Rhabdomyomas are the most common type of cardiac tumors in children. Anatomically, they can be considered as hamartomas. They are usually randomly diagnosed antenatally or postnatally sometimes presenting in the neonatal period with haemodynamic compromise or severe arrhythmias although most neonatal cases remain asymptomatic. Typically rhabdomyomas are multiple lesions and usually regress spontaneously but are often associated with tuberous sclerosis complex (TSC), an autosomal dominant multisystem disorder caused by mutations in either of the two genes, TSC1 or TSC2. Diagnosis of tuberous sclerosis is usually made on clinical grounds and eventually confirmed by a genetic test by searching for TSC genes mutations.

Rotavirus (RV) is among the most common vaccine-preventable diseases in children under five years of age. Despite the severity of rotavirus pathology in early childhood, rotavirus vaccination for children admitted to the neonatal intensive care unit (NICU), who are often born preterm and with various previous illnesses, is not performed. This multicenter, 3-year project aims to evaluate the safety of RV vaccine administration within the six main neonatal intensive care units of the Sicilian Region to preterm infants. Methods: Monovalent live attenuated anti-RV vaccination (RV1) was administered from April 2018 to December 2019 to preterm infants with gestational age ≥ 28 weeks. Vaccine administrations were performed in both inpatient and outpatient hospital settings as a post-discharge follow-up (NICU setting) starting at 6 weeks of age according to the official immunization schedule. Any adverse events (expected, unexpected, and serious) were monitored from vaccine administration up to 14 days (first assessment) and 28 days (second assessment) after each of the two scheduled vaccine doses. Results: At the end of December 2019, 449 preterm infants were vaccinated with both doses of rotavirus vaccine within the six participating Sicilian NICUs. Mean gestational age in weeks was 33.1 (±3.8 SD) and the first dose of RV vaccine was administered at 55 days (±12.9 SD) on average. The mean weight at the first dose was 3388 (SD ± 903) grams. Only 0.6% and 0.2% of infants reported abdominal colic and fever above 38.5 °C in the 14 days after the first dose, respectively. Overall, 1.9% EAEs were observed at 14 days and 0.4% at 28 days after the first/second dose administration. Conclusions: Data obtained from this study confirm the safety of the monovalent rotavirus vaccine even in preterm infants with gestational age ≥ 28 weeks, presenting an opportunity to improve the vaccination offer both in Sicily and in Italy by protecting the most fragile infants who are more at risk of contracting severe rotavirus gastroenteritis and nosocomial RV infection.

Background/Objectives: Metabolic bone disease of prematurity (MBDP) is a multifactorial disorder resulting from disrupted transplacental mineral transfer and postnatal nutritional deficits, particularly affecting preterm neonates born before 32 weeks of gestation or weighing under 1500 g. Although substantial research has focused on skeletal outcomes, few studies have explored the association between MBDP and neonatal neurological impairment. This narrative review is the first to integrate the pathophysiological mechanisms, diagnostic methods, and preventive strategies for MBDP, while simultaneously investigating its potential impact on neurodevelopment. Methods: A narrative review of recent peer-reviewed studies, systematic reviews, and clinical trials was performed focusing on biochemical markers (alkaline phosphatase, FGF23, calcium, and phosphorus), emerging tools such as bioelectrical impedance analysis (BIA), and the effects of early nutritional interventions on both skeletal and neurodevelopmental outcomes in preterm infants (n = seven included articles). Results: Early elevations in ALP, particularly when combined with low serum phosphorus and FGF23 levels, provide sensitive markers for identifying MBDP. Furthermore, insufficient vitamin D levels during gestation and in the neonatal period have been associated with increased risks of seizures, hypotonia, and developmental delays. Studies suggest that enhanced vitamin D supplementation in preterm infants (up to 800 IU/day) may improve mineral absorption and bone formation and confer neuroprotective benefits through anti-inflammatory and antioxidant mechanisms. Conclusions: This is the first review on the neurological implications of biochemical actors of MBDP. As a result, diagnostic and therapeutic strategies, including vitamin D supplementation, can improve bone and neurodevelopmental outcomes. Future prospective studies are required to standardize diagnostic criteria and optimize therapeutic regimens for enhanced long-term benefits.

