There are many techniques for long-term central venous catheter (CVC) placement, but none of them are specific for pediatric patients or focused on the delivered dose of ionizing radiation.

This retrospective study examined a sample of pediatric patients who received percutaneous long-term CVC positioning in a tertiary care pediatric hospital. Effective dose, dose-area product (DAP) and length of time of exposition during the procedure were determined, using an appropriate technical procedure, exam and program set of the angiograph, and compared with an unpaired t-test analysis.

The study included 1410 enrolled patients, with a median age of 10 years (range 0.2-18 years), between 2016 and 2019. In 2016 (318 pts), the mean effective dose was 0.13 mSv and the mean DAP dose was 18.95 µGy/m

In 2017 (353 pts), the mean effective dose was 0.11 mSv and the mean DAP dose was 17.26 µGy/m

. In 2018 (351 pts), the mean effective dose was 0.05 mSv and the mean DAP dose was 7.23 µGy/m

. In 2019 (388 pts), the mean effective dose was 0.02 mSv and the mean DAP dose was 3.10 µGy/m

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Medical and technical expertise led to a remarkable reduction in the radiation dose. Therefore, the authors’ hypothesis is that US- and fluoroscopy-guided percutaneous long-term CVC insertion technique is safer, more cost-effective and lower in terms of radiation exposure if correctly applied, compared to surgical or percutaneous by direct puncture techniques.

