchia, V. Fanos (Cagliari, Italy; Halifax, NS, Canada) LECT 73 • ANOREXIA • A. Ciubara (Galati, Romania) LECT 74 • NEONATAL TRANSPORT IN MIDDLE EASTERN AND MEDITERRANEAN COUNTRIES: PROCESSES, STRATEGIES, AND CHALLENGES • S. Rugolotto, C. Fanni, C. Loddo, F. Stefanachi (Rovigo, Italy) LECT 75 • ULTRASOUNDS IN NEONATOLOGY • D. Hamod (Beirut, Lebanon) LECT 76 • THE ROLE OF VITAMIN D IN NEONATOLOGY AND PEDIATRICS • R. Antonucci, M.G. Clemente, C. Locci, L. Antonucci (Sassari and Rome, Italy) LECT 77 • CRISPONI SYNDROME • G. Crisponi, F. Rutsch, L. Crisponi (Cagliari, Italy; Münster, Germany) LECT 78 • TYPE I DIABETES: THE ROLE OF THE EXPOSOME • M. Songini, C. Mannu (Cagliari, Italy) LECT 79 • LIPIDOMICS IN PSYCHOPATHOLOGY • R. Pintus, A. Dessì, V. Fanos (Cagliari, Italy) LECT 80 • LEONARDO DA VINCI: PAINTER AND ANATOMICAL INVESTIGATOR 500 YEARS LATER • L. Cataldi, V. Fanos (Rome and Cagliari, Italy) LECT 81 • CAKUT: THE VALUE OF ULTRASOUNDS • C. Porcu, G. Ledda, R. Pintus, C. Perna, V. Fanos, L. Saba (Cagliari, Italy) LECT 82 • CAKUT: THE VALUE OF CLINICS • G. Masnata (Cagliari, Italy) LECT 83 • NON-FAMILIAL HEMATURIA • N. Hooman (Tehran, Iran) LECT 84 • NEPHROGENIC SYNDROME OF INAPPROPRIATE ANTIDIURESIS • F. Bardanzellu, M.C. Pintus, V. Fanos, M.A Marcialis (Cagliari, Italy) LECT 85 • RENAL MANIFESTATIONS OF VASCULITIS IN CHILDREN • O. Soylemezoglu (Ankara, Turkey) LECT 86 • CLEFT-PALATE-LIPS • S. Oddini Carboni (Cagliari, Italy) LECT 87 • THE HEALING WITH MINIMALLY VISIBLE SCAR – OUR THIRTEEN YEARS OF EXPERIENCE WITH NEONATES CLEFT LIP SURGERY • J. Borský, M. Jurovčík, L. Jaklová, P. Dytrych, J. Skřivan, J. Velemínská (Prague, Czech Republic) LECT 88 • TONGUE TIE – FROM EMBRYOLOGY TO TREATMENT • A. Piras Denotti (Cagliari, Italy) LECT 89 • THE ORAL MICROBIOTA: SILENT ENEMY OR NECESSARY BACTERIAL TISSUE? • G. Orrù (Cagliari, Italy) LECT 90 • EARLY ORTHODONTIC TREATMENT: WHY, WHEN AND HOW • M. Maddalone (Milan, Italy) LECT 91 • NEONATAL CARDIOGENIC SHOCK: WHAT IS RIGHT? • M. Limone, P. Neroni, D. Manus, M.A. Farina, V. Fanos (Cagliari, Italy) LECT 92 • A CHALLENGING CASE OF GASTROESOPHAGEAL REFLUX • F. Olivero, M. Magistrali, L. Schena, A. Licari, G.L. Marseglia (Pavia, Italy) LECT 93 • A RARE CAUSE OF FAILURE TO THRIVE: DIAGNOSTIC APPROACH AND DISEASE COURSE • F. Guerra, E. Curridori, E. Flore, M. Balzarini, M. Marica, P. Moi (Cagliari, Italy) LECT 94 • A CASE OF RECURRENT INTESTINAL PSEUDO-OBSTRUCTION • M. Votto, A. Raffaele, A. Licari, L. Altieri, A. Apicella, M. Caironi, M. De Filippo, G.L. Marseglia (Pavia, Italy) LECT 95 • A STRANGE NYSTAGMUS: CLINICAL EVALUATION OF "DANCING EYES" • G. di Pietro, F. Lirosi, S. Cossu, A. Nonnis, R. Mura, D. Pruna (Cagliari, Italy) LECT 96 • IMMUNE SYSTEM OUT OF CONTROL: A CLINICAL CASE ON THE VERGE OF IMMUNODEFICIENCY AND IMMUNE DYSREGULATION • R. Castagnoli (Pavia, Italy) LECT 97 • NEW DIAGNOSTIC POSSIBILITIES FOR NEONATAL SEPSIS • C. Tzialla (Pavia, Italy) LECT 98 • HYPERBILIRUBINEMIA: DIAGNOSIS AND MANAGEMENT • G. Aramouni (Bellevue, Lebanon) LECT 99 • (MIS)PERCEPTIONS, METAPHORS, AND STEREOTYPES IN CHILD DEVELOPMENT • C. Gavrilovici, V.V. Lupu, I. Miron (Iasi, Romania) LECT 100 • SHORT STATURE MANAGEMENT • B. Al-Zoubi (Amman, Jordan) LECT 101 • PARTICULARITIES OF PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA IN THE 5 YEARS FOLLOW-UP OF IASI ONCOLOGY UNIT • I. Miron, V.V. Lupu, C. Gavrilovici, C. Rusu, M. Alecsa (Iasi, Romania) LECT 102 • HOW PHYTOTHERAPY COULD HELP PAEDIATRICIANS • M. Biagi (Siena, Italy) LECT 103 • PHYTOTHERAPY IN THE FIRST 1,000 DAYS OF LIFE AND BEYOND • O. Al Jamal (Cagliari, Italy) LECT 104 • COLDS AND COUGHS IN CHILDREN • G. Trapani (Sanremo, Italy) LECT 105 • PHYTOTHERAPY FOR SKIN DISEASES • V. Masci (Rome, Italy) LECT 106 • WHEN TO CHOOSE HERBAL REMEDIES FOR THE TREATMENT OF URINARY TRACT INFECTIONS (UTI) IN CHILDREN. FOCUS ON CRANBERRY • D. Careddu (Novara, Italy) LECT 107 • HERBAL REMEDIES FOR THE TREATMENT OF SLEEP DISORDERS IN CHILDREN • L. Zanino (Turin, Italy) LECT 108 • EVALUATION SCORE OF THE PARENTAL COMPETENCY IN NEONATAL INTENSIVE CARE UNITS • I. Demurtas, R. Pintus, C. Bicchiri (Cagliari, Italy) LECT 109 • PRETERM BIRTH REPRESENTS A TRAUMATIC EVENT IN A CRITICAL PERIOD FOR THE DEVELOPMENT OF THE NERVOUS SYSTEM • L. Melis (Cagliari, Italy) LECT 110 • THE SKIN OF CRITICAL NEWBORN, BETWEEN EVIDENCE AND GOOD PRACTICE • E. Bernabei (Aversa, Italy) LECT 111 • THE ITALIAN NEONATOLOGY NURSE TODAY • D. Pisano (Cagliari, Italy) LECT 112 • UPDATE ON PATHOGENESIS & MANAGEMENT OF KAWASAKI SYNDROME (DISEASE) • A.M. El-Halabi (Amman, Jordan) LECT 113 • DONKEY MILK: A NEW PERSPECTIVE FOR HEALTH OF CHILDREN • E. Bertino, C. Peila, S. Sottemano, G. Maiocco, S. Deantoni, M. Giribaldi, L. Cavallarin (Turin and Grugliasco, Italy) LECT 114 • STRATEGIES TO REDUCE MEDICATION ERRORS IN THE NICU • M. Pierro, G. Como (Brescia and Trento, Italy)

