Journal of Pediatric and Neonatal Individualized Medicine (JPNIM) <p>The <strong>Journal of Pediatric and Neonatal Individualized Medicine (JPNIM)</strong> is a peer-reviewed interdisciplinary journal which provides a forum on new perspectives in pediatric and neonatal medicine. The aim is to discuss and to bring readers up to date on the latest in research and clinical pediatrics and neonatology. Special emphasis is on developmental origin of health and disease or perinatal programming and on the so-called ‘-omic’ sciences. Systems medicine blazes a revolutionary trail from reductionist to holistic medicine, from descriptive medicine to predictive medicine, from an epidemiological perspective to a personalized approach. The journal will be relevance to clinicians and researchers concerned with personalized care for the newborn and child. Also medical humanities will be considered in a tailored way.</p> <p>Article submission (original research, review papers, invited editorials and clinical cases) will be considered in the following fields: fetal medicine, perinatology, neonatology, pediatrics, developmental programming, psychology and medical humanities.</p> en-US <p>© Hygeia Press</p> <p> </p> <h3>Copyright and publishing rights</h3> <p>Regarding copyright, before publication, Authors declare that, in consideration of the action of JPNIM in reviewing and editing their submission, they transfer, assign, or otherwise convey all copyright ownership, including any and all rights incidental thereto, exclusively to the JPNIM Publisher (Hygeia Press di Corridori Marinella).</p> <div> <div> <div> <div> <div> <p>Authors have the opportunity to reuse figures, tables and selected text up to 250 words from their article as finally published, providing that full and accurate credit shall be given to publication in JPNIM and that modifications are noted (otherwise no changes may be made).</p> </div> </div> </div> </div> </div> (JPNIM Staff) (JPNIM Staff) OJS 60 Selected Abstracts of the 16th International Workshop on Neonatology, Virtual Edition (Cagliari, Italy; 29-30 October, 2020) & of the 16th International Congress on Neonatology and Pediatrics, On Demand (Cagliari, Italy; November 20-December 31, 2020) <p><strong>Selected Abstracts of the 16<sup>th</sup> International Workshop on Neonatology, Virtual Edition (Cagliari, Italy; 29-30 October 2020) &amp; of the 16<sup>th</sup> International Congress on Neonatology and Pediatrics, On Demand (Cagliari, Italy; November 20-December 31, 2020)</strong></p> <p> </p> <p class="p1"><strong>ABS 1 • ACRAL ERYTHEMA AND SWELLING IN A NEWBORN: A RARE PRESENTATION OF COW’S MILK PROTEIN ALLERGY •</strong> F. Mecarini, B. Cuomo, A. Casati, G. Di Giorgio, R. Navas, G. Bracaglia (Viterbo and Cagliari, Italy)</p> <p class="p1"><strong>ABS 2 • ANALYSIS OF THE ORGANIZATIONAL CLIMATE AND JOB SATISFACTION OF THE NURSING TEAM IN PEDIATRICS •</strong> M. Galletta, L. Deidda, I. Portoghese, M. Agus, A. Azara, A. Piana, I. Piras (Cagliari and Sassari, Italy)</p> <p class="p1"><strong>ABS 3 • LABORATORY MEDICINE IN THE ERA OF COVID-19 PANDEMIC: A CHALLENGE FOR CHILDREN AND PEDIATRICIANS •</strong> M. Mussap (Cagliari, Italy)</p> <p class="p1"><strong>ABS 4 • RESPIRATORY MANAGEMENT OF TRANS­FERRED CRITICAL NEWBORNS: HAS IT CHANGED OVER TIME? •</strong> C. Loddo, F. Cavallin, R.L. Peloso, E. Baraldi, D. Trevisanuto (Cagliari and Padua, Italy)</p> <p class="p1"><strong>ABS 5 • EFFECTS OF THE INTRODUCTION OF A STANDARD PROTOCOL FOR THE EVALUATION OF FEEDING INTOLERANCE IN PRETERM INFANTS •</strong> E. Maggiora, A. Coscia, E. Spada, F. Vignali, S. Rovei, M. Scrufari, S. Gazzi, A. De Risi, E. Bertino, F. Cresi (Turin, Italy)</p> <p class="p1"><strong>ABS 6 • OBSTETRICAL AND PERINATAL PREDIS­POSING FACTORS FOR PERSISTENCE OF DUCTUS ARTERIOSUS IN A COHORT OF PREMATURE INFANTS: A RETROSPECTIVE STUDY •</strong> N.A.M. Vitiello, N. Ibba, F. Bardanzellu, A. Melis, P. Neroni, V. Fanos (Cagliari, Italy)</p> <p class="p1"><strong>ABS 7 • THE USE OF HUMAN MILK IN THE NICU. 10 YEARS OF EXPERIENCE IN HUMAN MILK BANKING •</strong> P.A. Quitadamo, G. Palumbo, L. Cianti, A. Villani (San Giovanni Rotondo [Foggia], Italy)</p> <p class="p1"><strong>ABS 8 • KEY ROLE OF MATERNAL DIET DURING BREASTFEEDING: FROM EPIGENETICS TO FLAVOUR PREFERENCE DEVELOPMENT •</strong> A. Bosco, A. Dessì (Turin and Cagliari, Italy)</p> <p class="p1"><strong>ABS 9 • CEMENTOBLASTOMA IN A 15-YEAR-OLD GIRL •</strong> M. Mureddu, F. Ledda, G. Cerrone, G. Faa, C. Gerosa (Cagliari, Italy)</p> <p class="p1"><strong>ABS 10 • A 4-YEAR-OLD CHILD WITH DESQUAMATING RASH: ALWAYS REMEMBER STAPHYLOCOC­CAL-SCALDED SKIN SYNDROME •</strong> F. Mecarini, E. Goldoni, P. Marenzoni, E. Gatta, R. Navas, G. Bracaglia (Viterbo and Cagliari, Italy)</p> <p class="p1"><strong>ABS 11 • HYDROPS FETALIS DURING THE COVID-19 ERA •</strong> F. Bardanzellu, A. Melis, M.A. Marcialis, M.C. Pintus, V. Fanos (Cagliari, Italy)</p> <p class="p1"><strong>ABS 12 • THE DIFFICULTIES PERCEIVED BY PARENTS OF CHILDREN WITH AUTISM SPECTRUM DISORDERS IN THE HEALTHCARE SETTINGS. A PILOT STUDY •</strong> I. Piras, M. Agus, E. Montis, A. Azara, A. Piana, M. Galletta (Sassari and Cagliari, Italy)</p> <p class="p1"><strong>ABS 13 • DOUBTFUL CAT-SCRATCH DISEASE: THE IMPORTANCE OF HISTOLOGICAL EVALUATION •</strong> G. Cerrone, C. Betti, V. Aimola, F. Ledda, D. Fanni, C. Gerosa (Cagliari, Italy)</p> <p class="p1"><strong>ABS 14 • THE BIRTH OF A NEWBORN AND HIS MICROBIOME •</strong> E. Caboni, F. Bardanzellu, A. Melis, D.G. Peroni, A. Coscia, V. Fanos (Cagliari, Pisa and Turin, Italy)</p> <p class="p1"><strong>ABS 15 • CONGENITAL SKULL DEPRESSION IN A PRE­TERM INFANT: A CASE REPORT •</strong> C. Loddo, C. Fanni, E. Curridori, A. Melis, C. Porcu, M.A. Marcialis, V. Fanos (Cagliari, Italy)</p> <p class="p1"><strong>ABS 16 • BREASTFEEDING AND POST-PARTUM SUP­PORT: A STUDY OF 161 INFANTS AND THEIR MOTHERS FROM THE “SOS MAMI” SURGERY •</strong> S. Giorri, R. Pintus, A. Dessì (Cagliari, Italy)</p> <p class="p1"><strong>ABS 17 • POTENTIAL PITFALLS OF EtCO<sub>2</sub> MONITORING DURING PAEDIATRIC OUT-OF-HOSPITAL CAR­DIAC ARREST. A CASE REPORT •</strong> P. Isoni, G. Piras, I. Piras (Cagliari and Sassari, Italy)</p> <p class="p1"><strong>ABS 18 • INTERACTIONS BETWEEN PREECLAMPSIA AND