Medical and technical expertise led to a remarkable reduction in the radiation dose. Therefore, the authors’ hypothesis is that US- and fluoroscopy-guided percutaneous long-term CVC insertion technique is safer, more cost-effective and lower in terms of radiation exposure if correctly applied, compared to surgical or percutaneous by direct puncture techniques.Fractures are extremely common in children […].The relationships between symptoms that comprise behavioral problems in children can be traced longitudinally to provide long-term support. This study identified signs that should be considered important in school age children by tracking changes in the relationships between different symptoms of behavioral problems in preschool and school age children. This study used Gaussian graphical network analysis to clarify the interaction of the overall subscales constituting the K-CBCL (Korean Child Behavior Checklist) and centrality in the network. In the Panel Study on Korean Children (PSKC), the K-CBCL/1.5-5 was used for children up to age six (first grade, elementary school), and the K-CBCL/6-18 was used for older children. In this study, 1323 PSKC samples (boys, n = 671; girls, n = 652) were used to distinguish nonclinical and (sub)clinical groups (T-score ≥ 60) compared to node centrality in each group’s CBCL subscale networks. Depression/anxiety was a persistent core symptom of the behavioral problem network in 5- and 7-year-old children. A new core symptom in 7-year-old children was posttraumatic stress problems added in version CBCL/6-18. Based on these results, it is necessary to consider both anxiety/depression and posttraumatic stress problems in preschool children to support the adaptation of school-age children.Cor triatriatum dexter (CTD) is an extremely uncommon and underreported congenital cardiac anomaly in which the persistence of the embryonic right venous valve separates the right atrium into two chambers with varying degrees of obstruction to antegrade flow and variable degree of right to left shunt at atrial level. Depending on the size of the valves, clinical manifestations vary from absence of symptoms to severe hypoxia, requiring urgent surgical correction. We herein describe the diagnostic difficulties in a case of neonatal CTD, who developed increasingly severe and unresponsive cyanosis, first interpreted as postnatal maladjustment with pulmonary hypertension. The failure to respond to oxygen and pulmonary vasodilators led us to reconsider a different diagnosis. The use of contrast echocardiography improved the diagnostic performance of transthoracic echocardiogram (TTE) and revealed a massive right-to-left shunt secondary to the presence of an atrial membrane that required urgent surgery.This study used a newly developed coding system for measuring the quality of parenting behavior to examine associations with children’s social-emotional development. The Risky Interaction Support and Challenge Scale (RISCS) measures the extent to which parents engage in behaviors that present physical and regulatory challenges to children, as well as parents’ tendency to allow children to pursue action goals autonomously. These behaviors were observed while parents (n = 57 fathers; n = 55 mothers; n = 50 pairs) interacted with their 1-year-olds who played on a structure that included a slide, a small climbing wall, and a tunnel. Trained raters reliably used the RISCS to measure several dimensions of parent behaviors related to children’s exploration, and all but one of the dimensions captured adequate variability in parent behavior. Although mothers and fathers did not differ in any of the dimensions, the associations between parent behavior and children’s social-emotional development did not overlap. Fathers who engaged in greater autonomy allowance and lower overprotection had toddlers with lower levels of internalizing behavior, whereas mothers who challenged children’s regulatory competence had toddlers with lower levels of externalizing behavior and greater competence. We discuss the implications of the findings for the literature on attachment theory and father-child relationships.MOGAD-transverse myelitis is a rare disorder in children and adults, but with a higher incidence in pediatric patients. We report a case of MOGAD-transverse myelitis in a boy who was admitted to hospital with bilateral motor deficit of the lower limbs associated with the impossibility of defecating and urinating. The symptoms progressively developed with severe fatigue within the week prior to admission, with the impossibility to stand occurring 36 h before admission. The anamnesis found that he was vaccinated for COVID-19 approximately 6 weeks before admission to our clinic. The laboratory tests revealed a normal complete cellular blood count, without any signs of inflammation or infection, except for both cryoglobulins and IgG anti-MOG antibodies. MRI showed a T2 hypersignal on vertebral segments C2-C5, Th2-Th5 and Th7-Th11, confirming the diagnosis of longitudinally extensive transverse myelitis. The patient received intravenous high-dose methylprednisolone (1 g) for 5 days, associated with prophylactic antibiotic treatment, subcutaneous low-molecular-weight heparin and other supportive treatment. The patient was discharged on the 12th day of admission, able to walk without support and with no bladder or bowel dysfunction. We can conclude that an early diagnosis was essential for improving the patient’s long-term outcome.This study aims to identify clinical variables that could affect successful weaning from nasal continuous positive airway pressure (NCPAP) in very preterm infants. Infants born at a gestational age (GA) of <32 weeks were retrospectively enrolled. Weaning from NCPAP was initiated when the infants were clinically stable. In the univariate analysis, GA, birth weight, body weight (BW) z-score at the time of successful NCPAP weaning, intubation, total duration of intubation, respiratory distress syndrome grade, APGAR score at the 1 and 5 min, initial shock, anemia, bronchopulmonary dysplasia, number of blood transfusions, total duration of dopamine use, administration of more than two doses of surfactant, use of aminophylline, use of a diuretic, and total duration of total parenteral nutrition were significantly associated with postmenstrual age (PMA) at the time of successful NCPAP weaning. Multivariate analysis showed that the total duration of intubation, bronchopulmonary dysplasia, and administration of more than two doses of surfactant were positively associated with PMA at the time of successful NCPAP weaning. A reverse association was noted between BW z-score and PMA at the time of successful NCPAP weaning. Sufficient nutrition and avoidance of further ventilator-induced lung injury could decrease NCPAP duration in very preterm infants.Kawasaki disease (KD) is rare in infants less than 3 months of age, and its recurrence is exceptional. Infants with KD are at higher risk of severe clinical presentation, therapy failure, complications and coronary aneurysms (CAAs), and this is the reason they deserve more aggressive therapy and a strict clinical follow-up. We report a 2-month-old male with KD, complicated by Macrophage Activation Syndrome (MAS). Despite timely and aggressive therapy with immunoglobulins, steroids and aspirin, multiple CAAs developed. Two-month therapy with anakinra completely reverted all the aneurysms. After six months, the infant experienced KD relapse and was successfully re-treated with immunoglobulins, steroids and aspirin. A strict echocardiographic follow-up did not show recurrence of aneurysms. Two years later, the child is healthy, without cardiac sequelae. In our experience, anakinra was effective in reverting multiple aneurysms and its effect proved to be long-lasting, even in front of KD recurrence. Based on this evidence, it seems reasonable to hypothesize not to limit the use of anakinra as rescue therapy for complicated or refractory KD, but to consider the possibility of adding it to first-line therapies for some subgroups of very-high-risk patients, in order to strengthen the prevention of CAAs.Axial twisting of the spine has been previously shown to be affected by scoliosis with decreased motion and asymmetric twisting. Existing methods for evaluating twisting may be cumbersome, unreliable, or require radiation exposure. In this study, we present an automated surface topographic measurement tool to evaluate global axial rotation of the spine, along with two measurements twisting range of motion (TROM) and twisting asymmetry index (TASI). The aim of this study is to evaluate the impact of scoliosis on axial range of motion. Adolescent idiopathic scoliosis (AIS) patients and asymptomatic controls were scanned in a topographic scanner while twisting maximally to the left and right. TROM was significantly lower for AIS patients compared to control patients (69.1° vs. 78.5°, p = 0.020). TASI was significantly higher for AIS patients compared to control patients (29.6 vs. 19.8, p = 0.023). After stratifying by scoliosis severity, both TROM and TASI were significantly different only between control and severe scoliosis patients (Cobb angle > 40°). AIS patients were then divided by their major curve region (thoracic, thoracolumbar, or lumbar). ANOVA and post hoc tests showed that only TROM is significantly different between thoracic AIS patients and control patients. Thus, we demonstrate that surface topographic scanning can be used to evaluate twisting in AIS patients.Familial intrahepatic cholestasis 1 (FIC1) disease is a genetic disorder characterized by hepatic and gastrointestinal disease due to ATP8B1 deficiency, often requiring liver transplantation (LT). Extrahepatic symptoms, such as diarrhea, malabsorption, and failure to thrive, do not improve and instead may be aggravated after LT. We describe a patient with FIC1 disease who underwent LT at 2 years, 8 months of age. After LT, the child developed severe refractory diarrhea and failed to thrive. The response to bile acid resins was unsatisfactory, and the parents declined our recommendation for partial external biliary diversion (PEBD). Quality of life was extremely impaired, especially due to severe diarrhea, making school attendance impossible. Attempting to reduce the total bile acids, we initiated off-label use of the ileal bile acid transporter (IBAT) inhibitor Elobixibat (Goofice™), later converted to Odevixibat (Bylvay™). After six months of treatment, the patient showed less stool output, increased weight and height, and improved physical energy levels.