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Discharge planning of preterm infants and transition from the neonatologist to the primary care paediatrician are key components of family-centred Neonatal Intensive Care Unit care. Growth support and monitoring, feeding choices, management of gastroesophageal reflux, neurodevelopmental issues, clinical follow-up and monitoring at home, screening and recommended vaccinations are issues that the primary care paediatrician will face in caring for these children. Many of the problems extremely preterm infants face are not yet resolved at the time of hospital discharge and will require continued outpatient management by the neonatologist, primary care paediatrician and other members of the multidisciplinary team. Parents will need to participate in a comprehensive discharge planning programme tailored to their infant’s individual needs and family resources. This article discusses the main clinical problems that primary care paediatricians have to face from the day of discharge and the successive care of the preterm infant, which is often very challenging and delicate.

To evaluate whether in a historical cohort of preterm infants, body composition at term equivalent age (TEA) correlated with Bayley scores at 2 years of corrected age. Ninety-five preterm babies were admitted to our neonatal intensive unit and underwent air-displacement plethysmography assessment at TEA. Of these, 74 completed Bayley tests at 2 years. We used multiple linear regression analysis to assess the association of body composition with Bayley scores. Mean gestational age and birthweight of our population were respectively 29.8 (±2.2) weeks and 1150 (±330) grams. Higher fat-free mass (FFM) z-score was associated with higher language (adjusted r = 0.28, p = 0.03) and motor composite scores (adjusted r = 0.33, p = 0.03) in both univariate and multiple regression analysis including birth weight, sex, maternal university degree, mechanical ventilation, and bilingualism. In our study FFM at term equivalent age was associated with higher Bayley composite motor and language scores at 2 years.

After the SARS-CoV-2 pandemic, we noticed a marked increase in high-flow nasal cannula use for bronchiolitis. This study aims to report the percentage of children treated with high-flow nasal cannula (HFNC) in various seasons. The secondary outcomes were admissions for bronchiolitis, virological results, hospital burden, and NICU/PICU need. We conducted a retrospective study in four Italian hospitals, examining the medical records of all infants (p p Conclusion: This study shows a marked increase in respiratory support and intensive care admissions this last winter. While these severity indexes were all driven by medical choices, more reliable indexes such as intubation rate and length of stay did not change. Therefore, we suggest that there is a more aggressive treatment attitude rather than a more severe disease. What is Known:• COVID-19 pandemic deeply impacted bronchiolitis epidemiology, reducing hospitalizations to onetenth. In the 2021-2022 winter, bronchiolitis resurged to pre-pandemic numbers in Europe. What is New:• Bronchiolitis hospitalization rose much faster in the 2021-2022 winter period, peaking at a higher level. Respiratory supports and high-flow nasal cannula increased significantly compared to the pre-pandemic era.

A 33+1-week female baby was born by caesarean section for worsening hydrops fetalis (HF) detected in the third trimester of pregnancy. Prenatal ultrasound showed a moderate enlargement of the right heart sections with a mild tricuspid insufficiency, without tachycardia, polyhydramnios, placentamegaly, renal agenesis and oesophageal atresia. At delivery, she developed transient hypotonia and apnoea and received nasal continuous positive airway pressure. Physical examination showed tachypnoea (70 breaths/min) and a moderate generalised subcutaneous oedema. Chest X-ray showed a cardiothoracic index of 0.82. At 90 min of life, her heart rate was 200–250 per minute. An ECG showed a paroxysmal supraventricular tachycardia (PSVT) with narrow complexes (figure 1). Vagal manoeuvres and five boluses of adenosine (250 μg/kg/dose) were ineffective, but she responded to amiodarone. Echocardiography showed severe tricuspid insufficiency and dilated right cardiac chambers. The baby presented further transient PSVT episodes, but these gradually improved on amiodarone, hydrochlorothiazide, spironolactone and furosemide. A primitive tricuspid valvulopathy with heart failure secondary to PSVT was diagnosed. …

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Objective This study aimed to evaluate if adaptive responses of very preterm newborns to neonatal intensive care unit (NICU) daily nursing, specifically bathing and weighing procedures are associated with their neurodevelopment after 2 years. Study Design Twenty-six very preterm newborns, with a gestational age Results Significant (p Conclusion Very preterm newborn adaptive responses to NICU daily nursing reveal to be positively related to forthcoming neurodevelopment 2 years later, as early as the 30-week PMA. Helping preterm babies to adapt to daily NICU nursing may promote their future neurobehavior. Key Points