COMPOSITION OF THE HUMAN MILK: WHAT DO WE KNOW? •</strong> C. Peila, E. Bertino, G. Maiocco, A. Coscia (Turin, Italy)</p> <p class="p1"><strong>ABS 19 • MULTIPLE ACCESSORY TRAGUS IN A 4-YEAR-OLD CHILD. CLUES OF A GOLDENHAR SYNDROME? •</strong> G. Pinna, J.S.A. Zanda, G. Cerrone, G. Faa, C. Gerosa (Cagliari, Italy)</p> <p class="p1"><strong>ABS 20 • NONINVASIVE MEASUREMENT OF BILIRUBIN IN TERM NEONATES •</strong> T. Itova, V. Atanasova (Ruse and Pleven, Bulgaria)</p> <p class="p1"><strong>ABS 21 • STAPHYLOCOCCAL SCALDED SKIN SYN­DROME IN A 20-DAY-OLD INFANT IN COVID-19 PANDEMIC: CASE REPORT •</strong> M.E. Yuliana, R. Sihombing, R. Muchtar (Jakarta, Indonesia)</p> --- Various Authors Copyright (c) 2020 © Hygeia Press Thu, 17 Dec 2020 00:00:00 +0100 Selected Lectures of the 16th International Congress on Neonatology and Pediatrics, On Demand; Cagliari (Italy); November 20th-December 31st, 2020 <p><strong>Selected Lectures of the 16<sup>th</sup> International Congress on Neonatology and Pediatrics, On Demand • Cagliari (Italy) • November 20<sup>th</sup>-December 31<sup>st</sup>, 2020</strong></p> <p>&nbsp;</p> <p><br><strong>LECT 1 • THE IMPACT OF ASSISTED REPRODUCTION, INTRAUTERINE GROWTH RESTRICTION AND PREMATURITY ON THE NEURODEVELOPMENT OF TWINS •</strong> D.D. Briana (Athens, Greece)</p> <p><strong>LECT 2 • PFAPA (PERIODIC FEVER – APHTHOUS STOMATITIS – PHARYNGITIS – ADENOPATHY) SYNDROME: LIGHTS IN THE DARK? •</strong> S. Manti, G.F. Parisi, M. Papale, P. Barone, S. Leonardi (Catania, Italy)</p> <p><strong>LECT 3 • EARLY LIFE INTERVENTIONS AND IMMUNE HEALTH RELEVANCE FOR SPECIALIZED NUTRITION •</strong> J. Garssen (Utrecht, The Netherlands)</p> <p><strong>LECT 4 • COVID-19 AND KAWASAKI SYNDROME: WHAT WE KNOW •</strong> P.P. Bassareo (Dublin, Ireland)</p> <p><strong>LECT 5 • HUMAN MILK AS A MAGIC FLUID •</strong> A. Dessì (Cagliari, Italy)</p> <p><strong>LECT 6 • NEUROPROTECTION OF NEONATAL BRAIN TODAY •</strong> G. Buonocore (Siena, Italy)</p> <p><strong>LECT 7 • PROBIOTICS: ARE ALL THE SAME? •</strong> R. Francavilla, V.N. Dargenio, F. Cristofori (Bari, Italy)</p> <p><strong>LECT 8 • VITAMIN D: FROM ROOTS TO METABOLOMICS •</strong> M. Puddu (Cagliari, Italy)</p> <p><strong>LECT 9 • RESPIRATORY SYNCYTIAL VIRUS: PRESENT AND FUTURE •</strong> L. Bonadies, A. Galderisi, E. Priante, V. Mardegan, E. Baraldi (Padua, Italy)</p> <p><strong>LECT 10 • GROWTH: NATURE OR NURTURE? WHERE DOES INEQUALITY BEGIN? •</strong> E. Bertino, G. Maiocco, S. Sottemano (Turin, Italy)</p> <p><strong>LECT 11 • OMICS IN AUTISM •</strong> M. Mussap (Cagliari, Italy)</p> <p><strong>LECT 12 • PLACENTA AND NEONATAL INFECTION: INTRIGUING CONNECTIONS •</strong> G. Faa, S. Angioni, V. Vallascas, M. Moi, F. Ledda, P. Van Eyken, D. Fanni, C. Gerosa (Cagliari, Italy, and Genk, Belgium)</p> <p><strong>LECT 13 • METABOLOMICS AND HUMAN MILK •</strong> V. Fanos, F. Bardanzellu, M. Puddu (Cagliari, Italy)</p> --- Various Authors Copyright (c) 2020 © Hygeia Press Sun, 08 Nov 2020 00:00:00 +0100 The COVID-19 pandemic and perinatology in Lithuania <p>During the first COVID-19 wave, there were not many cases in Lithuania, but the second wave impacted Lithuania quite strongly. <span class="s1">According to the morbidity rates, we became one of the worst affected countries in Europe. </span></p> <p>Perinatology, as one of the areas of healthcare, was also affected by this pandemic. We had to reorganize the working principles of the hospitals that provide perinatal medicine. Specialized, isolated wards, where <span class="s1">SARS-CoV-2-</span>infected women gave birth, were installed. However, once the second wave spread, these departments were not able to handle it anymore, so the <span class="s1">SARS-CoV-2</span>-infected women gave birth in almost all of the country’s hospitals. Out of the 25 hospitals that provide perinatal healthcare, there were <span class="s1">SARS-CoV-2-</span>infected women in 17 of them.</p> <p>In 2020, out of the country’s 2.794 million citizens, 151 SARS-CoV-2-infected women gave birth. Most of them were asymptomatic, and a few had light-to-medium symptoms. Two women had a severe form of COVID-19. All of the mothers who had <span class="s1">COVID-19 </span>recovered successfully.</p> <p>There were 10 SARS-CoV-2-infected babies in 2020 in Lithuania. Following the UENPS recommendations, the newborns were nursed in the rooms next to their mothers. The frequency of transmission of the virus was about 6.6% of all the SARS-CoV-2-positive mothers.</p> <p>COVID-19 changed the tactics of both delivery and newborn care in the hospital. Childbirth is a <span class="s1">significant </span>moment in a family. During the pandemic, the family-oriented policy suffered because <span class="s1">the second parent’s hospitalization </span>was not allowed anymore due to the restrictions. </p> <p><span class="s1">At the beginning of the pandemic, the Ministry of Health of the Republic of Lithuania, along with professional associations of perinatal medicine (the Lithuanian Association of Obstetricians and Gynecologists and the Lithuanian Neonatology As­sociation), published national guidelines.</span></p> Rasa Tamelienė Copyright (c) 2021 © Hygeia Press Tue, 19 Jan 2021 00:00:00 +0100 Seven secrets of COVID-19: fever, ACE2 receptors, gut-lung axis, metabolomics, microbiomics, probiotics, diet <p class="p1"><span class="s1">The aim of this work is to investigate 7 secrets of COVID-19 (fever, ACE2 receptors, gut-lung axis, metabolomics, microbiomics, probiotics, diet), hoping to reveal a small part of some of these and to increase anyhow the knowledge on SARS-CoV-2 and its weaknesses to be able to defeat it.</span></p> <p class="p1"><span class="s1">In particular, in the opinion of the authors, significant improvements in contrasting the Coronavirus, and the pandemics that will follow, could derive from the use of “omics” disciplines, namely metabolomics (the stethoscope of the future) and microbiomics (an unrecognized player).</span></p> <p class="p1"><span class="s1">The discovery of new biomarkers using metabolomics could be used in clinical practice as predictive diagnostic tools or to evaluate the effectiveness and toxicity of a drug, in order to be able to provide the patient with a personalized, tailor-made medicine: precision medicine.