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To assess ocular microvasculature changes using optical coherence tomography angiography (OCTA) in pediatric patients with inflammatory bowel disease (IBD). Patients (aged 6–18 years) with IBD were recruited between September 2021 and May 2023. All eligible participants underwent comprehensive clinical assessment and laboratory investigation. Patients with functional gastrointestinal disorders served as the controls. This study assessed specific IBD phenotypes, disease duration, clinical and endoscopic activity indices, laboratory markers, and medication histories. OCTA was utilized to evaluate ocular microvasculature changes in both groups. A total of 63 children (mean age 12.9 ± 3.3 years) were enrolled, comprising 38 in the IBD group (16 ulcerative colitis, 22 Crohn's disease, and 25 in the control group). Most patients in the IBD group were in remission or had mild‐to‐moderate disease activity at enrollment. Analysis of the OCTA results revealed significant differences in the choroidal luminal area and total choroidal area between the IBD and control groups. The study identified distinct ocular microvasculature changes in pediatric IBD patients through OCTA, suggestive of potential systemic endothelial dysfunction. These findings underscore the utility of OCTA in evaluating microvascular alterations associated with pediatric IBD, offering insights into potential systemic complications linked to inflammation in IBD patients. Inflammatory bowel diseases (IBD) encompass systemic inflammation due to immune and nonimmune cell activation leading to microvascular endothelial damage.Endothelium plays a crucial role in various physiological processes like vasoconstriction/vasodilation, coagulation, and leukocyte migration.IBD patients often exhibit early endothelial dysfunction in the gut microvascular system. Inflammatory bowel diseases (IBD) encompass systemic inflammation due to immune and nonimmune cell activation leading to microvascular endothelial damage. Endothelium plays a crucial role in various physiological processes like vasoconstriction/vasodilation, coagulation, and leukocyte migration. IBD patients often exhibit early endothelial dysfunction in the gut microvascular system. Optical coherence tomography angiography has been used for the first time in children to evaluate endothelial dysfunction in pediatric IBD.The study identified distinct ocular microvasculature changes in pediatric IBD patients and a significant inverse correlation between platelet count and choroidal vasculature.The findings suggest a potential link between ocular microvascular alterations and systemic endothelial dysfunction in pediatric IBD emphasizing that IBD‐related inflammation goes beyond the gut, impacting the microvasculature system of the eye. Optical coherence tomography angiography has been used for the first time in children to evaluate endothelial dysfunction in pediatric IBD. The study identified distinct ocular microvasculature changes in pediatric IBD patients and a significant inverse correlation between platelet count and choroidal vasculature. The findings suggest a potential link between ocular microvascular alterations and systemic endothelial dysfunction in pediatric IBD emphasizing that IBD‐related inflammation goes beyond the gut, impacting the microvasculature system of the eye.

Study objectives: The current criterion standard for measuring inspiratory effort, esophageal manometry, is an invasive procedure that young patients find intolerable. Inspiratory effort can also be assessed noninvasively by measuring [...]

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Paediatric studies on the role of antibiotic prophylaxis in the prevention of postoperative infections in children undergoing percutaneous endoscopic gastrostomy (PEG) are lacking. The aim of this study was to assess if a single dose of co-amoxiclav before PEG can decrease the rate of peristomal wound and systemic infection in children. In this prospective, randomised, double-blind, multicentre trial, children undergoing PEG were randomized to antibiotic prophylaxis with co-amoxiclav versus placebo and the rate of local and systemic infections were assessed. Of the 106 patients considered for inclusion, 49 patients were randomized. In the per-protocol analysis, the occurrence of wound infection was 5% (1/20) in the antibiotic group and 21% (4/19) in the placebo group (P= 0.13, 16% difference in proportions, odds ratio [OR] 0.19, 95% confidence interval [CI] 0.02–1.9). The occurrence of systemic infection was 9% (2/22) in the antibiotic group and 27.2% (6/25) in the placebo group [P= 0.17, 18% difference in proportions, OR 0.32, 95% CI 0.06%–1.80%]. Similar results were obtained in intention-to-treat analysis. Interestingly, the overall infection rate was significantly higher in the placebo group as compared with the antibiotic group (40% vs 13.6%; P= 0.04) and the duration of hospital stay was significantly longer in the placebo group as compared with the antibiotic group (4.4 ± 1.6 vs 3.5 ± 1.05; P= 0.02). The number-needed-to-treat (NTT) to prevent 1 peristomal infection on average are 6.7 patients. A preoperative dose of co-amoxiclav reduces the overall infection rate and the duration of hospital stay. Our data suggest that antibiotic prophylaxis should be recommended in every children undergoing PEG placement.