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Similar to other kinds of chronic diseases, hypertension tends to develop many years before the onset of its clinical signs and symptoms. In this respect, children with higher blood pressure values are more likely to become hypertensive during adulthood. According to literature data, the averaged prevalence of paediatric hypertension is around 5% in Europe and 3.5% in the USA. A strong relationship with familial history, smoking, overweight/obesity, salt intake, and diabetes has been demonstrated as well. Conversely, similar evidences are substantially still lacking in Ireland, and only sporadic data are available. What is known is the fact that a large number of adults in the Island are affected by high blood pressure and their number is expected to raise notably, with significant adverse consequences for these subjects and their families, the health and social care system and the economy of all Ireland. Based on these premises, preventive measures are strongly needed to identify those Irish children and adolescents with high blood pressure, as an early modification of their unhealthy lifestyle may be still effective to normalize its values with no drugs administration.

Background: Complex congenital heart defects (CHD) are among the non-infectious causes of childhood morbidity and mortality in developing countries, accounting for 25-30% of intensive care usage in some centers. In Abuja, the capital of Nigeria, there has been an upsurge in cases of complex CHD, thus creating the need for this study. Objectives: The study aimed at describing the incidence and outcome of complex CHD in children seen at the University of Abuja Teaching Hospital, Gwagwalada, Abuja. Methods: A prospective study of patients referred to the Pediatric Cardiology Unit of the hospital between 2013 and 2018 was performed. Results: Of the 1,420 patients examined, 344 (24.2%) had CHD; 55 (16.0%) of these belong to the complex category with a male:female ratio of 1.3:1. The incidence of complex CHD is 1.1 per 1,000 live births. Tetralogy of Fallot (TOF) was the commonest form of complex heart diseases. Patients with atresic valves tend to present in the neonatal and the immediate postnatal period, while those with TOF present much later. Only 8 (14.5%) had surgical interventions, 21 (38.2%) could not afford surgery, 14 (25.5%) were lost to follow up and 10 (18.2%) died. Patients that had need of emergency cardiac surgery had the worst prognosis. Two patients with truncus arteriosus presented too late and were classified inoperable. Financial constraint and lack of facility for cardiac surgeries contributed negatively to the outcome of patients with complex heart defects. Conclusions: Complex CHD occurred in this community with similar incidence rates as in the developed countries. The predominant complex heart defect in the locality is TOF. Defects with atresic valves carry the worst prognosis in this environment due to lack of the wherewithal to manage the condition.

Our aim was to develop an APpendictis-PEdiatric score (APPE score) in quantifying risk of acute appendicitis based on combination of clinical and laboratory markers. 1025 patients were classified in: acute appendicitis (AA) and non-appendicitis. Demographic/clinical features, and laboratory were collected. They were compared for quantitative-variables and categorical-variables. Significant predictors (P=

We report our experience with a sutureless technique for laparoscopic inguinal hernia repair in children. Twenty-eight children, 12 girls and 16 boys, aged 3 months to 7 years, underwent sutureless laparoscopic inguinal hernia repair. In girls, we utilized simple cauterization of the internal inguinal ring with a single trocar technique. In boys denudation of the peritoneum was obtained utilizing a three-trocar technique. The peritoneum around the internal inguinal ring was peeled off and detached from the vas and the vessels, and then wrapped around the grasper, resulting in a large area of denudation. No perioperative complications were observed. No recurrences nor testicular damage were noted after a mean follow-up of 18 months (range 6-35 months). The mean operative time was 12 min (range 7-20 min) for girls and 19 min (range 15-30 min) for boys. A 6-year-old girl exhibited a lymphocele. The sutureless technique appears to be easy, safe, and effective, provided that the patients are carefully selected. In boys, special attention needs to be paid to preservation of the vas and the testicular vessels.

Background: Sacrococcygeal teratoma (SCT) is a relatively uncommon tumor affecting neonates, infants, and children with a female preponderance. Age is an important predictor of malignancy in SCT. Early antenatal diagnosis influences the management and provides a better outcome. Aim: The present study was carried out to describe in detail various clinicopathological features and outcome of SCT patients; as many reports are available from the West, there is a paucity of literature on this entity from the Eastern region, especially India, which has a unique socioeconomic and demographic background. Materials and methods: The study included 52 patients of SCT operated for 16 years from 2000 to 2015. A retrospective review of various parameters was done from the medical case records available in the Department of Pediatric Surgery (PGIMS, Rohtak, Haryana, India). Result: There were 40 females and 12 males with age ranging from newborn to 13 years. Thirty-three children (63%) presented in the neonatal age group. There were 40 cases of benign (mature), 7 immature and 5 malignant teratomas. Four cases had a recurrence on follow-up. Out of 52 patients, 7 died while the others are doing well on follow-up. Conclusion: A prenatal diagnosis of SCT is essential for reducing morbidity and mortality. Delayed presentation and the presence of malignant changes continue to be poor prognostic factors. Strict follow-up by clinical examination, ultrasound and tumor markers is mandatory to look for any recurrence.