</span></p> <p class="p1"><span class="s1">Our understanding of the role of the gut microbiome in COVID-19 infection remains in its infancy, but future research may potentially aid our understanding of viral infection, and create new ways in which we might treat and prevent it.</span></p> <p class="p1"><span class="s1">We strongly believe that the 3 M’s (Metabolomics, Microbiomics and Machine learning [Artificial Intelligence]) will be the right route to the future for risk assessment, early diagnosis, patient management and decision-making.</span></p> <p class="p1"><span class="s1">By now, probiotics could help, fighting face to face against the virus. Moreover, the diet may be a key driver in determining the severity of COVID-19 and further studies are needed to explore the secret language between diet, bacteria, viruses and metabolites in determining individualized susceptibility or resilience to COVID-19.</span></p> Vassilios Fanos, Roberta Pintus, Maria Cristina Pintus, Michele Mussap, Maria Antonietta Marcialis Copyright (c) 2021 © Hygeia Press Wed, 20 Jan 2021 00:00:00 +0100 Congenital cytomegalovirus infection: from suspicion to confirmation <p class="p1"><strong>Introduction: </strong>Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection and the leading cause of sensorineural hearing loss in childhood. Maternal seroconversion during pregnancy carries a 30% to 75% risk of vertical transmission. Serological surveillance is not indicated. In a confirmed infection there is no effective treatment and, in seropositive pregnant women, reactivation and even reinfection by different strains may occur.</p> <p class="p1"><strong>Methods: </strong>A retrospective observational study (2008-2018) was conducted, analyzing children born in our hospital that maintained follow-up by suspected congenital CMV (cCMV) infection.</p> <p class="p1"><strong>Results:</strong> We identified 125 cases of children with suspected cCMV infection. In 91 (72.8%) cases, the mothers had positive IgM; in 23 of them a seroconversion was documented and 4 cases corresponded to reactivation. Only 13 of the pregnant women had immunity to CMV, but 3 of the confirmed cases came from this group. Almost 17% of mothers had an unknown serological status and, in these cases, the suspicion was raised by placental changes, identification of abnormalities on the transfontanellar ultrasound, fetal growth restriction or other clinical signs compatible with CMV infection. cCMV infection was confirmed in 12 cases, 4 of them with sensorineural hearing loss and/or psychomotor development delay.</p> <p class="p1"><strong>Discussion: </strong>Counseling all pregnant women on prevention strategies has proven to be an effective prophylactic measure. Even though universal screening for CMV in pregnant women remains unrecommended, studying children with suspected clinical signs allows early screening for vertical transmission and early detection of possible sequelae.</p> Teresa Pinheiro, Teresa Caldeira Copyright (c) 2021 © Hygeia Press Mon, 15 Feb 2021 00:00:00 +0100 Management of preterm low birth weight infants in Dhaka: a comparison between Standard Care and Kangaroo Mother Care <p class="p1"><span class="s1">In Bangladesh, government healthcare facilities are adopting Kangaroo Mother Care (KMC) more extensively for preterm low birth weight (LBW) infants to reduce neonatal deaths in the country. A quasi-experimental study was carried out to compare KMC and Standard Care (SC) outcomes for preterm LBW babies. Data were collected from December 2017 to June 2018. The study focused on the preterm neonates admitted to Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka. A total of 25 neonates under KMC and 25 neonates under SC were enrolled from the initial study population. The study revealed that during the length of hospital stay, the incidence of hypothermia (4% in KMC vs. 24% in SC) and hyperthermia (8% in KMC vs. 32% in SC) and clinical late-onset sepsis (36% in KMC vs. 64% in SC) were significantly lower among neonates of KMC. Times to first feed (1.80 ± 0.40 in KMC vs. 2.20 ± 0.42 in SC) and to full enteral feeding (8.32 ± 2.49 in KMC vs. 19.56 ± 6.80 in SC) were also found to be significantly shorter among KMC neonates. Moreover, KMC mothers show adequate breastfeeding more often than in SC group (88% in KMC vs. 64% in SC). On the other hand, a higher proportion of SC neonates compared to KMC neonates were found to have feeding intolerance (56% in SC vs. 8% in KMC), hyperglycaemia (24% in SC vs. 4% in KMC) and apnoea (32% in SC vs. 8% in KMC). Finally, mean hospital stay (12.04 ± 2.74 days in KMC vs. 25.24 ± 7.20 days in SC) and mean treatment cost (9,508 ± 4,142 Taka in KMC vs. 35,064 ± 13,352 Taka in SC) were found to be significantly lower for KMC. In conclusion, KMC seems to be a safe and effective method of care for preterm LBW infants in a limited resources health care setting.</span></p> Mousumi Akter, Salamat Khandker, Mohammad Shaheen, Nadira Mehriban, Sk Akhtar Ahmad Copyright (c) 2020 © Hygeia Press Wed, 18 Nov 2020 00:00:00 +0100 Predictors of preterm birth in Jimma town public hospitals, Jimma, Ethiopia <p class="p1"><strong>Background: </strong>Preterm birth is the most fundamental reason of adverse infant outcomes. Analyzing the preterm birth and its predictor helps health caregivers and policymakers to design better strategies. This study aims to assess predictors of preterm birth in Jimma town public hospitals.</p> <p class="p1"><strong>Method: </strong>Facility-based cross-sectional study was undertaken. Systematic sampling was used to select 319 study participants. Data was entered into EpiData version 3.1 and exported to SPSS® version 23 for analysis. Logistic regression was used to analyze the association between dependent and independent variables and variables with p-value &lt; 0.05 at 95% confidence interval (<span class="s1">95%CI</span>) in multivariable were considered statistically significant.