Italian Infant Research Articles

Draft genome sequence of non-pathogenic Escherichia coli 5C LMG S-33222, isolated from healthy donor feces.

We present the genome sequence of Escherichia coli 5C LMG S-33222, a non-pathogenic microorganism with potential probiotic features. The strain was isolated in 2021 from a fecal sample of a healthy Italian infant. The total genome size is 4,712,575 bp with a G + C content of 51%.

Novel de novo missense mutation in the interferon regulatory factor 6 gene in an Italian infant with IRF6-related disorder

BackgroundCongenital maxillomandibular syngnathia is a rare craniofacial anomaly leading to difficulties in feeding, breathing and ability to thrive. The fusion may consist of soft tissue union (synechiae) to hard tissue union. Isolated cases of maxillomandibular fusion are extremely rare, it is most often syndromic in etiology.Case presentationClinical management of a female newborn with oromaxillofacial abnormities (synechiae, cleft palate, craniofacial dysmorphisms, dental anomaly) and extraoral malformations (skinfold overlying the nails of both halluces, syndactyly, abnormal external genitalia) is presented. The associated malformations addressed to molecular genetic investigations revealing an interferon regulatory factor 6 (IRF6)-related disorder (van der Woude syndrome/popliteal pterygium syndrome). A novel de novo heterozygous mutation in exon 4 of IRF6 gene on chromosome 1q32.2, precisely c.262A > G (p.Asn88Asp), was found. Similarities are discussed with known asparagine missense mutations in the same codon, which may alter IRF6 gene function by reduced DNA-binding ability. A concomitant maternal Xp11.22 duplication involving two microRNA genes could contribute to possible epigenetic effects.ConclusionsOur reported case carrying a novel mutation can contribute to expand understandings of molecular mechanisms underlying synechiae and orofacial clefting and to correct diagnosing of incomplete or overlapping features in IRF6-related disorders. Additional multidisciplinary evaluations to establish the phenotypical extent of the IRF6-related disorder and to address family counseling should not only be focused on the surgical corrections of syngnathia and cleft palate, but also involve comprehensive otolaryngologic, audiologic, logopedic, dental, orthopedic, urological and psychological evaluations.

Age-Related Trends in the Diet of An Infant's Cohort in the Northeast of Italy from Six to Twelve Months of Age.

Complementary feeding is recognized as an important predictor of health later in life and is likely to affect the development of food preferences. This paper describes age-related trends in terms of energy, nutrients intake and dietary habits of an Italian infant sub cohort (n = 152), enrolled in Trieste. Infant dietary data, collected using a food diary at 6, 9 and 12 months of age, were used to estimate energy and nutrients intake using the Italian food composition database. Age-related trends were calculated using Page’s trend test. An increasing age-trend was observed in the percentages of contribution of macronutrients to total energy intake, with the exception of total lipids, which instead decreased over time. Most of the infants shared a low varied diet especially with regards to protein intake sources, represented mainly by dairy and meat products rather than pulses and fish. This could also account for the low intake of essential fatty acids (ω3) that play an important role in infant neurodevelopment. Moreover, non-commercial baby foods contributed more in terms of quantity, energy and macronutrients intake, compared with commercial products. Healthy eating habits should be encouraged during the first year of life, promoting a varied and well balanced diet at family level.

Lipoid congenital adrenal hyperplasia by steroidogenic acute regulatory protein (STAR) gene mutation in an Italian infant: an uncommon cause of adrenal insufficiency

BackgroundLipoid congenital adrenal hyperplasia (CAH) (OMIM n. 201710) is the most severe form of congenital adrenal hyperplasia. It is characterized by severe adrenal and gonadal steroidogenesis impairment due to a defect in the conversion of cholesterol to pregnenolone. Affected infants experience salt loss, but glucocorticoid and mineralocorticoid replacement therapy enables long-term survival. Classic lipoid congenital adrenal hyperplasia is relatively common in Japan and Korea but extremely rare in Caucasian populations.Case presentationA female infant of Italian origin came to our attention in late infancy with a clinical picture of acute adrenal insufficiency.The study of the STAR gene revealed two genomic variants c.562C > T and c.577C > T in compound heterozygosity. At the protein level, the two mutations determine the p.Arg188Cys variant (rs104894090) and the p.Arg193Ter variant (rs387907235), respectively. Sanger sequencing was used to confirm the identified variants and to perform familial study. The mother carried the p.Arg188Cys variant, while the father carried the p.Arg193Ter variant.ConclusionTo our knowledge this is the second case of classic lipoid congenital adrenal hyperplasia reported in the Italian population. STAR mutations resulting in lipoid congenital adrenal hyperplasia should be considered all over the world in the differential diagnosis of newborn babies and infants with primary adrenal insufficiency.