Ceftriaxone treatment of bacterial infections can be associated with biliary complications, more commonly in children than adults, in a dose-dependent manner. This study describes a clinical case series of children with ceftriaxone-related cholelithiasis. We performed a retrospective analysis of cases of ceftriaxone-related biliary complications admitted to the Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Italy, during the period 2005-2015. Four children with cholelithiasis occurring during, or soon after, the treatment with ceftriaxone are reported. Case 1 (6-month-old), case 2 (9-year-old) and case 4 (10-year-old) were symptomatic, while case 3 (3-year-old) was asymptomatic. After the ultrasonographic diagnosis of gallstones (cases 1 and 2) or biliary sludge (cases 3 and 4), ceftriaxone treatment was withdrawn, and ursodeoxycholic acid (UDCA) was started in cases 1 and 2. A complete recovery was observed in all but case 1, in whom cholelithiasis was still detectable at one-year follow-up by ultrasonography. This case underwent a triple antibiotic protocol for bacterial meningitis. The protocol included rifampicin, which is known to have an effect in decreasing hepatic concentration of bile salts. Therefore, in this case, both rifampicin and UDCA were of no benefit in preventing or treating ceftriaxone biliary complications. The current pharmacological approach for the treatment of ceftriaxone-related cholelithiasis seems to be ineffective, likely due to the high calcium content of gallstones. Therefore, the best strategy of intervention for ceftriaxone biliary complications in children remains the prevention of the risk factors.

Gastric duplication cysts (GDCs) represent 4-9% of alimentary tract duplications. Early diagnosis and surgical excision are essential to avoid morbidity or neoplastic degeneration. Roboticassisted excision of GDCs has never been described in childhood. We report an asymptomatic male patient with 2 gastric cystic masses at ultrasonography (US)-study (diameter 25mm and 8mm), increasing in size at follow-up. At 20 months of age, magnetic- resonance-imaging-scan confirmed 2 round gastric masses (44×35mm and 16×12mm, respectively). Two months later, an elective robotic-assisted excision of GDCs was completed without complications. The patient was discharged at day 6 after procedure. Histology confirmed the diagnosis of GDCs. At a 2-year follow- up, US-study did not evidence any issue. In this first reported case of robotic-assisted cystectomy for CGD in childhood, the procedure seems safe, effective, and feasible. This approach improves the movements of the surgical instruments with better 3- D visualization in comparison with the laparoscopic approach.

Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up.

Background: With the aim of better predicting the course of the community-acquired uncomplicated pneumonia (CAUP) the study presents the results of research of the cytokine profile based on the obtained rates of pro- (interleukin 1-beta [IL-1β], tumor necrosis factor-alpha [TNF-α]) and anti-inflammatory (interleukin 4 [IL-4]) cytokines in blood serum as well as results of the combined bacteriological and serological research of children with different level of physical development (PD), sick on CAUP. Methods: In order to reach the purpose of the research the work was carried out by controlled computer-generated randomization schedule in 2 stages. At the 1st stage the examination of 151 children with CAUP aged from 3 to 14 years from the onset of the disease and of 20 apparently healthy children (control group) was held. All children passed a study of sputum using staining of swabs according to Gram, culture test and determination of causative agents of pneumonia by the method of enzyme multiplied immunoassay (ELISA); in addition, the cytokine profile (IL-1β, IL-4 and TNF-α) was determined by the method of enzyme-linked immunosorbent assay. At the 2nd stage, according to the inclusion/exclusion criteria, 151 children in the dynamics of the disease were examined: on 7.2 ± 0.9 day from the onset of the disease, the cytokine profile rates were evaluated, and on 12.6 ± 0.9 day the level of IgM, IgG to atypical causative agents of pneumonia were recorded. Results: The results obtained during the research of the indices of the pro-inflammatory (IL-1β and TNF-α) and anti-inflammatory (IL-4) cytokines in blood serum of the children with CAUP and having different level of PD can be considered as factors for individually predicting the course of the CAUP of children with different PD. Conclusion: Data suggest that the ratio of pro- and anti-inflammatory cytokines during in­flammatory process in children with CAUP with different PD can be one of the additional, but not unique, factors for predicting the course of the dis­ease.