</p> <p class="p1"><strong>Result: </strong>This study showed that 13.8% from the total 319 mothers gave a preterm birth. Place of residence (p = 0.003, AOR = 0.37, 95%CI [0.11, 0.65]), interpregnancy interval (p = 0.023, AOR = 3.91, 95%CI [1.25, 7.30]), history of preterm births (p = 0.000, AOR = 1.83, 95%CI [0.93, 4.85], pregnancy-induced hypertension (p = 0.000, AOR = 7.52, 95%CI [3.33, 14.23]), chronic disease (p = 0.000, AOR = 5.70, 95%CI [2.81, 8.01]), history of abortion (p = 0.038, AOR = 3.23, 95%CI [1.12, 10.42]) and age 40-44 (p = 0.04, AOR = 1.62, 95%CI [0.21, 14.59]), were found to be significant predictors of preterm birth.</p> <p class="p1"><strong>Conclusion: </strong>Place of residence, short pregnancy interval, pregnancy-induced hypertension, previous history of preterm birth, presence of chronic medical diseases, maternal age between 40 and 44 years, and having abortion history were significant predictors of preterm birth. Therefore, as an important recommendation, health professionals and hospital administrative staff should work with their maximum effort to decrease the magnitude of preterm births and on early identification and management of mothers at risk to have a preterm birth.</p> Ebissa Bayana Kebede, Yonas Biratu Terfa, Bonsa Amsalu Geleta, Adugna Olani Akuma Copyright (c) 2021 © Hygeia Press Sun, 07 Feb 2021 00:00:00 +0100 Oct-4 is highly expressed in stem/progenitor cells and in primordial follicles of the fetal human ovary <p class="p1"><span class="s1">Oct-4 (Octamer-binding transcription factor 4) is a member of the POU (Pit-Oct-Unc) family. During development, Oct-4 is expressed in embryonic stem cells and in germ cell precursors. In this study, we investigated the expression of Oct-4 in the ovaries of human fetuses during gestation. The ovaries of 14 human fetuses and newborns, ranging in gestational age from 12 up to 38 weeks of gestation, were formalin-fixed, routinely processed and paraffin-embedded. Paraffin sections were immunostained with an anti-Oct-4 commercial antibody. Oct-4 expression was demonstrated in all the ovaries analyzed. Immunoreactivity for Oct-4 was detected in multiple stem/progenitor cells, including oogonia. Moreover, Oct-4 was expressed in oocytes, in primordial follicles. In ovarian stem/progenitor cells, Oct-4 was expressed in the nucleus, whereas in oocytes reactivity for Oct-4 was restricted to the cytoplasm. In the initial stages of gestation, the majority of Oct-4-positive precursor cells were detected in the external cortex. These preliminary data indicate Oct-4 as a major player in germ cell differentiation in the human ovary and as a useful marker for ovarian stem/progenitor cells. Given the ability of Oct-4 for the detection of ovarian stem/progenitor cells, further studies are needed in order to verify its ability to detect stem cells in adult ovaries.</span></p> Flaviana Cau, Daniela Fanni, Clara Gerosa, Maria Carolina Botta, Flaminia Bardanzellu, Sara Aversa, Ester Sorrentino, Francesco Ronchi, Cristiana Bellan, Gavino Faa, Massimo Castagnola Copyright (c) 2021 © Hygeia Press Thu, 25 Feb 2021 00:00:00 +0100 Investigating and determining the risk factors of neonatal seizures in NICU patients in the South of Iran <p class="p1"><span class="s1"><strong>Introduction: </strong>The incidence of neonatal seizures has been reported at 1.8 to 8.6 in 1,000 live births. It seems that the brain of premature children is more susceptible to seizures. The causes of neonatal seizures comprise a range of neurological disorders, including hypoxic-ischemic encephalopathy (HIE), central nervous system infection, intracranial hemorrhage, and structural disorder of the brain. Among all, the most common cause is HIE. Given the risks and consequences of neonatal seizures, this study aimed to investigate their risk factors.</span></p> <p class="p1"><span class="s1"><strong>Methods: </strong>This is a descriptive cross-sectional study of 92 neonates, aged &lt; 28 days, admitted to Neonatal Intensive Care Unit (NICU) during the period from March 2011 to May 2014, with the diagnosis of seizures. Demographic data including age, sex, gestational age, birth weight, fifth minute Apgar score were extracted from patient files. Data were analyzed using SPSS® version 19 software. </span></p> <p class="p1"><span class="s1"><strong>Results: </strong>Of 92 cases, 12 (13.0%) had the fifth minute Apgar score above 8, 79 (85.9%) had Apgar score between 3 and 8, and 1 (1.1%) had Apgar score less than 3. Asphyxia was present in 63 (68.5%) infants. Seizure types were clonic in 41 (44.6%) cases, myoclonic in 20 (21.7%) cases, of mild type in 14 (15.2%) cases, and tonic in 17 (18.5%) cases. Metabolic disturbances revealed hypoglycemia in 7.6%, hypocalcemia in 2.2%, hyponatremia in 4.3%. Hereditary metabolic disorders were observed in 6.5% of patients.</span></p> <p class="p1"><span class="s1"><strong>Conclusion: </strong>HIE was the most common cause of neonatal seizures, and cerebral hemorrhage and metabolic disorders were other two major causes of seizures after HIE. The most common type of seizures was the clonic type. The results suggest that male gender and a postnatal age &lt; 2 weeks are associated with an increased risk of seizure in normal and premature infants.</span></p> Ali Khaje, Seyed Hosein Soleimanzadeh Mousavi, Maryam Golmohammadi, Zeinab Tavakolikia, Ghasem Miri-Aliabad, Reza Keeykha, Maryam Keykha, Afshin Fayyazi, Mohammadhosein Akhlaghpasand Copyright (c) 2021 © Hygeia Press Fri, 12 Feb 2021 00:00:00 +0100 Symptomatic Meckel’s diverticulum in children: a 12-year survey <p class="p1"><strong>Introduction: </strong>Meckel’s diverticulum (MD) is usually asymptomatic but may be associated with severe complications that require awareness. This study aimed to assess the clinical and pathological features of symptomatic MD in children as well as the accuracy of [<sup>99m</sup>Tc]sodium pertechnetate scintigraphy.</p> <p class="p1"><strong>Methods:</strong> We retrospectively reviewed all symptomatic MD in pediatric patients treated between 2007 and 2018 at a tertiary center. Records included demographics, clinical presentation, scintigraphy with [<sup>99m</sup>Tc]sodium pertechnetate, surgical outcome, and histopathology.