Infant immunization coverage in Italy (2000-2016).

In Italy, national-level immunization polices are included in the National Immunization Prevention Plan (PNPV), whose latest edition - 2017-2019 PNPV - was finally approved in February 2017. Coverage rates are a key measure of immunization system performance; it can inform and support national and regional polices' implementation monitoring, as well as measure the impact of interventions aimed at increasing vaccine uptake. We collected, analysed and critically interpreted 2000-2016 Italian national infant immunization coverage trends, by different vaccine, target population, and by Region. Data were provided by the Directorate General for Prevention of the Italian Ministry of Health. In 2016, none of the mandatory or recommended vaccines reached the 95% national coverage target set in the PNPV. Weighted average national coverage for currently mandatory vaccines (against Polio, Tetanus, Diphtheria, Hepatitis B) and other antigens included in the hexavalent vaccine (Pertussis, and Haemophilus influenzae type b) ranged between 93.0% for Hepatitis B and 93.7% for Tetanus; it was lower for Measles, Mumps and Rubella vaccines (87.2%), pneumococcal (88.4%) and meningococcal C conjugate vaccines (80.7%), with a high degree of heterogeneity by Region. Both hexavalent and MMR vaccines coverage rates have been decreasing in the last years, respectively from 2012 (-2.8%) and from 2010 (-3.6%). Further efforts are needed to increase vaccine uptake in Italy, to improve data collection and reporting, as well as to fight the growing phenomenon of the vaccine hesitancy so that PNPV's objectives and targets can be met in the near future.

Family-school relationship in the Italian infant schools: not only a matter of cultural diversity.

BackgroundThe family-school relationship is a crucial component in achieving the optimum scholastic experience of pupils. Such a relationship is often described in somewhat reductive binary terms of collaboration/non-collaboration. However, the significant presence of families from different cultural backgrounds in Italy since the 1990s demonstrates how multiple types of rapport with schools can generate effective styles of relationship. Infant schools constitute a privileged location where such dynamics can be investigated. Firstly, because they exhibit the highest percentage of families that have moved to Italy from other countries (33.9%); secondly, because they represent the initial stage when school and family first come into contact, playing an “imprinting role” for all subsequent scholastic phases. Based on in-depth interviews with infant school teachers and parents of pupils coming from different backgrounds, this research investigated different factors that influence family-school relations: (1) interpersonal factors, that include listening skills, emotions and relational styles of parents or teachers; (2) structural factors, that are related to the living conditions of families and to the whole social welfare system in Italy; (3) cultural factors, that bring together values, lifestyles and educational cultures of both parents and teachers.ResultsThe idea regarding the inadequate distinction based on a dichotomy between Italian and migrant families seemed to be confirmed: Italian families and migrant families are characterized by many common features as well as by many inner differentiations. The results of this study suggest that the family-school relationship evolves into a communication framework that encompasses both obstacles and resources.ConclusionsThe results of our research suggest that the relationship between parents and teachers in Italian infant schools is influenced by different factors, not only cultural ones. All of these factors are related to both parents and teachers, and they should be taken into account when investigating this topic.

Implicit association to infant faces: Genetics, early care experiences, and cultural factors influence caregiving propensities

Genetics, early experience, and culture shape caregiving, but it is still not clear how genetics, early experiences, and cultural factors might interact to influence specific caregiving propensities, such as adult responsiveness to infant cues. To address this gap, 80 Italian adults (50% M; 18–25 years) were (1) genotyped for two oxytocin receptor gene polymorphisms (rs53576 and rs2254298) and the serotonin transporter gene polymorphism (5-HTTLPR), which are implicated in parenting behaviour, (2) completed the Adult Parental Acceptance/Rejection Questionnaire to evaluate their recollections of parental behaviours toward them in childhood, and (3) were administered a Single Category Implicit Association Test to evaluate their implicit responses to faces of Italian infants, Japanese infants, and Italian adults. Analysis of implicit associations revealed that Italian infant faces were evaluated as most positive; participants in the rs53576 GG group had the most positive implicit associations to Italian infant faces; the serotonin polymorphism moderated the effect of early care experiences on adults’ implicit association to both Italian infant and adult female faces. Finally, 5-HTTLPR S carriers showed less positive implicit responses to Japanese infant faces. We conclude that adult in-group preference extends to in-group infant faces and that implicit responses to social cues are influenced by interactions of genetics, early care experiences, and cultural factors. These findings have implications for understanding processes that regulate adult caregiving.