Eosinophilic esophagitis (EoE) is an emerging chronic immune and antigen-mediated clinicopathologic disease. During the last 2 decades, the incidence of this condition in children has increased significantly, thanks to practitioners for creating the awareness and higher use of diagnostic endoscopy. We have analysed paediatric literature on EoE focusing on the epidemiology, pathophysiology, clinical findings and diagnostic approach. EoE is pathogenically related to a Th2 inflammation characterized by a mixed IgE and non-IgEmediated reaction to food and/or environmental agents. This leads to esophageal dysfunction and remodeling accompanied by subepithelial fibrosis. EoE can be presented with several range of gastrointestinal symptoms, including regurgitation, vomiting, feeding difficulties or feeding refusal in infants and toddlers, as well as heartburn, dysphagia and food bolus impaction in older children and adults. The diagnostic suspicion is based on the presence of chronic symptoms of esophgeal dysfunction and esophageal eosinophilia characterised histologically by a significant eosinophilic infiltration of the oesophageal mucosa (>15 eosinophils per high powered field). In this review, we will provide an update on clinical presentation and diagnostic approach to EoE in children. We emphasized on the relevant aspects of the new clinical condition termed “PPI responsive esophageal eosinophilia”, as entities distinct from EoE and the role of PPI trial in the diagnostic workup, therefore we proposed a new diagnostic algorithm.

Despite the efforts to reduce the exposure to corrosive household products, caustic ingestion in children is currently a significant medical problem. The aims of the present study were to evaluate the clinical consequences of caustic ingestion and to identify prognostic factors that could concur in driving both diagnostic and therapeutic management. All consecutive children referred for ingestion of a caustic substance from June 2017 to June 2018 were enrolled. Medical records, laboratory and endoscopic findings were reviewed and analyzed. We enrolled 44 children with caustic ingestion. Alkaline agents were ingested by 26 of 44 (59.1%) patients, whereas acid agents were ingested by 18 of 44 patients (40.9%). Alkaline rather than acid agents were associated with a worse endoscopic score (r: 0.45) and a higher probability of early esophageal stricture occurrence (r: 0.38). The specific risk of the presence of severe esophageal lesions rose progressively with increasing number of symptoms whereas no esophageal injury was found in asymptomatic patients. Our data suggest that endoscopic evaluation is mandatory in symptomatic patients to direct therapeutic management, but it could be avoided in asymptomatic patients after accidental ingestion, particularly if the ingestion is only suspected and patients have no oropharyngeal burns.

Study design: Power spectrum analysis of heart rate variability (HRV) is a noninvasive technique that provides a quantitative assessment of cardiovascular neural control. Using this technique, we studied the autonomic [...]

IMPORTANCE: Although polysomnographic (PSG) testing is the gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children, the number of pediatric sleep laboratories is limited. Developing new screening methods for identifying OSAS may reduce the need for PSG testing. OBJECTIVE: To evaluate the combined use of the sleep clinical record (SCR) and nocturnal oximetry testing for predicting PSG results in children with clinically suspected OSAS. DESIGN, SETTING, AND PARTICIPANTS: Prospective study over 10 months. A cohort of 268 consecutive children (mean [SD], age 6 [3] years) referred for clinically suspected OSAS was studied at a pediatric sleep center at a university hospital. Children with disorders other than adenotonsillar hypertrophy or obesity were excluded. MAIN OUTCOMES AND MEASURES: Mild OSAS (obstructive apnea–hypopnea index [AHI], 1-5 episodes/h) and moderate-to-severe OSAS (AHI, >5 episodes/h) were the main outcome measures. Sleep clinical record scores greater than or equal to6.5 were considered positive, as were McGill oximetry scores (MOS) greater than 1, and these positive scores were the main explanatory variables in our study. Each participant was evaluated by the SCR, followed by pulse oximetry test the first night and PSG test in the sleep laboratory the second night. RESULTS: Of the total participants, 236 (88.1%) were diagnosed with OSAS, 236 (88.1%) had a positive SCR score, and 50 (18.7%) had a positive MOS. Participants with positive SCR scores had significantly increased risk of an AHI greater than or equal to 1 (adjusted odds ratio [AOR], 9.3; 95% CI, 3.7-23.2; P < .001). Children with an MOS greater than 1 were significantly more likely to have an AHI greater than 5 episodes/h than children with an MOS equal to 1 (AOR, 26.5; 95% CI, 7.8-89.2; P < .001). A positive SCR score had satisfactory sensitivity (91.9%) and positive predictive value (91.9%) but limited specificity (40.6%) and negative predictive value (40.6%) for OSAS. An MOS greater than 1 had excellent specificity (97.4%) and positive predictive value (94%) but low sensitivity (39.2%) and fair negative predictive value (60.8%) for moderate-to-severe OSAS among children with a positive SCR score. The combination of SCR scores and MOS correctly predicted primary snoring, mild OSAS, or moderate-to-severe OSAS in 154 of 268 (57.4%) participants. CONCLUSIONS AND RELEVANCE: The combined use of the SCR score and nocturnal oximetry results has moderate success in predicting sleep-disordered breathing severity when PSG testing is not an option.