</p> <p class="p1"><strong>Results: </strong>There were 47 patients (93.6% males) with a median age of 4.31 [1.76-8.10] years. The most common clinical presentation was digestive bleeding (n = 25, 53.2%), followed by intestinal obstruction (n = 12, 25.5%) and diverticulitis (n = 10, 21.3%). The patients with digestive bleeding were younger than those with intestinal obstruction or diverticulitis (2.76 vs. 6.02 years). All patients with digestive bleeding underwent scintigraphy that revealed ectopic gastric mucosa in 23. From the 23 positive scintigraphy, there were 22 available histological exams, from which 21 revealed ectopic gastric mucosa; the 2 negative scintigraphy studies also revealed ectopic gastric mucosa. Therefore, scintigraphy revealed a sensitivity of 91.3% (21/23) in patients presenting digestive bleeding. In the conclusive histological exams (n = 41), ectopic mucosa was detected in 82.9% of cases: 96% in digestive bleeding, 71% in intestinal obstruction, and 60% in diverticulitis. With a median follow-up of 7.2 years, there were no mortality or major complications.</p> <p class="p1"><strong>Conclusion:</strong> Symptomatic MD predominated in males, the digestive bleeding occurring at younger ages. Scintigraphy demonstrated high sensitivity in the detection of ectopic gastric mucosa in patients with digestive bleeding. Overall symptomatic MD usually has ectopic mucosa. Although the surgical outcome is excellent, complications of MD should be kept in mind.</p> Sara Fonseca, Francisco Mourão, Maria Teresa Faria, Sara Fernandes, Ana Catarina Fragoso, José Estevão-Costa Copyright (c) 2021 © Hygeia Press Mon, 08 Feb 2021 00:00:00 +0100 Cord blood hematological reference values in term and late preterm infants from the Mediterranean island of Sardinia: a preliminary study <p class="p1"><span class="s1"><strong>Background:</strong> Even though umbilical cord blood (UCB) has become an important source of hematopoietic stem cells for transplant, little is known about normal hematological values at birth. The aim of our preliminary retrospective study was to determine reference values for the main hematological parameters of UCB, stratified by gender, gestational age and delivery route in the Sardinian neonatal population.</span></p> <p class="p1"><span class="s1"><strong>Method:</strong> In our retrospective study we reviewed hematological blood counts from UCB samples collected consecutively at the Neonatal and Obstetric Division of San Gavino Hospital, Sardinia, Italy, between January 1, 2013, and June 30, 2014. Unsuitable samples (insufficient blood amount, clotted or hemolyzed samples) were excluded from the analysis.</span></p> <p class="p1"><span class="s1"><strong>Results:</strong> A total of 439 UCB samples from newborn infants with gestational age ranging from 34 to 42 weeks were included in the study. Newborn infants from vaginal delivery and preterm infants showed higher erythrocyte and leukocytes values, while no differences in hematological values were found between males and females. Interestingly, reticulocyte hemoglobin content was specifically evaluated and its values were found not to be influenced by gender, gestational age, and delivery route. </span></p> <p class="p1"><span class="s1"><strong>Conclusions:</strong> These preliminary findings may contribute to define reference values for UCB hematological parameters in term and late preterm infants from the Mediterranean island of Sardinia, thus favoring a wider use of these parameters in the clinical management of the newborn.</span></p> Francesco Ronchi, Annalisa Porcella, Pietro Paolo Porcu, Sergio Salis, Cristian Locci, Nadia Vacca, Claudio Fozza, Roberto Antonucci Copyright (c) 2020 © Hygeia Press Mon, 30 Nov 2020 00:00:00 +0100 Mean platelet volume in asymptomatic chorioamnionitis-exposed infants. A retrospective case-control study <p class="p1"><span class="s1"><strong>Introduction: </strong>Maternal chorioamnionitis (CA) is a serious condition causing several neonatal morbidities and long-term neurodevelopmental sequelae in exposed infants. Current guidelines still recommend admission, laboratory evaluation, and antibiotic administration to all CA-exposed infants. The incidence of early-onset neonatal sepsis (EOS) is currently low, owing to the routine intrapartum antibiotic administration to mothers identified to be at risk of developing CA. New diagnostic tools for early diagnosis of sepsis in apparently healthy infants exposed to maternal CA are needed. Previous studies showed that mean platelet volume (MPV) is evolving as a potential inflammatory marker of neonatal sepsis. We aimed to study whether MPV can be used as an adjuvant diagnostic tool for EOS in asymptomatic CA-exposed infants. </span></p> <p class="p1"><span class="s1"><strong>Objective: </strong>To evaluate the role of MPV as an adjuvant biomarker of EOS in cases of asymptomatic CA-exposed infants.</span></p> <p class="p1"><span class="s1"><strong>Design:</strong> Retrospective case-control study.</span></p> <p class="p1"><span class="s1"><strong>Setting:</strong> A tertiary care Neonatal Intensive Care Unit (NICU).</span></p> <p class="p1"><span class="s1"><strong>Patients:</strong> Asymptomatic CA-exposed infants 37-40 weeks of gestation admitted between May 2016 and April 2019 to the NICU of Dubai Hospital, UAE.</span></p> <p class="p1"><span class="s1"><strong>Results:</strong> A total of 1,300 infants were admitted to NICU during the study period. Fifty-eight infants were included in the CA-exposed group and met the inclusion criteria, and 63 infants were matched as controls. No statistically significant differences were found in the MPV between the CA-exposed infants’ group and the control group. Similarly, no significant differences were noted in total white blood cell count, platelet count, and absolute neutrophil count between the two study groups. Inflammatory markers were significantly elevated in the CA-exposed group; however, blood cultures were sterile in all included infants.</span></p> <p class="p1"><span class="s1"><strong>Conclusions:</strong> MPV is not a sensitive marker of EOS in asymptomatic CA-exposed infants whose mothers received intrapartum antibiotic prophylaxis.</span></p> Atef Alshafei, Moustafa Hassan, Yaser El saba, Anwar Khan, Mahmoud Ahmed Copyright (c) 2020 © Hygeia Press Mon, 28 Dec 2020 00:00:00 +0100 Synbiotic therapy in infantile colic resistant to conservative therapy: a clinical trial <p class="p1"><span class="s1"><strong>Background: </strong>Infantile colic is a disturbing problem for parents. The Rome IV criteria are the last modality for the diagnosis of colic. Available medications have variable effects on the treatment of colic. However, no definite treatment has been identified yet.