SALBUTAMOL IN THE MANAGEMENT OF WHEEZING IN CHILDREN Federico Marchetti, Laura Badina, Luca Pierantoni Medico E Bambino, 2026 Wheezing is a frequent respiratory condition in early childhood that affects up to one third of children in the first three years of life and represents a common cause of primary care visits, Emergency Unit access and hospital admission. In Italy, the 2014 AIFA regulatory note introduced major restrictions on the use of inhaled salbutamol in children younger than 2 years, by limiting administration to pressurised metered-dose inhalers (MDI) with spacer and recommending lower doses than those suggested by the international guidelines, without differentiating between care settings or disease severity. This precautionary approach, based on limited and heterogeneous evidence, has generated an ongoing debate within the paediatric community. Evidence suggests that short-acting β2-agonists (SABA) may be effective in selected cases of acute bronchospasm in infants and young children, particularly in wheezing phenotypes suggestive of reversible airway obstruction. They are not indicated for isolated cough or viral upper respiratory infections, and are not recommended in bronchiolitis according to the international guidelines. Since 2024, shortages of salbutamol MDI in Italy and across Europe have further complicated this scenario and increased the risk of undertreatment. Recent evidence, including a meta-analysis of randomised controlled trials, supports the short-term safety of inhaled salbutamol in children under 2 years with acute wheezing, with no increase in serious adverse events and a more favourable safety profile with MDI compared with nebulisation. Overall, the current framework highlights a gap between regulatory constraints, clinical evidence, real-world practice and drug availability, and underscores the need for an evidence-based revision of existing recommendations.
Skin of Color in Pediatric Dermatology: A Cross-Sectional Retrospective Analysis Addressing Inclusive Diagnosis and Care Arianna Dondi, Alice Ranieri, Laura Andreozzi, Miriam Leuzzi, Gabriele D’Alanno, et al. Life, 2026 Children with skin color (SOC) are underrepresented in dermatologic research, despite structural and functional differences that shape disease presentation. Atopic dermatitis (AD), one of the most common pediatric dermatoses, often appears differently in SOC than in white children. This study compared dermatologic conditions prompting Pediatric Emergency Department (PED) referral in SOC and white children, and described clinical features of AD in SOC. A retrospective study was performed at IRCCS AOUBO Policlinico di Sant’Orsola, Bologna, Italy, analyzing records and photographs from 2019. Patients presenting with dermatologic conditions and evaluated by a pediatric dermatologist were included. Of 411 patients, 109 (26.5%) had SOC. In SOC, common diagnoses were scabies (22%), AD (17.4%), viral infections (12.8%), burns (9.2%), and contact dermatitis (7.3%). In white children, viral infections (16.9%), burns (14.2%), contact dermatitis (13.9%), AD (12.9%), and insect bites (5.6%) predominated. Scabies and pruritus were significantly more frequent in SOC (p < 0.05). Among 38 SOC patients with AD, lichenoid (31.6%), pityriasis alba (29.0%), prurigo nodularis (26.3%), and classic AD (13.2%) were the most frequent variants. Erythema was often subtle or absent. Dermatologic conditions and AD morphology differ between SOC and white children, highlighting the need for tailored diagnostic approaches and equitable care.
The Use of Point-of-Care Tests and Multiplex PCR Tests in the Pediatric Emergency Department Reduces Antibiotic Prescription in Patients with Febrile Acute Respiratory Infections Luca Pierantoni, Arianna Dondi, Liliana Gabrielli, Valentina Lasala, Laura Andreozzi, et al. Pathogens, 2025 Background: Acute Respiratory Infections are a common reason for Pediatric Emergency Department (PED) visits. Differentiating bacterial and viral infections may be challenging and might result in incorrect antibiotic prescriptions and exacerbation of antimicrobial resistance. This study evaluated the impact of new diagnostic tests in PED. Methods: A retrospective cohort of 4882 acute febrile respiratory infection cases presenting to the PED was analyzed, comparing two periods: Period 1 (October 2016–March 2017, n = 2181) and Period 2 (October 2023–March 2024, n = 2701). During Period 1, Group A Streptococcus and Respiratory Syncytial Virus rapid antigen detection tests were available. During Period 2, new point-of-care tests (POCTs), including rapid C-reactive protein and rapid antigen detection for Influenza A, Influenza B, and SARS-CoV-2, and a multiplex PCR nasal swab, were introduced. Results: In Period 2, antibiotic prescriptions decreased by 28.4%, along with a reduction in broad-spectrum antibiotic use. A significant correlation was observed between reduced antibiotic prescription and the use of new POCTs and multiplex PCR tests. Performance of blood tests and chest radiographs also decreased. Conclusions: Implementing novel diagnostic tests in PED helps clinicians select more appropriate management options with an impact on reduced stress and radiation exposure and antibiotic prescription.
