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Background: The issue of retreatment with surfactant of infants with respiratory distress syndrome (RDS) has been poorly investigated. Our aim was to identify possible clinical predictors of the need for multiple doses of surfactant in a large cohort of very preterm infants., Methods: Data were analyzed from three previous studies on infants born between 25 + 0 and 31 + 6 weeks of gestation with RDS who were treated with surfactant., Results: We studied 448 infants. Among them 306 (68%) were treated with a single dose of surfactant and 142 (32%) were treated with multiple doses. Multivariable mixed effects logistic regression analysis showed that the odd of requiring multiple doses of surfactant was significantly lower in patients with higher gestational age (27-28 vs. 25-26 wks: OR 0.46, 95% C.l. 0.26-0.79; ≥29 vs. 25-26 wks: OR 0.34, 95% C.l. 0.13-0.85; overall P = 0.013), while it increased in infants born to mothers with hypertensive disorders of pregnancy (OR 2.53, 95% C.l. 1.49-4.31; P < 0.001) and with hemodynamically significant PDA (OR 2.74, 95% C.l. 1.66-4.53, P < 0.001)., Conclusions: Gestational age, hypertension in pregnancy, and hemodynamically significant PDA can predict the need for multiple doses of surfactant. Further investigation is needed to evaluate if these sub-groups of preterm infants represent specific phenotypes of RDS who deserve a peculiar surfactant treatment., Competing Interests: Declarations. Ethics approval and consent to participate: All studies used for pooled analyses were approved by pediatric ethics committees of Tuscany (ID 29/2011, ID 234/2019, and ID 58/2019, respectively) and carried out in accordance with the 1964 Declaration of Helsinki. Infants were enrolled after informed parental consent. Only data of infants who were treated with surfactant were analyzed. Local ethics committees approved the study. Parental consent was not required because this is a retrospective study and data were anonymized. Consent for publication: Not applicable. Competing interests: Prof. Carlo Dani received honoraria from Chiesi Farmaceutici SpA and Vyaire Medical Inc. for scientific consultancies. Other authors declare that there are no conflicts of interests. Prof. Carlo Dani and Dr. Raffaele Falsaperla are members of the Editorial Board of the Italian Journal of Pediatrics., (© 2024. The Author(s).)

Importance: Among preterm newborns undergoing resuscitation, delayed cord clamping for 60 seconds is associated with reduced mortality compared with early clamping. However, the effects of longer durations of cord clamping with respiratory support are unknown., Objective: To determine whether resuscitating preterm newborns while keeping the placental circulation intact and clamping the cord after a long delay would improve outcomes compared with umbilical cord milking., Design, Setting, and Participants: This randomized clinical trial (PCI Trial) was conducted at 8 Italian neonatal intensive care units from April 2016 through February 2023 and enrolled preterm newborns born between 23 weeks 0 days and 29 weeks 6 days of gestation from singleton pregnancies., Interventions: Enrolled newborns were randomly allocated to receive at-birth resuscitation with intact placental circulation for 180 seconds or umbilical cord milking followed by an early cord clamping (within 20 seconds of life)., Main Outcomes and Measures: The primary outcome was the composite end point of death, grade 3 to 4 intraventricular hemorrhage, and bronchopulmonary dysplasia at 36 weeks of postconception age. Prespecified secondary end points were the single components of the composite primary outcome. An intention-to-treat analysis was conducted., Results: Of 212 mother-newborn dyads who were randomized, 209 (median [IQR] gestational age, 27 [26-28] weeks; median [IQR] birth weight, 900 [700-1070] g) were enrolled in the intention-to-treat population; 105 were randomized to the placental circulation intact group, and 104 were randomized to the cord milking group. The composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 35 of 105 newborns (33%) in the placental circulation intact group vs 39 of 104 newborns (38%) in the cord milking group (odds ratio, 0.83; 95% CI, 0.47-1.47; P = .53)., Conclusions and Relevance: In a randomized clinical trial of preterm newborns at 23 to 29 weeks' gestational age, intact placental resuscitation for 3 minutes did not lower the composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia compared with umbilical cord milking., Trial Registration: Clinicaltrials.gov Identifier: NCT02671305.

Parents and caregivers may seek help with different questions or concerns on how to handle the diverse gender expressions of their children. Sometimes the issue may be evident while seeking medical advice for other concerns. Because of the many uncertainties around this topic, clinicians need to know what to say and what can be done to provide the best possible care for gender-diverse children., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

A novel synthetic procedure for the functionalisation of styrenic cross-linked polymers with perfluorinated acyl chains has been reported. The effective significant grafting of the fluorinated moieties is supported by { 1 H}- 13 C and { 19 F}- 13 C NMR characterisations. This kind of polymer appears promising as catalytic support for a variety of reactions requiring a highly lipophilic catalyst. Indeed, the improved lipophilicity of the materials resulted in enhanced catalytic properties of the corresponding sulfonic materials in the reaction of esterification of a solution in a vegetable oil of stearic acid with methanol.

Purpose: This longitudinal study examined how pre-intervention psychological health helps predict bariatric surgery (BS) success as percentage of expected body mass index loss (%EBMIL) over shorter to longer periods., Methods: Adult candidates for BS (N = 334, 67.4% females) completed the Symptoms Checklist 90 (SCL-90) questionnaire; on average, 11 months occurred between the pre-surgery psychological evaluations and the bariatric intervention. We explored the factor structure of the SCL-90 items and inspected how SCL-90 empirical factors compared with SCL-90 scales and general indices predicted %EBMIL at 3-6-month, 1-year, and 2-year follow-up occasions, adjusting for gender, pre-intervention use of antidepressants and actual and ideal BMIs., Results: Factor analysis combined the 90 items into 8 factors, which partially replicated the expected item structure. The SCL-90 empirical factors (but not the SCL-90 scales and indices) contributed to predict BS success. In fact, the Relational Distress factor directly protected from weight regain at 1-year follow-up, indirectly via 1-year %EBMIL at the 2-year follow-up, when it further strengthened the impact of the empirical factor of Generalized Anxiety on the 2-year BS outcome. The results also evidenced a cascade effect of the pre-surgery actual BMI across time as well as unique and direct effects of pre-surgery use of antidepressants and perceived ideal BMI on the 2-year outcome., Conclusions: SCL-90 empirical factor scores for obese patients are more efficient in anticipating BS success compared with original scale scores. They reveal that relational distress and anxiety are risk factors for postoperative weight loss, in addition to pre-intervention actual BMI, antidepressant therapy, and perceived ideal BMI., Level of Evidence: III, well-designed cohort., (© 2022. The Author(s).)