</span></p> <p class="p1"><span class="s1"><strong>Aims: </strong>To our knowledge, few clinical trials have compared the efficacy of synbiotics in infantile colic, so the present study was conducted. </span></p> <p class="p1"><span class="s1"><strong>Material and methods:</strong> This study was performed on 120 infants (51.66% boys; mean age: 42.09 ± 21.14 days; mean birth weight: 3,155 ± 420 g) with the diagnosis of infantile colic resistant to conservative therapy. The infants were randomly divided into groups A and B. A synbiotic containing <em>B. infantis</em>, <em>L. reuteri</em>, <em>L. rhamnosus</em>, and fructooligosaccharides (FOS) (PediLact® [Zist-Takhmir Co., Tehran, Iran] drop) was administered to group A, while group B received a synbiotic containing <em>B. lactis</em> and FOS (BBCare® [Zist-Takhmir Co., Tehran, Iran] drop). The primary outcome was the response rate to each synbiotic, and the secondary outcome was the complications of each synbiotic. </span></p> <p class="p1"><span class="s1"><strong>Results: </strong>The response rate to both synbiotics was significant after 1 week of intervention (1.97 ± 0.91 [44.95%] versus 1.64 ± 0.77 [54.23%], p = 0.000). Both groups showed a significant response rate to each synbiotic after 1 month of intervention too (1.19 ± 0.84 [63.48%] versus 0.70 ± 0.48 [79.65%], p = 0.000). The response rate was significantly higher in group B compared to group A after 1 week (54.23% versus 44.95%) and after 1 month (79.65% versus 63.48%) of intervention. Neither synbiotic was associated with adverse effects.</span></p> <p class="p1"><span class="s1"><strong>Conclusion: </strong>The present study showed that both synbiotics were effective in the treatment of infantile colic. However, the synbiotic containing <em>B. lactis</em> was significantly more effective than the synbiotic containing <em>B. infantis</em>, <em>L. reuteri</em>, and <em>L. rhamnosus</em> in infantile colic. </span></p> Peymaneh Alizadeh Taheri, Shima Rostami, Kambiz Eftekhari, Sedigheh Danesh Copyright (c) 2021 © Hygeia Press Sun, 07 Feb 2021 00:00:00 +0100 An urgent need to review the approach to a febrile child in the COVID-19 era? <p class="p1"><strong>Background: </strong>There have been reports of a new hyperinflammatory syndrome in children defined as the Paediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS). Our hospital has experienced a great proportion of children attending an Emergency Department (ED) with possible PIMS-TS so far reported in the UK.</p> <p class="p1"><strong>Objectives:</strong> We describe the clinical and biochemical findings in children with possible PIMS-TS in the context of a local ED.</p> <p class="p1"><strong>Settings:</strong> Queen Elizabeth Hospital (QEH), Woolwich, a District General Hospital (DGH) in South London.</p> <p class="p1"><strong>Participants: </strong>From 14<sup>th</sup> March to 18<sup>th</sup> May 2020, children presenting to QEH and transferred to tertiary care for possible PIMS-TS, with a history of fever and hyperinflammatory symptoms, raised inflammatory markers and without a clear clinical or microbial cause were identified. Demographic data, clinical and laboratory data were recorded as median [range].</p> <p class="p1"><strong>Results: </strong>17 children (12 male) were identified aged 11 [1-16] years. 17/17 had a fever; other common symptoms were conjunctival injection, rash and gastrointestinal symptoms. Lymphopenia and raised inflammatory markers were evident. 15/17 were tested with nasopharyngeal and oropharyngeal SARS-CoV-2 PCR swabs and 15/15 were negative. Before transfer, one child required intubation and four required inotropes. All children were transferred to a tertiary unit, 10 within the first 24 hours. After transfer, 2/17 had microbial causes evident on urine/stool culture.</p> <p class="p1"><strong>Conclusions:</strong> PIMS-TS is proving challenging to diagnose in a DGH ED because of heterogeneity of symptoms and laboratory markers, overlapping with other diseases, and cardiac complications despite deceptively benign presentations. There is an urgent need to review the approach to a febrile child in this setting, to optimise identification of PIMS-TS. Prognostic markers and risk stratification methods would help paediatricians working in the ED and general paediatric wards.</p> Rashmi S. D'Souza, Joana Freitas, Victoria Rainsley, Felix Mason, Julia Kenny, Jessica Thomas Copyright (c) 2020 © Hygeia Press Wed, 25 Nov 2020 00:00:00 +0100 A new approach to managing neonates born to mothers at risk for early-onset neonatal sepsis: is it cost-effective and can it reduce NICU admissions? <p class="p1"><strong>Introduction: </strong>In Minia University Hospital for Obstetrics and Gynecology and Pediatrics (Minia, Egypt), all neonates born to mothers with suspected or confirmed intrauterine inflammation or infection (triple I) or with group B <em>Streptococcus</em> (GBS) bacteriuria, were directly admitted to the neonatal intensive care unit (NICU) for clinical assessment and treatment of suspected sepsis for at least 48 hours, regardless of their clinical condition. Establishment of a risk-identification system for those high-risk neonates based on the EOS detection standard checklist may decrease NICU admissions and antibiotics exposure in asymptomatic neonates.</p> <p class="p1"><strong>Methods: </strong>We marginally altered a standard checklist outlined by The American College of Obstetricians and Gynecologists for the early discovery of neonates at risk for EOS. Participants of the study were inborn neonates ≥ 34 weeks born to mothers with suspected or confirmed triple I or with GBS bacteriuria, who received intrapartum antibiotic prophylaxis (IAP) at least 4 hours before delivery. Neonates for mothers at risk for EOS who did not get IAP were excluded from the study. Numerous sessions were conducted to teach nursing and medical staff to apply the standard checklist for the identification of EOS within the nursery. Symptomatic neonates were admitted directly to NICU for laboratory evaluation and intravenous antibiotics. Asymptomatic neonates were closely observed within the nursery.