Objective The aim of this study was to evaluate sleep quality and psychological effects on pediatric healthcare workers during the first wave of COVID-19 epidemic in Italy and to evaluate differences between primary and secondary care operators. Pediatric healthcare workers were involved in an online survey to assess sleep quality, stress and anxiety level, self-efficacy and social support in Italian pediatric healthcare workers during COVID-19 pandemic. Results We found that 67.4% of our sample suffered from sleep disturbance and 19.4% of subjects suffered from anxiety. Lower values of anxiety and social support were found in primary care staff compared to secondary care one. The associations between healthcare professional figures (being primary or secondary care operators) and mental health outcomes were not statistically significant. However, sex, age and having a SARS-CoV-2 infected relative/friend had an independent effect on mental health outcomes. It is crucial to provide social and psychological support to pediatric healthcare workers. A tailored psychological screening would be desirable for female healthcare workers and for those who have a SARS-CoV-2 infected relative/friend.

BackgroundBreastfeeding is associated with a lower risk of wheezing in early childhood, but its effect later in childhood remains unclear. We investigated the association of breastfeeding and respiratory outcomes in children aged 11 years.Materials and MethodsWe performed an observational longitudinal study including 110 prepubertal children. Information about breastfeeding duration, wheezing and asthma was collected by questionnaires. At 11 years of age, we measured spirometry parameters, lung volumes, diffusing lung capacity, and fractional exhaled nitric oxide. We used logistic and linear regression models to examine the associations of breastfeeding duration with the odds of asthma and lung function measures. All multivariable analyses were adjusted for sex, smoking during pregnancy, gestational age at birth, twins, and mode of delivery (confounder model).ResultsBreastfeeding duration was associated with FEV1 z-score [β = 0.04, CI 95% (0.02–0.09)], FEF75 z-score [β = 0.06, CI 95% (0.03–0.09)] and FEV1/FVC z-score [β = 0.03, CI 95% (0.00–0.07)], but not with diffusing lung capacity and fractional exhaled nitric oxide. No association of breastfeeding duration with preschool wheezing, ever asthma and current asthma was documented.ConclusionWe showed that children breastfed for longer time presented higher FEV1, FEV1/FVC, and FEF75 z-score values at 11 years of age compared to children breastfed for shorter time, suggesting a protective effect of breastfeeding on airways, and not on lung parenchyma (lung volumes and alveolar capillary membrane) or allergic airway inflammation. The positive effect of breastfeeding duration on lung function lays the foundation to promote breastfeeding more and more as effective preventive measure.

Background: Few studies investigated COVID-19 pandemic psychological effects on pediatric healthcare staff. The aim of this study was to evaluate sleep quality and psychological effects of pediatric healthcare workers during COVID-19 epidemic in Italy and to evaluate potential differences between Primary and Secondary Care operators. Methods: Pediatric healthcare workers were involved in an online survey aimed to characterize responders and to define their clinical expertise in the management of suspected or confirmed COVID-19 patients during pandemic. Using validated scores, the online questionnaire assessed sleep quality, stress and anxiety level, self-efficacy and social support in pediatric healthcare workers. Results: During COVID-19 outbreak, 67.43% of our population were suffering sleep disturbance, and we found a positive correlation between sleep disturbances with stress and anxiety. Furthermore, 19.42% of subjects were suffering anxiety and 53% were at risk of developing an acute stress disorder. Stress resulted inversely correlated with self-efficacy and social support.Secondary care operators were more affected than family pediatricians by sleep disturbances, stress but especially by anxiety. Social support was considerably higher in secondary care operators compared to family pediatricians.Conclusions: Despite the less exposure and the less infection probability, much of pediatric healthcare workers were suffered sleep disturbance, anxiety and potential stress disorder. In the Pediatric Units, these psychological effects could be related to other factors compared to frontline departments, such as the early confused situation, the difficulties in workplaces managing and in finding personal protective equipment, as well as the subsequent sense of helplessness and frustration.

COVID-19 seems to be less frequent and severe in children compared to adults. Despite the very few symptoms usually found in children, great attention was recorded when in April 2020 a hyperinflammatory process in children with fever and multiorgan involvement after a paucisymptomatic COVID infection was reported. The United States Centers for Disease Control and the World Health Organization recognized and defined this syndrome as “Multisystem Inflammatory Syndrome in Children (MIS-C).” We describe two cases of MIS-C presenting with fever, cutaneous rash, and a mild cardiac involvement expressed with a transient mitral valve involvement and a first-degree atrioventricular block. Acute treatment was managed with intravenous immunoglobulin, oral aspirin, and intravenous corticosteroids reaching consequent good outcome. Clinical characteristics, treatment management, follow-up, and long-term evolution of children with MIS-C are still poorly defined. Further research is needed to better understand the pathogenesis of this newly described condition, to validate a high-level recommended therapy and a specific therapy tapering timings.

Deep neck space infections (DNSI) are defined as infections in the potential spaces and fascial planes of the neck. We show the clinical case of a retro and para-pharyngeal abscess in a healthy 5-year-old child complicated by compression and dislocation of the larynx with marked airway caliber reduction and potentially fatal extension up to the mediastinal aditus. DNSI can occur at any age and, due to its rapid progression, requires immediate treatment in children. In healthy children, concurrent abscesses in separate neck spaces are rare. DNSI recurrence should alert the physician to the possibility of a congenital problem, and if imaging fails, laryngoscopy may be the best diagnostic technique.