A 12-year-old girl presented with an oval swelling in the left submandibular region. The tumor had gradually increased in size, during the last 9 months. Preoperative ultrasonography evidenced an hypoechoic oval mass, 14 x 12 mm in size. Submandibulectomy was performed. At macroscopy, the tumor was surrounded by a fibrous capsule, and appeared tan-white in color. At histology, an admixture of epithelial and mesenchymal cell components characterized the tumor. Epithelial cells showed large polymorphous atypical nuclei, with irregular nuclear membranes. The mesenchymal cells were embedded in a myxoid matrix, with focal areas of chondroid differentiation. The tumor showed pushing margins, focally extending into the fibrous capsule. Occasionally, some scattered foci of capsular pseudo-infiltration were detected. The proliferative index of tumor cells, detected by Ki67 immunostaining, reached levels around 10% in some tumor areas characterized by the highest frequency of atypical tumor cells. On these bases, a diagnosis of atypical pleomorphic adenoma was performed. A lymphocytic infiltrate, sometimes organized in lymphoid nodules, was observed in the surrounding submandibular gland. After 1 year of follow-up, the patient is in good health, in the absence of any recurrence. The case here reported confirms that tumors of the salivary gland occurring in children are characterized by a higher aggressive potential, here represented by the atypical tumor cells associated with the high proliferative index and with the pressure on the tumor capsule, and deserve the complete resection of the affected salivary gland, in order to prevent their potential malignant transformation. The association of the salivary gland tumor presenting in our patient with lymphocytic nodular sialoadenitis confirms previous reports of this peculiar association, and reinforces the hypothesis that the two conditions might share a common etiology.

Second generation antipsychotics (SGA) are used in children for the treatment of various psychiatric diseases, including pervasive developmental disorders. These drugs can cause metabolic effects as hyperglycemia and diabetes. A 16-year-old young-boy, diagnosed with autism, developed diabetes mellitus type 1 whilst he was on treatment with olanzapine (started 4 months before), clomipramine, valproic acid and lithium. The hypothesis of druginduced diabetes imposed olanzapine interruption and clozapine initiation. Insulin therapy was practiced, with progressive dosage reduction, until complete cessation of treatment after 13 months. Blood sugar and HbA1c levels remained stable for about a year and then increased again, requiring the introduction of metformin that improved glycemia. In children and adolescents assuming SGA serum glucose and lipid profile should always be assessed before therapy and then frequently monitored. Drug selection must consider family history and the individual risk. Molecule final choice remains equilibrium between efficacy and safety.

Popliteal fossa masses are rare in paediatric age group. Even rarer are the malignancies of this area. Low-grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma. It is a rare tumor with benign histologic appearance but high metastasizing potential. We describe an 11-year-old child with a popliteal fossa mass, which was excised, and histopathological report revealed LGFMS.

S. aureus is a relatively uncommon causative agent of community-acquired pneumonia. The clinical presentation of staphylococcal community-acquired pneumonia is typically acute and severe. Rarely, its clinical and imaging features may mimic other lung diseases, thereby delaying and misleading the diagnosis. We report a case of a 13-year-old girl without predisposing factors who was admitted with a recent history of mild chest pain, weakness and slight fever. Although clinical presentation and imaging findings suggested tuberculosis infection, broncho-alveolar lavage results showed a positivity for methicillin-susceptible S. aureus. A complete recovery was observed after a 21-day course of antibiotics. Our case highlights that staphylococcal pneumonia may develop in adolescents without underlying risk factors, mimicking, in rare cases, clinical presentation and radiological features of pulmonary tuberculosis.

Introduction: The microrganisms of the human oral cavity include more than 700 species or phenotypes of bacteria. Some “diseases of civilization” are strictly correlated to changes in the microbiome following the food revolution that occurred after WWII. For that reason, a precise recognition of the microbiome profile before and after this period should be useful to determine the health-compatible model of microbiome. The aim of this study was to compare the microbiome profiles (number of total cells, and pathogen types) of dental samples obtained from two distinct groups of children, a 200-year-old retrieved one and a present one. Methods: Two different groups of samples have been studied. The first group was a set of 50 recent subgingival plaque samples obtained from children of age 2-8 years, 14 males and 36 females. They were enrolled by the Department of Dental Disease Prevention (University of Cagliari, in Sardinia, Italy) during standard dental care procedures. None reported periodontal disease and none had been under antibiotic therapy during the previous 6 months. The second group was an old retrieved group that included 24 teeth from 6 different 6- to 8-year-old crania fragments; they were obtained from a 200-year-old charnel-house located in Villaputzu, a city close to Cagliari. Representative periodontal bacteria have been identified by a previously published real-time PCR procedure (Sokransky et al., 1998) in which P. gingivalis and T. forsythia (red complex), A. actinomycetemcomitans (green complex) and F. nucleatum (orange complex) were detected. In addition, the title of each pathogen was expressed as a percentage of the total bacteria (biofilm) in the sample. Results and discussion: The profile of periodontal microbiomes, between recent/ancient samples showed a significant difference relative to Sokransky’s red complex bacteria (p < 0.05). In all analyzed periodontal strains, the pathogenic bacteria P. gingivalis and T. forsythia showed the highest title in the recent group. Conclusions: Our hypothesis is that the transfer of “commensal-pathogen” as an absolute number on the oral biofilm might be linked to the distinct alimentary habits of the two populations. Some diet rich in reducing agents, such as processed meat-based foods, might be able to increase the average number of pathogen anaerobic bacteria in the oral microbiota. The outcome would be an increase of the oral systemic diseases reported with these pathogens. Our data suggest that the ancient Sardinian population was able to control the pathogen oral anaerobic biofilm by some diet rich in antioxidant compounds. Further investigations are required to focus on the genetic profile and the health status of this ancient population but it appears that molecular microbiology might be considered as the “time machine” in oral biology.