</p> <p class="p1"><strong>Results: </strong>From June 2017 to June 2019, there were 624 at-risk neonates recognized and assessed utilizing the standard checklist. Of these 624 neonates, 456 (73%) did not require admission to the NICU based on their risk assessment utilizing the standard checklist. Implementation of a standard checklist for at-risk neonates decreased NICU rates of admission by 50%, decreased pediatrician practice variability, decreased the number of laboratory procedures, promoted family bonding, increased rates of breastfeeding at hospital discharge, diminished financial burden on the hospital and community, and promoted antibiotic stewardship.</p> <p class="p1"><strong>Conclusion: </strong>This study concludes that utilization of the standard checklist for early identification of EOS can decrease the need for NICU admission of asymptomatic neonates at risk for EOS.</p> Nagwa Sabry, Mahmoud H. Ibrahim Copyright (c) 2021 © Hygeia Press Wed, 06 Jan 2021 00:00:00 +0100 Normal postnatal outcome in an r(X) mosaic male fetus with retained XIST gene <p class="p1"><span class="s1">We report the case of a pregnant woman who underwent prenatal diagnosis by chorionic villi sampling for increased risk of trisomy 21 due to advanced age and abnormal results of the first trimester combined screening test. </span></p> <p class="p1"><span class="s1">Karyotype analysis of the chorionic villi sampling showed a normal male karyotype (46,XY) in16 metaphases derived from the trophoblast culture and a mosaic in the mesenchymal culture for the presence of a supernumerary marker chromosome (SMC) in 6 metaphases (47,XY,+mar[6]/46,XY[16]). </span></p> <p class="p1"><span class="s1">To evaluate the presence of a real mosaicism, karyotype analysis was repeated on amniocytes derived from a single primary culture, confirming the presence of an abnormal cell line with a mosaicism of 27% (47,XY+mar[4]/46,XY[11]). </span></p> <p class="p1"><span class="s1">The distribution and the extent of the mosaicism were better characterized by the analysis of fetal blood, which allowed the definition of the SMC as an X derivative with a ring structure present at mosaic in 24% of the peripheral lymphocytes (47,XY,r(X)[23]/46XY[73]). </span></p> <p class="p1"><span class="s1">CGH-array on fetal blood-derived DNA defined the extent for 43 Mb of the X chromosome duplication from Xp21.1 to Xq21.1. </span></p> <p class="p1"><span class="s1">FISH analysis, using X centromeric and <em>XIST</em> probes, confirmed the X derivation of the marker and the inclusion of the <em>XIST</em> gene within the duplicated fragment. </span></p> <p class="p1"><span class="s1">Ultrasound fetal evaluation was unremarkable and the woman, counseled positively for the conservation of the <em>XIST</em> gene, decided to continue the pregnancy, proceeding to term. </span></p> <p class="p1">The woman delivered an apparently normal male baby who, at the follow-up to 13 months, appears morphologically and developmentally normal.</p> Maura Mingoia, Francesca Sessini, Daniela Gasperini, Paolo Moi Copyright (c) 2020 © Hygeia Press Fri, 27 Nov 2020 00:00:00 +0100 Neonatal inflammatory skin and bowel disease type 2: a very rare disease associated with EGFR mutation <p class="p1">Homozygous Epidermal Growth Factor Receptor (EGFR) mutation is associated with neonatal inflammatory skin and bowel disease type 2.</p> <p class="p1"><span class="s1">We present the case of a preterm female infant with severe growth restriction and a severe and complex clinical course. She presented from birth with erosive and inflammatory skin lesions as well as several malformations (sparse scalp hair, craniofacial abnormalities, thin and long limbs, arachnodactyly, absence of subcutaneous fat, arthrogryposis and severe congenital heart disease). She developed recurrent skin and respiratory infections, failure to thrive, severe electrolyte imbalances and progressive heart failure. Neonatal inflammatory skin and bowel disease type 2 was suspected and directed genetic testing confirmed the presence of an EGFR gene mutation in homozygosity. Despite the optimization of medical therapy, the infant died of progressive cardiac failure at 3 months of age.</span></p> Mariana Lemos, Joana S. Gonçalves, Cátia R. Correia, Ana Teresa Maria Copyright (c) 2020 © Hygeia Press Wed, 02 Dec 2020 00:00:00 +0100 Orange discoloration of the skin in mother and newborn with SARS-CoV-2 infection: is hypercarotenosis a sign of COVID-19? <p class="p1">Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and represents a potentially fatal disease. Recently, dermatological manifestations have been reported to be signs of COVID-19. We describe a case of a newborn and her mother affected by SARS-CoV-2, that developed hypercarotenosis (HC) about 5 weeks after delivery. The aim of this report is to identify the pathological mechanism of this association and to underline the importance of investigating any dubious skin manifestation in case of contact with patients with suspected or confirmed COVID-19, because it may be a clinical sign of infection. Even if not previously described in the literature, this case report suggests a possible association between HC and SARS-CoV-2 infection.</p> Dario Alario, Giorgio Bracaglia, Giulia Franceschini, Fabio Arcangeli, Federico Mecarini Copyright (c) 2020 © Hygeia Press Fri, 20 Nov 2020 00:00:00 +0100 Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Kawasaki Disease in a three-year-old girl with SARS-CoV-2 infection <p class="p1"><span class="s1">Kawasaki Disease (KD) is an acute and restrictive vasculitis. Studies have noted a viral association with the occurrence of this syndrome. This article </span><span class="s2">reports a child with several severe inflammatory syndrome symptoms associated </span><span class="s1">with COVID-19 and KD. The patient, a three-year-old Iranian Kurdish girl without a history of internal diseases and with no history of drug and food allergies, was referred to Imam Hasan hospital three days after diarrhea, nausea, and pain in the inner part of the left thigh. Scattered rashes around the face, neck, and arms during fever were significant. Reverse transcription polymerase chain reaction (RT-PCR) was positive for COVID-19, but the lung high-resolution computed tomography (HRCT) did not show involvement, so the diagnosis of KD associated with viral infection was suggested. In further studies, Wright and 2ME tests, Widal, and purified protein derivative (PPD) tests were declared negative. After intravenous immunoglobulin (IVIG), the patient’s fever continued, but other symptoms improved. </span></p> <p class="p1">Since COVID-19 is a new disease and our understanding of its numerous symptoms is evolving, we recommend physicians to be vigilant about secondary inflammatory syndromes that induce KD; rapid treatment with IVIG and steroids may improve patients’ conditions.