Burden and Clinical Characteristics of Influenza and Its Complications in Children Across Multiple Epidemic Seasons Arianna Dondi, Fiorentina Guida, Ludovica Trombetta, Maddalena De Peppo Cocco, Giulia Piccirilli, et al. Viruses, 2025 Seasonal influenza is a major cause of morbidity and hospitalization in children, with the potential for severe complications and considerable socioeconomic impact. We conducted a retrospective observational study including 1046 children aged 0–14 years with laboratory-confirmed influenza who accessed the Paediatric Emergency Department of a tertiary center in Bologna, Italy, across three consecutive epidemic seasons (2022–2025). While the entire cohort was analysed, particular attention was given to children with severe complications requiring hospitalization, for whom more detailed clinical and laboratory data were available. Overall, 12.3% of patients required hospitalization, and 6.1% experienced complications, most frequently influenza-associated encephalopathy, lower respiratory tract infections and myositis. Influenza A predominated overall (82.0%), except for in the last season, which saw a predominance of influenza B (57.4%), closely associated with myositis and elevated creatine phosphokinase levels. Younger age was consistently associated with increased severity and hospitalization. Intensive care admissions were rare (0.8%), and no deaths were recorded. Our findings suggest that, although influenza is generally self-limiting, younger children are at higher risk of complications. These results highlight the importance of active surveillance, careful monitoring of clinical manifestations and targeted paediatric vaccination strategies to reduce the burden of seasonal influenza.
High Flow Nasal Cannula and Non Invasive Ventilation for Acute Bronchiolitis in the Paediatric Wards Luca Pierantoni, Giacomo Stera, Carlotta Biagi, Arianna Dondi, Lawrence M. Scheier, et al. Acta Paediatrica International Journal of Paediatrics, 2025 AimBronchiolitis is a leading cause of respiratory distress and hospital admissions in infants. While high‐flow nasal cannula is effective for patients unresponsive to standard oxygen therapy, evidence regarding continuous positive airway pressure and noninvasive ventilation in the wards remains inconclusive. This review explores the feasibility and criteria for initiation, titration, and monitoring of high‐flow nasal cannula, continuous positive airway pressure, and noninvasive ventilation in infants with bronchiolitis in paediatric wards.MethodsNarrative review of studies from PubMed and the Cochrane Library (2000–2024), focusing on high‐flow nasal cannula, continuous positive airway pressure, and noninvasive ventilation in bronchiolitis, particularly in paediatric wards.ResultsHigh‐flow nasal cannula is widely used in paediatric wards as a safe and effective option for bronchiolitis. Evidence for continuous positive airway pressure and noninvasive ventilation outside intensive care is limited but suggests potential to reduce escalation in selected cases.ConclusionContinuous positive airway pressure and noninvasive ventilation in paediatric wards appear to carry limited safety concerns. While not proven superior to high‐flow nasal cannula or standardised in their use, when applied selectively with trained staff and close monitoring, they may serve as rescue therapies. Better understanding of current evidence may support standardisation and improve resource allocation.
Salbutamol safety in children under 2 years of age with acute wheezing: a meta-analysis of randomised controlled trials Luca Pierantoni, Edoardo Muratore, Sara Cerasi, Daniele Zama, Chiara Del Bono, et al. Archives of Disease in Childhood, 2025 ObjectiveTo evaluate the safety of short-term use of inhaled salbutamol in children under 2 years of age with acute wheezing.Data sourcesElectronic databases (PubMed, Trip, MEDLINE) and the Cochrane Library were searched for studies published up to October 2022.Study selectionThe search was restricted to randomised controlled trials published in English regarding the safety of inhaled salbutamol in wheezing children under the age of 2.Data extraction and synthesisThe literature search strategy yielded 3532 references. The meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Main outcome(s) and measure(s)The incidence of adverse reactions associated with inhaled salbutamol administration compared with placebo.ResultsA total of 24 records were included. In 7 studies involving 597 patients, inhaled salbutamol was compared with controls and no statistically significant difference in the incidence of adverse drug reactions was found between the two groups (OR 2.12, 95% CI 0.69 to 6.51; p=0.19). Salbutamol administration via nebulisation was associated with an increased incidence of adverse reactions (OR 6.76, 95% CI 2.01 to 22.71; p=0.002). None of the studies reported severe cardiac side effects that necessitated withdrawal from the study following salbutamol administration. Only one study reported a significant non-cardiac side effect (severe tremulousness) that necessitated withdrawal from therapy.ConclusionsInhaled salbutamol can be safely used in children under 2 years of age with acute wheeze with the administration via a metered-dose inhaler being potentially safer than a nebulised formulation. Neither of the formulations was associated with severe adverse effects.
Addressing Bias and Data Scarcity in AI-Based Skin Disease Diagnosis with Non-Dermoscopic Images Ceur Workshop Proceedings, 2025
Endothelial Dysfunction: Molecular Mechanisms and Therapeutic Strategies in Kawasaki Disease Lucia Paolini, Fiorentina Guida, Antonino Calvaruso, Laura Andreozzi, Luca Pierantoni, et al. International Journal of Molecular Sciences, 2024 The endothelium plays a key role in regulating vascular homeostasis by responding to a large spectrum of chemical and physical stimuli. Vasculitis is a group of inflammatory conditions affecting the vascular bed, and it is known that they are strongly linked to endothelial dysfunction (ED). Kawasaki disease (KD) is one childhood systemic vasculitis, and it represents the leading cause of acquired cardiac disease in children due to coronary damage and subsequent cardiovascular (CV) morbidity and mortality. We aimed to focus on the actual knowledge of ED in the pathogenesis of KD and its practical implications on therapeutical strategies to limit cardiovascular complications. Understanding ED in KD provides insight into the underlying mechanisms and identifies potential therapeutic targets to mitigate vascular damage, ultimately improving cardiovascular outcomes in both the acute and chronic stages of the disease. However, research gaps remain, particularly in translating findings from animal models into clinical applications for cardiovascular lesions and related morbidity in KD patients.