Adolescents with type 1 diabetes and obesity present higher cardiovascular risk and ambulatory blood pressure measurements (ABPM) has been shown to predict vascular events, especially by identifying the nondipper status. The aim of our observational cross-sectional study conducted in adolescents with type 1 diabetes, overweight subjects and healthy controls was to assess mean blood pressure parameters to identify subclinical cardiovascular risk. The study included adolescents patients with type 1 diabetes followed in our Pediatric Department in University of Catania between January 2011 and 2013. A total of 60 patients were enrolled, and 48 (32 male and 16 female) completed the study. For each subject we performed systolic and diastolic Ambulatory Blood Pressure Measurements (ABPM) during wakefulness and sleep recording blood pressure every 30 min for 24 h with the Tonoport V/2 GE CardioSoft V6.51 device. We compared the data of patients with those of overweight subjects and healthy controls. ABPM revealed no significant difference between type 1 diabetic patients and overweight subjects in 24 h Systolic, 24 h Diastolic, Day-time Systolic, Night-time systolic and Day-time Diastolic blood pressure values but significantly different values in Night-time Diastolic blood pressure values (p < 0.001). We found significant differences between type 1 diabetic patients and healthy controls in all 24 h Systolic (p < 0.001), 24 h Diastolic (p < 0.01), Day-time Systolic (p < 0.01), Night-time Systolic (p < 0.001), Day-time Diastolic (p < 0.05) and Night-time Diastolic (p < 0.001) blood pressure values. We detected hypertension in 12/48 (25 %) type 1 diabetic patients and in 10/48 overweight subjects (p = 0.62; OR 1.2; CI 0.48–3.29), whereas no-one of healthy controls presented hypertension (p < 0.001). We observed nondipper pattern in 40/48 (83.3 %) type 1 diabetic patients, in 33/48 (68.8 %) overweight subjects (p = 0.094; OR 2.27; CI 0.85–6.01), and in 16/48 (33.3 %) of healthy controls (p < 0.001; OR 10; CI 3.79–26.3). ABPM studies might help to define a subset of patients at increased risk for the development of hypertension. In evaluating blood pressure in type 1 diabetes and overweight subjects, ABPM should be used since a reduced dipping can indicate incipient hypertension.

Rotavirus disease is the world’s leading cause of severe gastroenteritis and mortality in children up to 5 years of age. Premature infants are more vulnerable to rotavirus gastroenteritis (RVGE) and its complications. International authorities strongly recommend vaccination because of the consistent reduction in infections, hospitalizations, deaths, and related costs. Background/Objectives: The objective of the present study was to evaluate the safety of anti-rotavirus vaccination in premature infants admitted and vaccinated in the main Sicilian Neonatal Intensive Care Units (NICUs) during the pandemic period. Methods: The human monovalent rotavirus vaccination (RV1) was administered to preterm infants of gestational age ≥28 weeks in the main Sicilian NICUs from January 2020 to December 2022, as a prolongation of a similar study conducted from April 2018 to December 2019. Rotavirus vaccinations were provided both to hospitalized infants and to those returning for post-discharge follow-up, beginning at six weeks of age according to the official immunization schedule. All potential adverse events—whether expected, unexpected, or serious—were recorded from the day of vaccination through 14 days (first follow-up) and 28 days (second follow-up) after each of the two scheduled doses. Results: A total of 355 preterm infants were fully vaccinated with RV in four Sicilian NICUs. The mean gestational age of newborns was 33.2 weeks (±2.7), 53% of whom were male. Vaccination was performed on average at 7 weeks of age (±2.1), and the mean weight at the time of vaccination was 3439 g (SD ± 745.2). No expected/unexpected or serious adverse events were observed either within the 14-day or within the 28-day period after administration of both two doses. Conclusions: Data confirm that vaccination in preterm infants ≥28 weeks gestational age is safe. The prolongation of this Public Health strategy, strongly recommended by the Sicilian Health Department during the pandemic period that also generally has led to a reduction of vaccination adherence and acceptance of pediatric vaccination, demonstrates the importance of multidisciplinary collaboration with neonatologists and pediatricians to continue promoting in-hospital vaccinations for fragile subjects.

Vitamin K prophylaxis represents a paradigmatic example of how molecular mechanisms directly translate into effective neonatal preventive care. In newborns, physiological immaturity of vitamin K metabolism, including limited placental transfer, low hepatic reserves, immature intestinal absorption, and dependence on vitamin K-dependent γ-carboxylation pathways, creates a unique vulnerability to vitamin K deficiency bleeding (VKDB). This narrative review integrates molecular and biochemical mechanisms with neonatal physiology and clinical evidence to examine the effectiveness of current prophylactic strategies. At the molecular and pharmacokinetic level, intramuscular (IM) administration ensures sustained bioavailability and reliable activation of vitamin K-dependent proteins, whereas oral regimens are more sensitive to formulation, dosing schedules, and absorption efficiency. Consistently, clinical and surveillance data demonstrate near-complete protection against both classic and late VKDB following IM prophylaxis, while oral approaches show greater variability, particularly in real-world settings. Importantly, increasing parental refusal of IM vitamin K undermines an intervention with well-established molecular efficacy, contributing to preventable severe bleeding events. By linking mechanistic foundations to clinical outcomes and implementation challenges, this review provides a translational framework for clinicians, researchers, and policymakers aiming to optimize neonatal vitamin K prophylaxis in contemporary practice.