Osteonecrosis is a significant adverse effect of treatment administered to children suffering from acute lymphoblastic leukemia (ALL) that may have a negative effect on the quality of life. The purpose of this study is to evaluate the rate of secondary vascular osteonecrosis (ON) in a population of pediatric patients with ALL treated with corticosteroids and cytostatic agents. A retrospective analysis of prospectively collected data of the medical records of 328 patients with ALL identified 4 cases with ON, corresponding to 1.2% of all cases observed. Of the 4 patients identified in our study 3 were girls and 1 was a boy, aged from 10 to 16 years old (average age at diagnosis, 12 years). Median time between the diagnosis of ALL and ON was 12.5 months (range, 12 to 36 months). Regarding the lesion size of ON, in all cases the femoral head (monolateral in 1 case and bilateral in 3 cases) was involved and was associated with the scapula-humeral joint in one case. ON of the weight-bearing joints has been identified as a severe complication in children with leukemia that may be associated with the development of articular surface collapse, subsequent debilitating arthritis, sometimes needing arthroplasty. For this reason it is very important to implement prevention strategies, especially in adolescent girls treated with steroids and chemotherapy. An early diagnosis of ON and careful orthopedic follow-up are necessary in order to avoid bone deformations related to the late start or the wrong therapy.

Copyright of Children's Nurses: Italian Journal of Pediatric Nursing Science / Infermieri dei Bambini: Giornale Italiano di Scienze Infermieristiche Pediatriche is the property of Societa Italiana di Scienze Infermieristiche Pediatriche and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Scienza Riabilitativa is the property of Associazione Italiana Fisioterapisti and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The approach to research on gender differences in an evolutionary context has always been complex. Many factors, from those initially linked to preliminary considerations about the differences between the sexes in different historical and cultural moments have often influenced studies of this type. Gender Medicine, consolidated in the United States as a research field since the 1980s, studies the way in which membership in gender, male or female, affects the development and impact of disease and response to therapy. We can say that this is a new, transverse dimension of Medicine that assesses gender differences in physiology and pathophysiology of many clinical diseases, with the aim of reaching treatment decisions based on evidence in both men and women. In an historical moment focused on the individualization/personalization of care, among the objectives that modern health care has been given, there is this research aimed at identifying as early as possible gender-related diseases with the aim of identifying causes and possible methods of intervention. It leads to defining a kind of Medicine, a recent branch of biomedical science, that focuses on recognizing and analyzing the differences arising from the belonging to a gender, male or female, from several aspects: organic, functional, psychological, pharmacological, social and cultural. A gender approach to Medicine can reduce the level of error in medical practice, promote therapeutic appropriateness, improve and customize therapies and generate savings for healthcare systems. These effects have been demonstrated for adults and need to be confirmed during infancy and childhood. The purpose of this discipline is to innovate and guarantee everyone, man or woman, newborn and children, the best possible treatment based on scientific evidence.

Dear Editor, We thank the authors for their interest and comments on our paper. They have raised some very valid points. This corrispondence refers to the following article: Taksande AM, Yeole M. Risk factors of Acute Respiratory Infection (ARI) in under-fives in a rural hospital of Central India. J Pediatr Neonat Individual Med. 2016;5(1):e050105. doi: 10.7363/050105. Comments can be found in the following article: Mandal A, Sahi PK. Correspondence: risk factors of acute respiratory infection in under-fives in a rural hospital of Central India. J Pediatr Neonat Individual Med. 2016;5(2):e050207. doi: 10.7363/050207.

Dear Editor, We read with great interest the article by Taksande et al. published in the latest issue of your journal. First, we would like to commend the authors for their endeavor. We have comments regarding the methodological issues which require further clarification by the authors for the benefit of the readers of JPNIM. This corrispondence refers to the following article: Taksande AM, Yeole M. Risk factors of Acute Respiratory Infection (ARI) in under-fives in a rural hospital of Central India. J Pediatr Neonat Individual Med. 2016;5(1):e050105. doi: 10.7363/050105. Authors’ reply can be found in the following article: Taksande A, Yeole M. Correspondence: risk factors of acute respiratory infection in under-fives in a rural hospital of Central India – Authors’ reply. J Pediatr Neonat Individual Med. 2016;5(2):e050208. doi: 10.7363/050208.

