The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021–2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking in February. We performed a prospective observational study in four referral pediatric centers located in different geographical areas in Italy (two in the north, one in the center and one in the south). From 1 July 2021 to 31 January 2022, we collected all new clinical diagnoses of bronchiolitis in children younger than two years of age recording demographic, clinical and microbiological data. A total of 657 children with a clinical diagnosis of bronchiolitis were enrolled; 56% children were admitted and 5.9% required PICU admission. The first cases were detected during the summer, peaking in November 2021 and declining into December 2021 with only a few cases detected in January 2022. RSV was the commonest etiological agent, while SARS-CoV-2 was rarely detected and only since the end of December 2021. Disease severity was similar in children with RSV vs. non-RSV bronchiolitis, and in those with a single infectious agent detected compared with children with co-infections. The 2021–2022 bronchiolitis season in Italy started and peaked earlier than the usual pre-pandemic seasons, but had a shorter duration. Importantly, the current bronchiolitis season was not more severe when data were compared with Italian published data, and SARS-CoV-2 was rarely a cause of bronchiolitis in children younger than 24 months of age.

We described changes caused by the COVID-19 pandemic in the frequency of Emergency Department (ED) visits for mental health disorders (MHDs) in adolescents on a wider temporal range—that is, not just “the waves” of the pandemic—and characterized the profile of the adolescent seeking emergency psychiatric care. We conducted a retrospective longitudinal study by analyzing ED visits for MHDs from 10 March 2019 to 10 March 2021. A total of 1407 ED visits for MHDs were registered: 702 in the pre-COVID-19 and 707 in the COVID-19 period. The cumulative incidence of ED visits for MHDs was 1.22% in the pre-COVID-19 period and 1.77% in the COVID-19 period, with a statistically significant difference (p < 0.001). The principal characteristics of the adolescent with MHDs during the pandemic period: the odds of comorbidities decreased by 26% (p = 0.02), and the odds of transfer from other hospitals decreased by 71% (p < 0.001), while the odds of the ED presentation as first psychiatric episode were twice greater (p < 0.001). The risk of hospitalization increased by 54% (p = 0.001). Regarding psychopathology, the likelihood of attempted suicide increased by 74% during the pandemic (p = 0.02). The rate of mood and eating disorders grew significantly during the COVID-19 pandemic period (p = 0.005 and p = 0.031, respectively). Monitoring ED visits for MHDs and understanding changes in the profile of adolescents presenting to ED helps to reinforce the role of ED in identifying special clinical needs for these vulnerable patients in case of a future public health crisis.

Background: To date, there are no data regarding the systematic application of Point-of-Care Lung Ultrasound (PoC-LUS) in children with Multisystem Inflammatory Syndrome in Children (MIS-C). The main aim of this study is to show the role of Point-of-Care Lung Ultrasound as an additional aid in the diagnosis of COVID-19-related Multisystem Inflammatory Syndrome in Children (MIS-C). Methods: Between April 2020 and April 2021, patients aged 0–18 years referred to our emergency department for fever, and later hospitalized without a specific diagnosis, underwent PoC-LUS. Ultrasound images of patients with a final diagnosis of MIS-C were retrospectively evaluated. Results: Ten patients were enrolled. All were described to have pleural irregularities and B-lines. In particular: 8/10 children presented with isolated B-lines in at least half of the lung areas of interest; 8/10 presented with multiple B-lines and 3/8 had them in at least 50% of lung areas; 5/10 had a white lung appearance in at least one lung area and 1/5 had them in half of the areas of interest. Pleural effusion was described in 9/10. Conclusions: During the ongoing COVID-19 pandemic, we suggest performing PoC-LUS in febrile patients with high levels of inflammatory indices and clinical suspicion of MIS-C, or without a certain diagnosis; the finding of many B-lines and pleural effusion would support the diagnosis of a systemic inflammatory disease.

Background: We proposed to analyze thoroughly the impact of the COVID-19 lockdown (CL) in changes of profiles and in trend of the domestic accidents (DAs) in children. Methods: This was a single experience, cross-sectional study conducted at the emergency department (ED) of III trauma center. We enrolled children under 18 years admitted to ED with a diagnosis of DAs comparing the CL period from 10^th March 2020 to 4^th May 2020 with the same period of the previous year,10^th March 2019 to 4^th May 2019. Results: In CL period, the cumulative incidence of ED visits for DAs increased from 86.88 to 272.13 per 1,000 children and the cumulative incidence of hospitalizations for DAs increased from 409.72 to 534.48 per 1,000 children. We reported in CL a decrease in the severity of ED presentation assessed by proxy measures: the level of priority ED visits reduced by 67% in CL period (OR: 0.33; 95%CI 0.22–0.48; p < 0.001); the likelihood of delayed time of presentation to ED increased by 65% in case of domestic injuries occurring in CL period (OR: 1.65; 95% CI: 1.17–2.34; p = 0.004); the odds of transfer from other hospital decreased by 78% in CL (OR: 0.15–0.33; p < 0.001). Children were more at risk of poisoning (OR:3.35–106.11; p = 0.001), of body foreign ingestion (OR: 1.83–14.39; p = 0.002) and less at risk of animal bite trauma (OR:0.05–0.35; p < 0.001). Conclusion: Although the need to stay home has made a decisive breakthrough on the spread of COVID-19, the experience from this study underlines how this preventive measure has also had a downside in term of increased cumulative incidence of ED visits and of hospitalizations for DA.

The child obesity and its complications are associated with an alarming increased health care use, including the emergency department (ED). We evaluated the effects of the obesity and overweight in children admitted to ED, especially in patients with injury diagnosis. A retrospective study of patients aged 6–18 years was conducted. Patients were categorized into normal weight (body mass index, BMI < 85th); overweight (BMI ≥ 85th e < 95th); obesity (BMI ≥ 95th). Multiple logistic analysis was used for estimation of risk factors associated with the BMI and to explore the association between injury diagnosis and BMI. The predictive factors associated with obesity and overweight were school age (p < 0.001), male gender (p < 0.001) and number of visits for year (obesity: p < 0.001 and overweight: p < 0.05). Obese children were less at injury risk than normal weight (p < 0.05). In injury subset, fractures in school age were more likely to occur in obesity (p < 0.01). Dislocated fractures (p < 0.01) and fractures at lower extremity were more likely to occur in obesity and overweight (p < 0.05). School age children presenting to ED are more at risk of excess body weight than adolescents and are at higher fracture risk if obese and overweight. This has clear implication to support the efforts to reduce the obesity in childhood. The ED may represent a crucial setting for the early identification of these children and of co-morbidities related BMI ≥ 85th, and for a timely specialist referral of these children, especially if school age.