Bone health starts with maternal health and nutrition, which influences bone mass and density already in utero. The mechanisms underlying the effect of the intrauterine environment on bone health are partly unknown but certainly include the ‘foetal programming’ of oxidative stress and endocrine systems, which influence later skeletal growth and development. With this narrative review, we describe the current evidence for identifying patients with risk factors for developing osteopenia, today’s management of these populations, and screening and prevention programs based on gestational age, weight, and morbidity. Challenges for bone health prevention include the need for new technologies that are specific and applicable to pregnant women, the foetus, and, later, the newborn. Radiofrequency ultrasound spectrometry (REMS) has proven to be a useful tool in the assessment of bone mineral density (BMD) in pregnant women. Few studies have reported that transmission ultrasound can also be used to assess BMD in newborns. The advantages of this technology in the foetus and newborn are the absence of ionising radiation, ease of use, and, above all, the possibility of performing longitudinal studies from intrauterine to extrauterine life. The use of these technologies already in the intrauterine period could help prevent associated diseases, such as osteoporosis and osteopenia, which are characterised by a reduction in bone mass and degeneration of bone structure and lead to an increased risk of fractures in adulthood with considerable social repercussions for the related direct and indirect costs.

Neonatal respiratory distress syndrome (RDS) is a common and potentially life-threatening condition in preterm infants, primarily due to surfactant deficiency. Early and accurate diagnosis is critical to guide timely interventions such as surfactant administration and respiratory support. Traditionally, chest X-rays have been used for diagnosis, but lung ultrasound (LUS) has gained prominence due to its non-invasive, radiation-free, and bedside applicability. Compared to chest X-rays and CT scans, LUS demonstrates superior sensitivity and specificity in diagnosing RDS, particularly in identifying surfactant need and predicting CPAP failure. Additionally, LUS offers real-time imaging without radiation exposure, an advantage over other modalities. However, its broader adoption is limited by challenges in standardizing training, ensuring diagnostic reproducibility, and validating scoring systems, especially in resource-limited settings. This narrative review aims to evaluate the role of LUS in the diagnosis and management of neonatal RDS over the past decade, focusing on its clinical utility, scoring systems, and emerging applications. We reviewed the literature from 2013 to 2023, focusing on studies evaluating LUS’ diagnostic accuracy, scoring systems, and its potential role in guiding surfactant therapy and predicting CPAP failure. Despite its benefits, addressing the variability in operator expertise and integrating artificial intelligence to enhance usability are crucial for ensuring LUS’ efficacy across diverse clinical environments. Future research should prioritize standardizing training and scoring protocols to facilitate wider implementation and optimize neonatal respiratory care outcomes.

Background: Community-acquired pneumonia (CAP) remains a leading cause of pediatric morbidity and mortality worldwide, particularly in low-resource settings. Although antimicrobial therapy is the cornerstone of treatment, disease severity is often influenced not only by pathogen burden but also by dysregulated host inflammation. Systemic corticosteroids have therefore been investigated as adjunctive agents to reduce inflammation-mediated lung injury, but their role in children remains controversial. Methods: This narrative review summarizes current evidence on systemic corticosteroid use in pediatric pneumonia. The review focuses on biological mechanisms, clinical indications, patient selection, therapeutic regimens, timing and duration of therapy, clinical outcomes, and safety. Particular attention is given to severe CAP, Mycoplasma pneumoniae pneumonia, complicated pneumonia with parapneumonic effusion or empyema, viral pneumonia, wheezing-associated phenotypes, and immunocompromised children. Results: Available evidence suggests that corticosteroids may provide benefit in selected pediatric phenotypes characterized by severe inflammation, respiratory compromise, refractory disease, or airway hyperreactivity. Reported benefits include faster fever resolution, reduction in inflammatory markers, shorter hospital stay, more rapid clinical stabilization, and improved radiographic recovery, particularly in severe or refractory Mycoplasma pneumoniae pneumonia and selected complicated cases. However, findings are inconsistent, and treatment effects appear strongly dependent on etiology, disease severity, timing of administration, corticosteroid regimen, and patient phenotype. Routine use in uncomplicated CAP or unselected pediatric populations is not supported. Potential adverse effects include hyperglycemia, gastrointestinal and neurobehavioral symptoms, sleep disturbance, immunosuppression with an increased risk of secondary infection, delayed viral clearance in selected viral infections, and possible masking of inadequate anti-infective response or evolving complications. Conclusions: Current evidence supports a cautious, individualized, phenotype-driven approach to corticosteroid therapy in pediatric CAP. Well-designed pediatric randomized controlled trials are needed to define precise indications, optimal regimens, timing, and long-term safety.