Purpose of the study: Frequency of habitual snoring is significantly higher in obese than in normal-weight subjects. Obesity and adeno-tonsillar size are risk factors of snoring. Other factors, such as fat distribution and upper airway collapsibility, could explain the relationship between obesity, snoring and obtructive sleep apneas. The aim of the study was to investigate clinical and instrumental significance of snoring in exogenous obese children referred to our department. Methodology: This preliminary study takes part of a larger prospective respiratory sleep study. In 36 consecutive obese children (18 males), body mass index (BMI), BMI Z score and neck circumference were calculated according to age and sex. Nasal patency, tonsil size, palate position scoring were also recorded. An overnight polygraphy was performed using a portable ambulatory device. Statistical analysis was done using SPSS® Statistics 19.0 software for Windows®. Main findings: Snoring, objectively measured by polygraphy, was associated with palate position and with oxygen desaturation index (ODI). The correlation between snoring and ODI completely disappeared when adjusting for palate position scoring. Key conclusions: Low palate position can be identified as an adjunctive, although not unique, factor that can contribute to making snoring and increased desaturation events possibly related to increased risk of upper airway collapsibility during sleep in obese children.

Introduction: Acute Respiratory Infection (ARI) is a major cause of morbidity and mortality in developing countries in children especially in under-fives. Every year in the world, about 13 million under-5 children dies, 95% from developing countries; one third of total deaths are due to ARI. The aim of this study was to identify the significant risk factors for ARI in children less than five years of age living in rural areas of Central India. Methods: A hospital based case control study was undertaken to determine risk factors associated with respiratory tract infections in children. Children less than 5 years admitted in a pediatric ward with diagnosis of ARI were enrolled in the study as cases (n = 300) while the same number of controls (n = 300) were selected from neighborhood and were matched for age, sex and religion. Details of risk factors in cases and controls were recorded in pre-designed proforma. Results: A significant association was found between ARI and lack of breastfeeding, nutritional status, immunization status, delayed weaning, prelactal feeding, living in overcrowded conditions, mothers’ literacy status, low birth weight and prematurity. Among the environmental variables, inadequate ventilation, improper housing condition, exposure to indoor air pollution in form of combustion from fuel used for cooking were found as significant risk factors for ARI in under-fives. Conclusions: ARIs are affected by socio-demographic and socio-cultural risk factors, which can be modified with simple interventions. The various risk factors identified in this study were lack of breastfeeding, undernutrition, delayed weaning, overcrowding and prelactal feeding.

The authors report their experience in laparoscopic repair of inguinal hernias in children. From May 2010 to November 2013, 122 patients with inguinal hernia underwent laparoscopic herniorrhaphy (92 males and 30 females). Telescope used was 5 mm, while trocars for the operative instruments were 3 or 2 mm. After introducing the camera at the umbilical level and trocars in triangulation, a 4-0 nonabsorbable monofilament suture was inserted directly through the abdominal wall. The internal inguinal ring was then closed by N or double N suture. All operations were performed in one-day surgery setting. In the case of association of inguinal and umbilical hernia an original technique was performed for positioning and fixing the umbilical trocar and for the primary closure of the abdominal wall defect. The postoperative follow-up consisted of outpatient visits at 1 week and 1, 3, and 6 months. The mean age of patients was 38.5 months. Of all patients, 26 were also suffering from umbilical hernia (19 males and 7 females). A total of 160 herniorrhaphies were performed; 84 were unilateral (66 inguinal hernia, 18 inguinal hernia associated with umbilical hernia), 38 bilateral (30 inguinal hernia, 8 inguinal hernia associated with umbilical hernia). Nine of 122 patients (6 males and 3 females) were operated in emergency for incarcerated hernia. A pre-operative diagnosis of unilateral inguinal hernia was performed in 106 cases. Of these patients, laparoscopy revealed a controlateral open internal inguinal ring in 22 cases (20.7%). The mean operative time was 29.9±15.9 min for the monolateral herniorrhaphies, while in case of bilateral repair the mean operative time was 41.5±10.4 min. The mean operative time for the repair of unilateral inguinal hernia associated with umbilical hernia was 30.1±7.4 while for the correction of bilateral inguinal hernia associated with umbilical hernia 39.5±10.6 min. There were 3 recurrences (1.8%): 2 cases in unilateral repair and 1 case a unilateral recurrence in a bilateral repair. No other complications were seen. Laparoscopic repair of inguinal hernia in children performed in this experience resulted a safe and effective procedure.