</p> Koroush Yousefi, Salar Poorbarat, Amin Hoseinzadeh, Sajad Rahimi, Zohreh Abbasi Copyright (c) 2020 © Hygeia Press Tue, 29 Dec 2020 00:00:00 +0100 Successful antibiotic treatment of liver abscess in an eight-year-old boy after perforated appendix <p class="p1">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.</p> Marko Bašković, Antun Kljenak, Ante Čizmić, Dora Škrljak Šoša, Katarina Vulin, Ivana Đaković Copyright (c) 2021 © Hygeia Press Sat, 09 Jan 2021 00:00:00 +0100 Congenital glaucoma – a severe form <p class="p1">Primary congenital glaucoma is a rare disease and results from malformations of the trabecular meshwork that determines the increase of intraocular pressure (IOP). It is characterized by a globe enlargement, corneal edema and opacification. It also is associated with rupture of Descemet’s membrane with Haab’s striae, thinning of the anterior sclera and iris atrophy, normally with IOP above 21 mmHg.</p> <p class="p1">We report a case of a full-term neonate girl in which a bilateral corneal opacity was observed. Ophthalmologic examination revealed corneal edema, Haab’s striae and IOP of 37.3 mmHg in the right eye and 40 mmHg in the left eye. To achieve control of IOP, she performed sequential interventions: bilateral trabeculotomy; trabeculectomy and iridectomy on the left eye; and finally bilateral drainage implant.</p> <p class="p1">In this patient, despite early diagnosis and multiple surgical interventions, the severe presentation and poor response to surgical treatment with maintenance of high IOP establishes an obscure prognosis. The child needs frequent follow-ups.</p> Mariana Portela, Carmo Ferreira, Tiago Fernandes, Nicole Silva Copyright (c) 2021 © Hygeia Press Sun, 14 Feb 2021 00:00:00 +0100 An unexpected association – cord hemangioma and patent urachus <p class="p1">A patent urachus is the presence of structures found early in pregnancy, which could be associated with other abnormality in 46% cases.</p> <p class="p1">Hemangiomas are benign tumors and are more common in the skin. Umbilical cord hemangiomas are very rare, with fewer than 50 cases described in the literature.</p> <p class="p1">Here we report a clinical case of a neonate with a prenatal diagnosis of an umbilical cord hemangioma and a patent urachus. We would like to draw attention to the differential diagnosis of cord masses, as well as to the importance of early diagnosis and the appropriate management of the newborn. To our knowledge, this is the first case reported of a newborn diagnosed with this association.</p> Ana Lachado, Fábio Barroso, Rafael Brás, Maria do Céu Rodrigues, Ana Coelho, Ana Sofia Marinho, Fátima Carvalho, Elisa Proença, Céu Mota Copyright (c) 2020 © Hygeia Press Wed, 23 Dec 2020 00:00:00 +0100 Correspondence: the donation of human milk during the COVID-19 pandemic <p><strong>Dear Editor,</strong></p> <p>In previous epidemics, it has been shown that the use of breast milk represents one of the first crucial measures to be taken in emergencies.</p> <p>On the occasion of the World Day for the Donation of Human Milk, which was celebrated on May 22, the Italian Society of Neonatology (SIN) reaffirmed the importance of Human Milk Banks (HMBs), reassuring mothers about the safety of donation at HMBs, also in this pandemic period.</p> <p>In the Neonatal Intensive Care Unit (NICU) of San Giovanni Rotondo, Italy, we found that the restrictive measures did not represent a reason to limit breastfeeding nor donation. We have been close to nursing and donating mothers, providing constant support from the HMB and NICU staff, with practical advice and psychological closeness.</p> <p>In particular, in the February-May period, the crucial one of the pandemic, 15 donors donated 91.25 liters. In comparison with the average of previous years of donation data to the HMB, the balance is even in favor of the current year. In fact, in 2019, in the same period, 12 mothers were recruited and 58.7 liters were collected and, in 2018, the donor women were 10 but they donated 119.5 liters.</p> <p>As manager of the HMB, I found it useful to report the experience of our HMB and our NICU on this specific aspect, and I hope that other HMBs can do the same. I believe that these testimonies can represent an element of hope, encouragement and reflection. Solidarity did not end with the lockdown.</p> Pasqua Anna Quitadamo Copyright (c) 2020 © Hygeia Press Sun, 08 Nov 2020 00:00:00 +0100 Correspondence: early identification of COVID-19 positive outpatient children, is it useful? <p>The differential diagnosis between COVID-19 and the common cold, or allergic cough, or mild respiratory symptoms with or without fever is not easy for Primary Care Pediatricians (PCPs).<br />According to the official Italian report “<em>Rapporto ISS COVID-19 n. 58/2020</em>” of August 21<sup>st</sup>, 2020, all children with COVID-19 common symptoms and/or a corporal temperature higher than 37.5°C, are considered as suspected cases and have to be tested with a nasopharyngeal swab. <br />We have identified risk factors that could be useful in PCPs' clinical practice to define priorities in addressing children to the proper diagnostic procedure. <br />For the physical and mental health of the children and their families and to allow the PCPs to fulfill their duty, it is important to look for less invasive tools to perform the proper diagnosis. This should also allow children to go to school and to go on with their daily life.</p> Gianfranco Trapani, Osama Al Jamal Copyright (c) 2020 © Hygeia Press Sun, 22 Nov 2020 00:00:00 +0100