Conditions, Standards and Practices of Inclusion for Children with Disabilities in Italian Infant School

The highly integrative choice that Italy has decided to make for many decades is much appreciated at international level. It is an irreversible choice that requires continual improvements to be made in the school context which includes a great variety of individuals. During childhood, in fact, Italian school embraces, promotes and enriches the experience of every child from a developmental perspective; the educational activities offer opportunities for growth within a context oriented towards well-being, awareness and gradual development of the competences expected at different ages, between three and six years old. In such educational activities, the school is coherent with the principles of the inclusion of the person, considering the acceptance of diversity and active participation in each of the fundamental values. This paper regards the perspective of inclusion of children with disabilities in Italian infant school. It describes, both quantitatively and qualitatively, the situation, according to a framework of fundamental principles sanctioned internationally, based on the Italian Constitution, current laws, documents, informations and data from authoritative sources. The research, presented by the author in the «Deutschen Gesellschaft fur Erziehungswissenschaft Kongress» (Humboldt Universitat, Berlin, 9-12 March 2014), arose from a designed European comparative study from four selected member countries of the EU: Italy, England, Germany and Slovenia. The study aims to explain how inclusive education of children with disabilities in european school has developed, and how, currently, is arranged in connection with the school system’s resources, the teachers training and the social expectations on the kindergarden.

Cost-effectiveness of new adult pneumococcal vaccination strategies in Italy

Community-acquired pneumonia (CAP) and invasive pneumococcal disease (IPD) are very relevant pathologies among elderly people (≥ 65 y old), with a consequent high disease burden. Immunization with the 23-valent pneumococcal polysaccharide vaccine (PPV23) has been differently implemented in the Italian regions in the past years, reaching overall low coverage rates even in those with medical indications. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) became available and recommended in the universal Italian infant immunization program. Since October 2012, indications for use of PCV13 were extended to subjects ≥ 50 y to prevent invasive pneumococcal diseases. The Italian decision makers should now revise regional indications for the prevention of pneumococcal diseases in the elderly. Pharmaco-economic analyses represent a useful tool to value the feasibility of new immunization programs and their sustainability. Therefore, an ad hoc population model was developed in order to value the clinical and economic impact of an adult pneumococcal vaccination program in Italy. Particularly, different immunization scenarios were modeled: vaccination of 65 y-olds (1 cohort strategy), simultaneous vaccination of people aged 65 and 70 y (double cohort strategy) and, lastly, immunization of people aged 65, 70 and 75 y (triple cohort strategy), thus leading to the vaccination of 5, 10 and 15 cohorts during the 5 y of the program. In addition, the administration of a PPV23 dose one year after PCV13 was evaluated, in order to verify the economic impact of the supplemental serotype coverage in elderly people. The mathematical model valued the clinical impact of PCV13 vaccination on the number of bacteraemic pneumococcal pneumonia (BPP) and pneumococcal meningitis (PM) cases, and related hospitalizations and deaths. Although PCV13 is not yet formally indicated for the prevention of pneumococcal CAP by the European Medicine Agency (differently from FDA, whose indications include all pneumococcal diseases in subjects ≥ 50 y), the model calculated also the possible impact of vaccination on CAP cases (non-bacteraemic), considering the rate of this disease due to S. pneumoniae. The results of the analysis show that, in Italy, an age-based PCV13 vaccination program in elderly people is cost-effective from the payer perspective, with costs per QALY ranging from 17,000 to 22,000 Euro, according to the adopted vaccination strategy. The subsequent PPV23 offer results in an increment of costs per QALY (from 21,000 to 28,000 Euro, according to the vaccination strategy adopted). Pneumococcal vaccination using the conjugate vaccine turned out to be already favorable in the second year of implementation, with incremental costs per QALY comparable to those of other already adopted prevention activities in Italy (for instance, universal HPV vaccination of 12 y-old girls), with further benefits obtained when extending the study period beyond the 5-y horizon of our analysis.