Today, obesity represents one of the most serious health problems facing both children and adults. Childhood obesity has several causes, including genetic factors, dietary habits, personal behaviours, and interaction of all of these. It often leads to adult obesity, which causes health problems including heart disease, diabetes, and even early death. Thus, many studies have investigated possible measures to prevent childhood obesity, and breastfeeding is considered an important early preventive intervention. Despite the fact that several milk formulas have been demonstrated to be safe and effective for feeding both term and premature infants, for its immunological and nutritional qualitative advantages, human milk is nowadays universally recognized as the optimal feeding choice for healthy, sick and preterm infants. To date, it is however still unclear whether breastfeeding can prevent childhood obesity. In fact, literature data provide controversial results, probably due to several confounding factors, including maternal habits, age, level of education, lifestyle, race, parity, pregnancy complications, types of delivery, and infant health factors. Thus, whether breastfeeding protects against obesity is still unclear. Further researches, by reducing the influence of confounding factors and improving the accuracy of the effect estimate, are needed to confirm the validity of the role of breastfeeding in reducing the risk of developing childhood overweight. This review briefly summarizes what is known on the possible relationship between breastfeeding and prevention of obesity development.

More than 90% of renal injuries in children result from blunt abdominal trauma. A 10-year-old female had a blunt abdominal trauma with macro-hematuria. The computed tomography scan revealed the presence of a horseshoe kidney and a 3rd grade renal lesion and contrast leakage from the right ureter. The ureteral rupture was confirmed by cystoscopy and ascendant pyelography and than a double J-stent was implanted. The stent was removed one month later. Non-surgical management has become the standard of care for both ureteral and renal lesions in children. Non-surgical treatment is a safe procedure for renal trauma with ureteral rupture in children.

Respiratory tract infections are one of the most common childhood illnesses, especially in pre-school children. These infections impose an enormous burden on both the healthcare system (frequent medical consultations and hospitalizations), and on society (parental absenteeism and loss of productivity). Their recurrence still poses a diagnostic challenge in pediatrics due to the difficulty in discriminating between otherwise healthy children and those with more serious underlying pathologies. Moreover, even if viral agents are typically the main cause being responsible of up to 95% of all upper respiratory tract infections, high antibiotic prescription is often reported in clinical practice. It is well known that frequent inappropriate antibiotic use has now led to a significant increase in bacterial resistance. In this context immunostimulants could be a promising preventive approach. Even if the evidence of effectiveness has been debated in the last years, studies focused on one of these compounds (Pidotimod) have recently attempted to better clarify and define its mechanisms of action both in vitro and in vivo and have provided new evidence of efficacy. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26th-31st, 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)

Bronchiolitis is an acute infection of the lower respiratory tract affecting infants and young children, with Respiratory Syncytial Virus (RSV) being the most common pathogen. Bronchiolitis is generally a mild disease, but may present with severe signs and symptoms requiring hospitalization. Risk factors including prematurity, bronchopulmonary dysplasia, immunodeficiency and congenital heart defects may predispose patients to develop a severe disease. The diagnosis should be based on clinical evaluation, without supportive radiographic and laboratory studies. Etiological diagnosis may be helpful to decrease the hospital transmission of virus and to avoid inappropriate use of antibiotics. The mainstay of therapy for bronchiolitis is supportive care, which should be directed at maintaining adequate oxygenation, ensuring a proper respiratory toilet, and meeting the requirements of fluids and nutrition. The use of nebulized hypertonic saline should be limited to hospitalized patients. Severe respiratory failure may require mechanical ventilatory support. Neither corticosteroids nor antibiotics offer consistent benefit in the treatment of bronchiolitis, and thus should not be used. A trial of a bronchodilator may be appropriate, but should be continued exclusively if a prompt favorable response occurs. Effective interventions to prevent the spread of RSV infection include hand washing or disinfection by caregivers and contact isolation. The use of palivizumab, a monoclonal antibody directed against RSV, is a safe prophylactic option, but should be restricted to children at high-risk for severe RSV disease, during the epidemic period. Current evidence suggests that early RSV bronchiolitis predisposes children to recurrent wheezing and asthma in the first decade of life. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26th-31st, 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)