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Prenatal and infant exposure to drugs of abuse is an emerging social and public health problem affecting children health and which may relate to child abuse and neglect. Exposure to drugs of abuse may occur through different routes, including intrauterine, breastfeeding, accidental intake, passive inhalation, and intentional administration. Currently, cases of suspected exposure can be investigated by hair toxicological analysis, the interpretation of which is, however, often difficult, leading to consequent difficulties in the management of such cases. In order to provide a contribution in terms of interpretation of the analytical results, this study aimed to search for the possible existence of elements, from a toxicological point of view, indicative towards the route of exposure. A retrospective study was performed on cases of suspected exposure to drugs of abuse in children aged 0-1 year, evaluated at a University Hospital between 2018 and 2022. Data of children hair toxicological analysis were analyzed and then compared with those of their mothers, when available; 41.6% children tested positive for cocaine. The study found a significant correlation between cocaine and benzoylecgonine concentrations, and a benzoylecgonine/cocaine ratio that tends to decrease as the age of children increases. From the comparison with mothers, a child/mother cocaine concentration ratio lower than 1 was found in all cases of hair sampled within the first week of life, and a ratio greater than or equal to 1 in all cases in which the sampling was performed later. These results, if confirmed in a larger cohort, could represent a contribution in the interpretation of cases of infant exposure to drugs of abuse and be integrated in the context of their multidisciplinary evaluation.

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The interest in cannabis, cannabis-based compounds, and treatments is rapidly growing along with the legalization of marijuana in many countries and widespread use of cannabis derivatives in medical products. A growing body of literature is warning about possible unintentional intoxication in children because of unregulated and unsupervised use of cannabinoids by parents; to our knowledge, very rarely have parental self-prescription and self-administration to their children (affected by neurologic or other disorders or no disorders at all) been reported. We report a 4-year-old child, suffering from an anti-N-methyl-D-aspartate receptor encephalitis, who was found unpredictably positive for cannabis and other illicit substances after drug testing was performed in order to investigate the child's treatment-resistant behavioral disturbances. Toxicologic analyses were also extended to the child's parents, who finally disclosed that they had deliberately administered a cannabis-derived product (cannabidiol extract) as a home remedy for managing their child's behavior. Careless with regard to the possible adverse effects and certain that the product was legal, they presumed there was no need for them to inform the physicians in charge of treating the child of this practice.

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Child victims of sexual abuse may present with physical findings whose interpretation requires the most exhaustive evaluation and an accurate collection of a detailed history. Genital bleeding is usually considered as an acute sign, related to a trauma that occurred shortly before its appearance. We report a case of a 34-month-old child who was referred to the emergency room with a significant vaginal hemorrhage, originating from a wide laceration of the posterior fourchette, and a negative history for accidental trauma. The characteristics of the lesion, compared to the temporal evolution of the healing process, and the witnesses' depositions led us to assume that the time elapsed between the abusive event and the physical examination was longer in respect to what had appeared at the first sight. The judicial reconstruction of the events confirmed our assumption, allowing the charge of the right abuse perpetrator. As the literature regarding this eventuality is very poor, we report this case to stress the importance for physicians to consider that an active bleeding may be the manifestation of a trauma that occurred very long before.

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This study aims to compare in hemiplegic children the effectiveness of intensive training (unimanual and bimanual) versus standard treatment in improving hand function, assessing the persistence after 6 months. A multicenter, prospective, cluster-randomized controlled clinical trial was designed comparing 2 groups of children with hemiplegic cerebral palsy, treated for 10 weeks (3 h/d 7 d/wk; first with unimanual constraint-induced movement therapy, second with intensive bimanual training) with a standard treatment group. Children were assessed before and after treatment and at 3 and 6 months postintervention using Quality of Upper Extremity Skills Test (QUEST) and Besta Scales. One hundred five children were recruited (39 constraint-induced movement therapy, 33 intensive bimanual training, 33 standard treatment). Constraint-induced movement therapy and intensive bimanual training groups had significantly improved hand function, showing constant increase in time. Grasp improved immediately and significantly with constraint-induced movement therapy, and with bimanual training grasp improved gradually, reaching the same result. In both, spontaneous hand use increased in long-term assessment.