Preliminary assessment of the risk linked to furan ingestion by babies consuming only ready-to-eat food

The risk linked to furan ingestion has been assessed in previous papers for Belgian adults and children. The present paper focuses on infants consuming only ready-to-eat baby food. As there is no Belgian baby dietary database, the furan exposure assessment was carried out by using an Italian infant consumption database and Belgian contamination data. The estimated daily intake (EDI) was calculated according to a deterministic methodology. It involved 42 commercially available ready-to-eat baby food and 36 baby consumption records. The mean EDI was 1460 ng*(kgbw*day)−1 which is 3.8 times higher than the 381 ng*(kgbw*day)−1 reported for Belgian adults, and 3.5 times higher than the 419 ng*(kgbw*day)−1 measured for Belgian children. To assess and characterise the risk for babies’ exposure, the margin of exposure (MoE) was calculated. It highlighted that 74% of infants have a MoE < 1000, with a minimum of 140. However, these are only preliminary results as they were calculated from a very small dataset and the infant cytochrome P450 activity is significantly different compared with the adult’s. Therefore, the risk linked to furan ingestion by babies should be assessed in a different manner. To this end, additional data regarding a baby diet as well as a better understanding of furan toxicity for babies are needed to characterise more accurately the risk for infants.

Attachment the Italian Way

In the present meta-analysis 627 Strange Situation Procedures (SSP; Ainsworth, Blehar, Waters, &amp; Wall, 1978 ) from 17 Italian infant attachment studies and 2,258 Adult Attachment Interviews (AAI; Main, Kaplan, &amp; Cassidy, 1985 ) from 50 Italian adult attachment studies were included. All studies were published between 1990 and 2009. Our aim was to test the universality hypothesis of attachment theory in this Italian database. Results indicated that the majority of nonclinical Italian infants were classified as securely attached (53%); similarly, the majority of nonclinical Italian adults were secure (60%). Although cross-cultural similarities provide evidence for the universality hypothesis of attachment theory, our meta-analysis revealed also interesting cultural specificities. First, nonclinical Italian infants’ distribution showed an overrepresentation of avoidant attachments compared to the normative distribution. Second, the underrepresentation of unresolved loss among Italian nonclinical adults was noteworthy.

Mycoestrogen Pollution of Italian Infant Food

Mycoestrogen Pollution of Italian Infant Food

The Sardinian experience of the lowest Italian infant mortality at the turn of the twentieth century. True or false empirical evidence?

Résumé Selon les sources statistiques officielles italiennes, la Sardaigne, dans les décennies qui ont suivi l’unification nationale (1861), présentait le plus faible taux de mortalité néonatale et infantile du pays et un taux de mortinatalité nettement inférieur à la moyenne nationale. L’objectif principal de cet article est de voir à nouveaux frais l’évolution de la mortalité infantile dans l’île, en tenant compte des progrès de l’enregistrement des décès (mort-nés et décès néonataux précoces) dans la période, élément essentiel d’une bonne évaluation de la mortalité infantile. Les statistiques officielles du nouveau Royaume d’Italie comportent des lacunes et des biais de collecte. Selon les différentes régions, les pratiques d’enregistrement ont été différentes au point d’affecter les taux de mortinatalité et de mortalité néonatale, tant entre régions que selon les périodes d’observation. Cette question de la définition et des règles d’enregistrement des mort-nés a été l’objet de peu de travaux, en Italie comme d’ailleurs pour nombre d’autres pays. La reconstruction de la population d’Alghero (nord-ouest de la Sardaigne), à partir de sources nominatives civiles et religieuses, a permis d’apporter des éléments remettant en cause le « record » sarde en matière de mortalité infantile. Les données officielles – au moins pour la communauté d’Alghero –, la sous-estiment largement, en particulier pour la mortalité néonatale précoce. Des recherches complémentaires restent cependant nécessaires pour vérifier cette hypothèse qui bouscule une opinion largement admise. La dernière partie de cet article propose une analyse multivariée des déterminants de la mortalité précoce à Alghero. Les résultats confirment la prédominance des facteurs bio-démographiques, l’effet des variables socio-économiques étant particulièrement faibles.

