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Background Trisomy 18 was once considered a fatal diagnosis due to the presence of cardiac and extracardiac lesions. However, with the increasing use of therapeutic management, 3% to 25% of infants with trisomy 18 may survive beyond their first year, depending on the interventions provided. Currently, there are no clear and widely accepted criteria to guide medical decisions for children with trisomy 18. This means that patients could often be at risk of either over-treatment or therapeutic abandonment. We aimed to explore the effectiveness of intensive and non-intensive treatments in enhancing the clinical burden of disease and survival of children with trisomy 18 syndrome Methods a retrospective monocentric study in Bambino Gesù Children’s Hospital, IRCCS Rome, Italy. We enrolled all patients discharged from our hospital with genetic diagnosis of trisomy 18 between 2018 and 2023. Clinical data from birth were collected and categorized into two groups: those who received intensive treatment and those who underwent a palliative approach. Intensive treatment was defined as corrective heart surgery, use of invasive respiratory support, or at least one hospitalization in an intensive care unit. Survival probabilities at different age intervals were calculated, and the clinical burden of disease was assessed, taking into account device dependence, number of emergency department visits per year, and the daily intake of medications at home Results 32 patients were enrolled. Children with a low device dependence had significantly higher survival(p= 0,01). Neither palliative nor corrective heart surgery affected survival for patients with major cardiac defects. Conversely in children with minor heart defects surgery significantly increased survival probability(p= 0.01), particularly the corrective approach(p= 0.01). High number of emergency department visits(p=0.03) and high number of drugs taken daily(p=0.02) significantly reduced survival. No significant differences emerged between the two groups in terms of burden of disease. Conclusions proportional to the initial clinical conditions all treatment options, which may include both comfort care and heart surgery, should be re-evaluated to determine the approach that prioritizes the best interest of each child with trisomy 18.

Background SARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring. Materials and methods Sixty-five children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs. Results During the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. One patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days. Conclusion Our experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

Background Viral respiratory infections are one of the main causes of hospitalization in children. Even if mortality rate is low, 2% to 3% of the hospitalized children need mechanical ventilation. Risk factors for admission to the pediatric intensive care unit (PICU) are well known, while few studies have described risk factors for invasive ventilator support and prolonged hospitalization. Methods A retrospective study including all patients aged between 2 and 18 months with a confirmed viral respiratory infection, requiring admission to PICU from September to March between 2015 and 2019, was conducted at Bambino Gesù Children's Hospital in Rome, Italy. Results One hundred ninety patients were enrolled, with a median age of 2.7 months; 32.1% had at least one comorbidity, mainly prematurity. The most frequent isolated viruses were RSV‐B, rhinovirus, and RSV‐A; 38.4% needed mechanical ventilation. This subgroup of patients had lower median birth weight compared with patients not requiring mechanical ventilation (2800 g vs. 3180 g, p = 0.02); moreover, comorbidities were present in 43.8% of intubated patients and in 24.8% of patients treated with non‐invasive ventilation (p = 0.006). Viral coinfection did not result to be a risk factor for mechanical support, while virus–bacteria coinfection was significantly associated with mechanical ventilation (p < 0.001). Similar risk factors were identified for prolonged hospitalization. Conclusions Early identification of patients who could have a sudden respiratory deterioration and need of mechanical ventilation is crucial to reduce complications due to orotracheal intubation and prolonged hospitalization in PICU. Further studies are needed to define high‐risk group of patients and to design targeted interventions.