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OBJECTIVE: The aim of this study was to compare the effects of modified constraint-induced movement therapy (mCIMT; restraint of unaffected limb combined with unimanual intensive rehabilitation) with those of a bimanual intensive rehabilitation treatment (IRP) in children with hemiplegic cerebral palsy after a 10-wk practice vs. standard treatment (ST). DESIGN: This study is a multicenter, cluster-randomized controlled clinical trial of tested groups of children with hemiplegic cerebral palsy treated using mCIMT, IRP, or ST. For 10 wks, in mCIMT and IRP, the intensive practice lasted 3 hrs/day, 7 days/wk; in ST, 1-hr sessions twice a week were provided. The primary outcomes are upper limb/hand function (Quality of Upper Extremity Skills Test) and activities of daily living (Besta Scale), which are assessed before and after treatment. One hundred five patients were recruited, 39 to the mCIMT group, 33 to the IRP group, and 33 to the ST group. RESULTS: IRP and mCIMT significantly improved paretic hand function both in the Quality of Upper Extremity Skills Test and in the Besta Scale, whereas ST did not. mCIMT improved grasp more than IRP did (P < 0.01), whereas bimanual spontaneous use in play increased more with IRP (P = 0.0005). Activities of daily living in 2- to 6-yr-olds improved more with IRP (P < 0.0001) than with mCIMT (P = 0.011). Unaffected limb improved more from bimanual practice (IRP; P = 0.02). CONCLUSIONS: More advantages resulted from intensive practice than in the standard one, in mCIMT for grasp and in IRP for bimanual spontaneous use and activities of daily living in younger children.

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The role of cryptic translocations in human syndromes is a matter of fact, though this phenomenon is apparently rare. Apart from episodic case reports due to the increasing application of new molecular cytogenetic techniques, no data on its frequency in the general population are currently available. Rearrangements due to the unbalanced segregation of cryptic translocations are found in many anomalies responsible for different clinical pictures. In nearly 50% of cases, subtelomeric abnormalities are inherited from a parent carrying a balanced cryptic chromosome rearrangement. To date, very few cases of partial trisomies of 19q have been reported, with different breakpoints. Involvement of the distal region 19q is even more rare, and the delineation of its main clinical characteristics is still vague and awaiting better definition. We report two new cases of partial 19q13.42-qter trisomy associated with a partial 20p13-pter monosomy in a family found to have the cryptic translocation t(19;20)(q13.42;p13). We investigated a 5-year-old boy and his 49-year-old paternal uncle, and both had a similar, previously unrecognized mental retardation pattern, associated with the same subtelomeric rearrangement.

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OBJECTIVE: In the past decades, several treatment approaches have been used to improve upper limb function in hemiplegic cerebral palsy. Only recently has constraint-induced movement therapy emerged as a treatment approach for children with hemiplegic cerebral palsy with the aim of reversing the behavioral suppression of movement in the affected upper limb. To date, evidence on this treatment has been very poor and limited, because all currently available trials reveal methodological limitations and a need for additional research to support the application of this treatment technique. This article presents the methodological choices, design, and main characteristics of an ongoing controlled clinical trial on the effectiveness and safety of constraint-induced movement therapy combined with an intensive rehabilitation program and compared with two comparison groups: one treated with an intensive rehabilitation program and the other with standard treatment. METHODS: Twenty-one rehabilitation sites are currently recruiting patients with hemiplegic cerebral palsy, aged between 2 and 8 yrs, who have never undergone constraint therapy. Primary outcome measures include two major domains: upper limb motor ability (Quality of Upper Extremity Skills Test) and hand function assessment evaluating both grip function and spontaneous use of the affected side (Besta scale). Secondary outcome measures concern overall function, behavior, compliance, and satisfaction with treatment program of both child and family. Patients' follow-up is of 12 mos after treatment. RESULTS: Research in children has always been neglected in comparison with adults, because of ethical reasons regarding the use of children for experimental purposes. The consequence has been the utilization of treatment and assessment tools and techniques that have not always been tested in pediatric patients or evidence is very scarce. CONCLUSION: Discussing and working on pediatric research methods represents an urgent need in rehabilitation research.

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