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To investigate whether the wide variation in the frequency of bronchopulmonary dysplasia (BPD) between hospitals is due to differences in delivery room intubation rates.Data on 1260 infants of birth weight1500 g and 23-31 weeks gestational age, born in 1999-2002 and surviving to 36 weeks, were collected; 196 (15.6%) developed BPD defined as oxygen need at 36 weeks postmenstrual age. Generalised estimating equations and conditional logistic models adjusting for centre, gestational age, propensity score for intubation, and other potential confounders were used.Rates of BPD, delivery room intubation and mechanical ventilation for24 h differed significantly between hospitals. Centres with high delivery room intubation rates had higher ventilation and BPD rates. Hospitals ventilating more often also did so for a longer time. Although delivery room intubation was associated with BPD in unadjusted analyses, neither delivery room intubation nor brief (24 h) mechanical ventilation were risk factors for BPD in multivariate analyses adjusting for gestational age, case mix and other pre- and perinatal factors, indicating no causal effect or unmeasured confounding. Significant risk factors for developing BPD were low gestational age, prolonged ventilation (24 h: adjusted OR (aOR) 2.4;7 days: aOR 14.9), male sex (aOR 1.7), being small for gestational age (SGA; aOR 4.3) and late-onset sepsis (aOR 2.2). After taking into account these variables/procedures, centre differences remained significant but explained only about 5% of variance.Differences in BPD frequency between hospitals are explained by differences in procedures, chiefly mechanical ventilation, rather than by differences in initial management or case mix. Delivery room intubation and brief mechanical ventilation did not increase BPD risk.

Background: The role of nasal continuous positive airways pressure (nCPAP) in the management of respiratory distress syndrome in preterm infants is not completely defined. Objective: To evaluate the benefits and risks of prophylactic nCPAP in infants of 28–31 weeks gestation. Design: Multicentre randomised controlled clinical trial. Setting: Seventeen Italian neonatal intensive care units. Patients: A total of 230 newborns of 28–31 weeks gestation, not intubated in the delivery room and without major malformations, were randomly assigned to prophylactic or rescue nCPAP. Interventions: Prophylactic nCPAP was started within 30 minutes of birth, irrespective of oxygen requirement and clinical status. Rescue nCPAP was started when FIO2 requirement was > 0.4, for more than 30 minutes, to maintain transcutaneous oxygen saturation between 93% and 96%. Exogenous surfactant was given when FIO2 requirement was > 0.4 in nCPAP in the presence of radiological signs of respiratory distress syndrome. Main outcome measures: Primary end point: need for exogenous surfactant. Secondary end points: need for mechanical ventilation and incidence of air leaks. Results: Surfactant was needed by 22.6% in the prophylaxis group and 21.7% in the rescue group. Mechanical ventilation was required by 12.2% in both the prophylaxis and rescue group. The incidence of air leaks was 2.6% in both groups. More than 80% of both groups had received prenatal steroids. Conclusions: In newborns of 28–31 weeks gestation, there is no greater benefit in giving prophylactic nCPAP than in starting nCPAP when the oxygen requirement increases to a FIO2 > 0.4.

The project "Biodiversity MARE Tricase" aims to research and promote coastal and marine biodiversity at the MARE Outpost (Avamposto MARE), a marine station established in Tricase (Lecce, Italy) in 2015. From March 2016 to September 2017, the first biodiversity inventory of the Tricase coastal area (Ionian Sea) was realized with the aid of citizen scientists (e.g. local fishermen, divers, bathers, and tourists). Preliminary results include 556 taxa, of which the 95% were identified at the species level. Despite the broad knowledge on Mediterranean coastal biodiversity, 71 species represented new records for the Ionian Sea. In parallel with the research activities, people's awareness of the value of biodiversity was raised with scientific dissemination initiatives, involving about 1700 people. The "Biodiversity MARE Tricase" project realized a first small-scale species inventory contributing to the distributional, taxonomic, and ecological knowledge of the present Mediterranean biota. The coastal area of Tricase will be soon included in a new Marine Protected Area and this project represents a step forward for the sustainable development of the community of this coast.