A male preterm infant was born at 36 weeks of gestational age by vaginal delivery after an uncomplicated monochorionic diamniotic twin pregnancy. He was the fourth child, and his neonatal weight was 2420 g. At birth, a downward right deviation of the mouth was noted during crying (figure 1), with no asymmetry at rest. No other asymmetric features were observed. His twin brother had an unremarkable physical examination. Figure 1 A newborn with asymmetric face due to congenital hypoplasia of the depressor anguli oris muscle. A full-term female infant was born to a primigravida mother by emergency caesarean section after unsuccessful attempts of vaginal delivery by means of vacuum extractor and forceps for mechanical dystocia. Neonatal weight was 3335 g. At birth, an asymmetric crying face was noted with downward deviation of the mouth on the right side (figure 2). The left eye remained persistently open, and the left side of the forehead and the …

A 15-day-old full-term newborn was admitted to the emergency department for right scrotal swelling, irritability and poor feeding that started 12 hours earlier, without fever or vomiting. Parents reported that his last defecation occurred 3 days before admission. Physical examination was remarkable for a swollen, erythematous and tender right hemiscrotum (figure 1). Figure 1 Erythema and swelling of the right hemiscrotum. Scrotal ultrasonography showed an inguinal hernia with an air-filled tubular structure that seemed somehow different from a typical intestinal loop; the plain radiography confirmed this finding. Emergency surgical exploration of the right groin …

A female neonate was born with asymmetric lower limbs, the right leg appearing enlarged, with thickened, reddish-purple skin and ectasic superficial reticulum (figure 1A,B). Limb pulses were present and symmetrical. The girl’s family history and prenatal scans were unremarkable. Laboratory findings were within the normal range, except for a mild thrombocytopenia (90 000/μL), which spontaneously resolved during the next few days. A leg X-ray and the Doppler analysis ruled out the presence of calcifications and venous varices, respectively. Ultrasound showed significant skin thickening, with marked dermal hypertrophy and hyperechogenicity. Magnetic resonance showed circumferential thickening of the derma, with mild hypertrophy of some perforating vessels (figure 2). A biopsy of the right thigh showed capillary malformations on histology.Figure 1(A, B) Hypertrophy of the right lower limb, with large capillary malformation extending to the gluteus and the external genitalia.Figure 2Axial THRIVE magnetic resonance scan of the thighs’ proximal third, showing circumferential dermal thickening and inhomogeneity of the right leg’s subcutaneous tissue.QuestionsBased on the clinical picture and investigations results, which is the most likely diagnosis?Beckwith-WiedemannCLOVES syndromeKlippel-Trenaunay syndromeKaposiform hemangioendotheliomaHow can the diagnosis be confirmed?CT with PETLymphoscintigraphyGenetic testingNone of the above, the diagnosis is clinicalWhat is the mainstay of management?Conservative with follow-upPharmacotherapySclerotherapySurgeryWhich of the following complications can occur?ScoliosisGlaucomaUrinary and gastrointestinal bleedingAll of the aboveAnswers can be found on page 02.

A case of Cutaneous Congenital Candidiasis (CCC) in a preterm newborn is described. The diagnostic and therapeutic implications of CCC are discussed.

ObjectiveTo evaluate the pattern of cortical activation during a painful procedure, such as a venipuncture, in children with intellectual disability and compare it with that of cognitively healthy children.Study design and settingA cohort study was conducted and cortical activation was assessed by multichannel cerebral near-infrared spectroscopy to monitor variations in oxyhaemoglobin and deoxyhaemoglobin (Hbb) in children with and without intellectual disability during a venipuncture for blood sampling with topical anaesthesia. Pain and distress were assessed as well using different validated pain scales (visual analogue scale and Non-Communicating Children’s Pain Checklist-Postoperative Version for children with intellectual disability), and compared between groups.Participants16 children with severe to profound intellectual disability and 20 cognitively healthy peers (age range: 4–17 years).ResultsWhen Hbb was analysed, children with intellectual disability exhibited a bilateral activation of the somatosensory (pConclusionsWhen subjected to a painful procedure, only children with intellectual disability show an activation of the cerebral cortex, even if topical anaesthesia is applied, and express more pain than cognitively healthy peers. The role of other issues in painful procedures, such as anxiety, fear or physical restraint, deserves further investigation.

A full-term male infant presented at birth with a hard swelling of the left knee. The lemon-sized lesion was fixed to the underlying knee muscles, while the overlying skin was stretched and shiny; there was no bruit. Radiography, sonography and MRI suggested a soft-tissue tumour. After surgical excision, histology showed the presence of fibrous and mesenchymal tissue, with mature adipose tissue. Fibrous hamartoma of infancy was diagnosed. Among soft-tissue tumours, fibrous hamartoma of infancy is a rare and benign lesion, occurring in the first 2 years of life. The tumour mainly affects the trunk, axilla, and upper extremities. This infant had unique involvement of the knee. The treatment of choice is local excision.