Evaluation of beauvericin and enniatins in Italian cereal products and multicereal food by liquid chromatography coupled to triple quadrupole mass spectrometry

In this study, 48 multicereal baby foods samples including 25 of pasta and 23 of multicereal baby foods from supermarkets of Campania region (Italy) were analysed for evaluating the presence of beauvericin (BEA) and enniatins (ENs) A, A1, B, B1 and B4. Subsequently to evaluate the risk exposure of Italian population and infant population over the consumption of pasta or multicereal baby food, was, respectively, evaluated.For the above mentioned evaluation, a method developed in our laboratory by liquid chromatography tandem mass spectrometry was used. A liquid phase dispersion procedure was optimised for the simultaneous extraction of BEA and the five ENs from multicereal baby food samples and pasta. The main parameters affecting extraction yield and selectivity, extraction solvent were evaluated.The method was validated by analysis for pasta and multicereal baby food samples fortified at different concentration levels (from 0.5 to 20μg/kg). Average recoveries (n=5) ranged from 85% to 99% with relative standard deviation lower than 13%. Limits of quantification (LQs) for both matrices ranged from 1 to 10μg/kg.Analytical results showed that the occurrence of BEA, ENA, ENA1, ENB, ENB1 and ENB4 in analysed pasta and multicereal baby food samples were below 68% and 74%, respectively. ENB was the mycotoxin most found and levels in pasta and baby food ranged from <LQ to 106 and from <LQ to 1100μg/kg, respectively. It was observed a high incidence (70.3%) and high contamination levels (<1100μg/kg) of these mycotoxins in multicereal baby food and its intakes could represent a risk for the infant population (estimated daily intake <7.23μg/kgbw/day).

Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy

BackgroundIn infants, vitamin B12 deficiency may be due to an inborn error of absorption and metabolism, or nutritional problems.Case presentationAn exclusively breastfed 5-month-old Italian male infant, who was born after a normal full-term pregnancy to a vegan mother who was apparently daily treated with a multivitamin oral preparation during the second and third trimester, was hospitalised because of poor weight gain, feeding difficulties, severe pallor, muscle hypotonia and somnolence. Upon admission, his weight, length and head circumference were below the third percentile, he had an enlarged liver and spleen, and showed a significant delay in developmental milestones and communicative reactions. He had a hemoglobin level of 4.7 g/dL with an MCV of 84.2 fL, a white blood cell count of 4,680/mm3, and a platelet count of 45,000/mm3. His serum vitamin B12 level was 57 pg/mL (normal value 180–500 pg/mL) and serum folate level 12.8 ng/mL (normal value >3 ng/mL). The results of metabolic examinations excluded a cobalamin C disorder, whereas nutritional screening showed a serum iron concentration of 9 μg/dL and serum ferritin of 4 ng/mL. Magnetic resonance imaging of the brain showed mild dilatation of the lateral ventricles with diffuse delayed myelination. The child was diagnosed as having vitamin B12 and iron deficiency due to nutritional inadequacy and was immediately treated with packed red blood cells, intramuscular vitamin B12 injections, and iron supplementation. A few days after the start of therapy, his hemoglobin levels and other hematological parameters rapidly improved, and a clinical improvement was observed within few weeks. There was an increase in his achievement of developmental milestones, but his development was still retarded seven months after the start of therapy.ConclusionThis case underlines the importance of adequately controlling maternal vitamin B12 intake during pregnancy by means of supplementation which, in the case of vegan mothers, should be significantly greater than that usually given. Moreover, the supplementation should be continued during lactation in order to avoid the development of signs of deficiency that may be associated with persistent neurological problems in infants. The case also highlights the need to consider vitamin B12 deficiency in infants with severe anemia even if their hematological parameters do not indicate megaloblastic anemia because the concomitant presence of substantial iron deficiency may modify the characteristics of the anemia.

Mycoestrogen Pollution of Italian Infant Food

To determine the concentrations of zearalenone and its metabolites in the leading brands of infant formula milks and meat-based infant foods commonly marketed in Italy, and to assess their repercussion in the provisional tolerable daily intakes of these estrogenic mycotoxins. A total of 185 cow's milk-based infant formulas and 44 samples of meat-based infant foods samples were analyzed. The analysis of mycotoxins was performed by immunoaffinity column clean-up and high-pressure liquid chromatography with fluorescence detection. Zearalenone was detected in 17 (9%) milk samples (maximum 0.76 μg/L). The α-zearalenol was detected in 49 (26%) milk samples (maximum 12.91 μg/L). The β-zearalenol was detected in 53 (28%) milk samples (maximum 73.24 μg/L). The α-zearalanol and β-zearalanol were not detected in milk samples. Although α-zearalenol was detected in 12 (27%) meat samples (maximum 30.50 μg/kg), only one meat-based sample was contaminated by α-zearalanol (950 μg/kg). Zearalenone, β-zearalenol, and β-zearalanol were not detected in meat samples. This study shows the presence of mycoestrogens in infant (milk-based and meat-based) food, and this is likely to have great implications for subsequent generations, suggesting the need to perform occurrence surveys in this type of food.