A deficit in arousal process has been implicated as a mechanism of sudden infant death syndrome (SIDS). Compared with control infants, SIDS victims showed significantly more subcortical activations and fewer cortical arousals than matched control infants. Apparent life-threatening event (ALTE) is often considered as an aborted SIDS event. The aim of this study was to study the arousal characteristics of ALTE infants during the first months of life.

ABSTRACTOverweight and obesity may be associated with cognitive problems and both may share “neuroendocrinobiological roots” in common cerebral areas. We investigated intellectual performances and a possible “specific cognitive profile” in overweight/obese children. A cross-sectional study was conducted on 898 school children (6 to 13 years) attending primary schools. Wechsler Intelligence Scale for Children-revised (WISC-R) revealed significant differences in performance intelligence quotient (PIQ) scores between body mass index (BMI) subgroups (p<0.01). Regression analysis identified BMI as the only variable significantly related to PIQ (p<0.05). Gender (p<0.05) and parental educational score (p<0.001) were significantly related to verbal intelligence quotient (VIQ). Parental educational score was the only factor significantly related to total intelligence quotient (TIQ) (p<0.05). Parental education seems to play a major role in TIQ and VIQ; a lower PIQ score is clearly related to a higher BMI. A routine neurocognitive assessment in overweight/ obese children is recommended.Finally, we have added some reflections on common neuroendocrinobiological roots.

The aim of our study was to investigate cardiovascular autonomic activity during wakefulness, using cardiovascular tests, in a population of children with OSAS.

Sleep breathing disorders may trigger paroxysmal events during sleep such as parasomnias and may exacerbate preexisting seizures. We verified the hypothesis that the amount of EEG paroxysmal activity (PA) may be high in children with obstructive sleep apnea syndrome (OSAS).

The propensity to arouse from sleep is an integrative part of the sleep structure and can have direct implications in various clinical conditions. This study was conducted to evaluate the maturation of spontaneous arousals during the first year of life in healthy infants.

To evaluate NREM sleep instability, as measured by the cyclic alternating pattern (CAP), in a cohort of children with mild sleep disordered breathing (SDB) or frank obstructive sleep apnea (OSA) and normal controls.

To describe the ictal polysomnographic features of a patient with Panayiotopoulos syndrome, a peculiar epileptic syndrome characterized by infrequent, often single, prolonged, nocturnal, focal seizures comprising an unusual constellation of autonomic symptoms (malaise, nausea, pallor, tachycardia, vomiting) and unilateral deviation of the eyes at the onset of seizures. These clinical, ictal manifestations are rarely followed by post‐ictal headache. In the literature, there is little information on the ictal EEG characteristics of Panayiotopoulos syndrome and, in particular, on certain autonomic manifestations, such as tachycardia, as the sole ictal phenomena at the onset of seizures. Methods and results.One, all‐night videopolysomnography, during which one seizure was recorded. Video‐EEG data were evaluated visually and by means of quantitative spectral analysis. The spectral analysis of the recorded seizure showed a complex ictal pattern of cortical involvement with focal onset in the right occipital area followed by the recruitment of widespread extraoccipital cortical regions. This is the first such analysis of this peculiar epileptic condition. Most of the symptoms were consistent with a diagnosis of severe Panayiotopoulos syndrome, although the patient also presented “atypical findings”: a relatively high frequency of seizures, post‐ictal headache, no spontaneous remission of seizures with age, and late onset of visual hallucinations; this last finding is more frequent in “Gastaut‐type childhood occipital epilepsy”, in which onset typically occurs later than in Panayiotopoulos syndrome. [Published with video sequences] Content available: Video

• Bronchial reactivity was studied via carbachol testing In 46 patients affected by type 1 diabetes mellitus and in 30 control subjects and via exercise testing In 55 diabetic patients and 60 control subjects. In all subjects, reactivity to skin allergen tests, the existence of atopic Illnesses, and family history for these diseases were evaluated. Diabetic patients were less affected by asthma than control subjects, although their family history of atopy is greater. Bronchial reactivity, as expressed by the results of carbachol testing, was lower In diabetic patients than In control subjects. Furthermore, the duration of disease In diabetic patients was positively correlated with the results of carbachol testing. Reduced bronchial reactivity might be an Indication of Initial damage to the autonomic nervous system, which would thus appear to be both a complication and a protective factor.(AJDC 1988;142:726-729)