Neonatal pulmonary hypertension (PH) is a major cause of illness and death in newborns. Neonatologist-performed echocardiography (NPE) is increasingly used as a bedside tool to assess heart function, shunt patterns, and pulmonary blood flow in real time, helping clinicians better understand the severity and type of PH. This narrative review summarizes current evidence on the use of NPE in diagnosing, monitoring, and treating neonatal PH, drawing on clinical studies, guidelines, and expert recommendations. NPE provides key diagnostic and therapeutic information, including evaluation of ventricular function, estimation of pulmonary pressures, and assessment of shunt direction. Advanced measures—such as tricuspid annular plane systolic excursion (TAPSE), myocardial performance index, pulmonary artery acceleration time (PAAT), and deformation imaging—improve accuracy and help guide therapies like inhaled nitric oxide, milrinone, and sildenafil. NPE is also useful in chronic conditions such as bronchopulmonary dysplasia (BPD)- and congenital diaphragmatic hernia (CDH)-associated PH. Despite its clear clinical value, NPE use remains limited by variations in training, protocols, and resource availability. Standardized curricula, accreditation, and unified reporting practices are needed to ensure safe, consistent integration of NPE into neonatal care pathways.

Background: Community-acquired pneumonia (CAP) remains a leading cause of pediatric morbid-ity and mortality worldwide, particularly in low-resource settings. Although antimicrobial therapy is the cornerstone of treatment, disease severity is often influenced not only by pathogen burden but also by dysregulated host inflammation. Systemic corticosteroids have therefore been investigated as adjunctive agents to reduce inflammation-mediated lung injury, but their role in children remains controversial. Methods: This narrative review summarizes current evidence on systemic cortico-steroid use in pediatric pneumonia. The review focuses on biological mechanisms, clinical indica-tions, patient selection, therapeutic regimens, timing and duration of therapy, clinical outcomes, and safety. Particular attention is given to severe CAP, Mycoplasma pneumoniae pneumonia, complicated pneumonia with parapneumonic effusion or empyema, viral pneumonia, wheezing-associated phenotypes, and immunocompromised children. Results: Available evidence suggests that cortico-steroids may provide benefit in selected pediatric phenotypes characterized by severe inflammation, respiratory compromise, refractory disease, or airway hyperreactivity. Reported benefits include faster fever resolution, reduction in inflammatory markers, shorter hospital stay, more rapid clinical stabilization, and improved radiographic recovery, particularly in severe or refractory Mycoplasma pneumoniae pneumonia and selected complicated cases. However, findings are inconsistent, and treatment effects appear strongly dependent on etiology, disease severity, timing of administration, corticosteroid regimen, and patient phenotype. Routine use in uncomplicated CAP or unselected pediatric populations is not supported. Potential adverse effects include hyperglycemia, gastroin-testinal symptoms, behavioral changes, sleep disturbance, immunosuppression, and delayed viral clearance in selected viral infections. Conclusion: Current evidence supports a cautious, individu-alized, phenotype-driven approach to corticosteroid therapy in pediatric CAP. Well-designed pe-diatric randomized controlled trials are needed to define precise indications, optimal regimens, timing, and long-term safety.