Adults' and Children's Language in Different Situational Contexts in Italian Nursery and Infant Schools

The aim of the present study is to analyse, through direct observations, the communicative competence of children's caregivers and children's language development in different situational contexts in Italian nursery schools (for children aged between six and 36 months, i.e. crèches) and infant schools (for children aged between 38 and 72 months, i.e. kindergartens). Children's and adults' language production (i.e. number of utterances, number of words, and mean length of utterances), interactive episodes (i.e. a string of sentences involving at least two interlocutors), and adults' conversational functions) were considered in three situational contexts in both nursery and infant schools (mealtime, storytime and free play for the former; circle time, direct questions, and free conversation for the latter). One hundred and nineteen preschool children and 21 adults (12 educators for the nurseries and nine teachers for the infant schools) from seven educational settings participated in the study. Data analysis showed differences in children's language production, adults' conversational functions, categories of interactive episodes and adults' communicative competence in the situational contexts considered both in the two facilities taken separately, and between the two facilities. Moreover, there emerged a relationship between children's language development and adult speech characteristics: in particular, the educators' and teachers' tutorial and conversational functions appeared to be related to greater language production in the children within the contexts.

Interatrial defect and patent ductus arteriosus

We greatly appreciated the letter to the Editor by Rana Olgunturk and Serdar Kula. We can say that his interpretation coincides with our interpretation and with the knowledge about patent ductus arteriosus (PDA) and secundum atrial septal defects. Although functional closure of PDA usually occurs in the first few hours of life in healthy infants born at term (about 15 h of life in healthy infants born at term), true anatomic closure, in which the ductus loses the ability to reopen, may take several weeks. Persistent, patency for up to 10 days after birth is encountered in premature infants. The male Italian newborn infant of the cited case report was referred at the age of 2 days to the Cardiology Unit for a cardiovascular check-up (in the text: "in a 3-day-old newborn infant" must be comprehended as "in a 2-day-old newborn infant") and was mature. Interatrial septal shunts in newborns are frequently encountered. Since there are no definitive diagnostic criteria for both patent foramen ovale and secundum atrial septal defects, it is difficult to differentiate these two lesions by echocardiography, particularly in the early newborn period. Some authors, called these two lesions as "interatrial septal openings". The diagnosis, in the case report cited, was made not only on the basis of the first observation but also on the basis of the persistence of abnormalities during the long-term follow-up and therefore the infant was referred to a pediatric heart surgical unit were the abnormalities were confirmed.

Congenital glioblastoma

We describe the case a 2-day-old female with congenital glioblastoma. Total resection was followed by adjuvant and high dose chemotherapy, as indicated by the current Italian infant protocol. The child is alive and well 18 months after diagnosis. A review of 67 selected congenital brain tumors showed the mortality rate was 82%. Even though the majority of patients had glioblastoma, only 5/67 had received adjuvant therapy. To ensure optimal outcomes, we recommend total or subtotal surgical resection, followed by adjuvant and high dose chemotherapy. Given the lack specific protocols for congenital brain tumors an international consensus seems to be needed, starting with congenital glioblastoma.

Role of respiratory pathogens in infants hospitalized for a first episode of wheezing and their impact on recurrences

In order to evaluate the infectious agents associated with the first episode of severe acute wheezing in otherwise healthy infants and to define the role of each of them in recurrences, 85 patients in Italy, aged <12 months, hospitalized because of a first acute episode of wheezing, were prospectively enrolled between 1 October 2005 and 31 March 2006. Upon enrolment, nasopharyngeal swabs were collected for the real‐time PCR detection of respiratory syncytial virus (RSV) types A and B, influenza virus types A and B, adenovirus, parainfluenza viruses types 1, 2, 3 and 4, rhinovirus, human metapneumovirus, human coronavirus types 229E, OC43, NL63, and HKU1, bocavirus, enterovirus, and paraechovirus; nasopharyngeal aspirates were also obtained to detect atypical bacteria. At least one infectious agent was identified in 76 children (89.4%). RSV was the most frequently detected pathogen and its prevalence was significantly higher than that of the other pathogens in both age groups, and significantly higher in the children aged 3–12 months than in those aged <3 months. Only the children with RSV infection experienced recurrent wheezing. Viral load was significantly higher in children with than in those without recurrent wheezing. This study shows that RSV is the main reason for hospitalization during the first wheezing episode in infants, and that it appears to be the only pathogen associated with a high frequency of recurrences. A high viral load seems to be strictly related to the likelihood of recurrence.