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Background: Gestational diabetes mellitus (GDM) affects roughly 14% of pregnancies, its prevalence is increasing, and it is associated with a significant risk of complications for both mother and offspring. A high proportion of women with GDM can be detected early in pregnancy. In Italy, early GDM screening occurs in a selective way, as it is performed only in the presence of important risk factors. It remains to be elucidated not only how and when to diagnose early GDM but especially whether to treat it. This study aimed to compare the characteristics and complications of early vs late GDM as assessed and treated in a real-world setting, according to the Italian guidelines of the Istituto Superiore di Sanità., Methods: We conducted a retrospective cohort study in women with GDM delivering singletons between 2017 and 2021., Results: Women with early GDM had higher BMI and a higher proportion of Middle Eastern or African women. Early GDM was independently associated with the use of insulin (p < 0.001). It required also higher doses of insulin, possibly due to the higher BMI. Early GDM was also independently associated with higher post-prandial (after dinner) glucose levels during the 3° trimester (p = 0.04). Nevertheless, early GDM women achieved glucose targets and put on less weight during gestation. Early GDM was independently associated with preeclampsia (p = 0.05). Otherwise, there were no other differences between early and late GDM in terms of pregnancy complications. After delivery, early GDM was independently associated with abnormal glucose tolerance., Conclusions: Early GDM women exhibited more severe GDM features. However, after achieving recommended glucose and body weight targets, there were no substantial differences between early and late GDM in terms of pregnancy complications apart from preeclampsia. These data support diagnosis and treatment of women with early GDM., Competing Interests: Declarations Conflict of interest All the authors have no conflict of interests. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The protocol was approved by the Institutional Review Board of the Comitato Etico Univo Regionale FVG (CEUR-2019-SPER-113). Informed consent Informed consent was obtained from all subjects involved in this study., (© 2024. Springer-Verlag Italia S.r.l., part of Springer Nature.)

Tele-support in breastfeeding can be defined as any support provided by a service that connects health workers and/or lactation consultants with breastfeeding parents through video visits, although a telephone contact with the breastfeeding mother remains the first method of remote breastfeeding support. The tele-support in breastfeeding has increased significantly during the SARS-CoV2 pandemic worldwide and, given its effectiveness, may be maintained also after the pandemic. The Italian Society of Neonatology on the basis of: 1) two focus group studies on the tele-support in breastfeeding conducted in Italy with 11 Neonatal Intensive Care Unit nurses and 10 neonatologists, respectively, 2) a national survey on tele-support in breastfeeding addressing the Italian Neonatal Intensive Care Units, and 3) a review of the available experiences and literature, has provided a Position Statement, limitedly to the individual tele-support in breastfeeding. The Italian Society of Neonatology states that: 1) the tele-support in breastfeeding can be used when a consultation in person is not shortly available and may allow to select those situations that require an in-person visit; 2) the organization of a tele-support in breastfeeding session requires the use of a competent, dedicated healthcare staff (specifically trained and/or with adequate experience) and an appropriate methodology while preparing, running and concluding the support session. According to Italian Society of Neonatology the tele-support in breastfeeding may be an effective intervention to promote breastfeeding as a complementary method to the in-person assistance and should be possibly provided in an integrated manner by the Community Health Services and the Maternity Hospital., (© 2024. The Author(s).)

Background: Hemoglobinopathies are the commonest genetic defect worldwide (7% of the world's population has at least one hemoglobin mutation). Although prenatal screening for hemoglobinopathies is not obligatory during pregnancy in Italy, it is offered to women by the Italian National Health Service in the pre-conception phase. The screening of newborns is a valid alternative, and has been adopted in various European countries, albeit in a piecemeal fashion. Neonatal screening has the advantage of providing early diagnosis of a hemoglobinopathy. Here we report the findings from the experience with neonatal screening in Friuli-Venezia Giulia since 2010., Materials and Methods: The hemoglobinopathy screening project in Friuli-Venezia Giulia, a Region in north Italy, began in November 2010. High-performance liquid chromatography was performed on dried blood spot samples collected by obstetric nurses from neonates within 5-8 days after birth., Results: From 2010 to 2019, 11,956 newborns were screened, and abnormal hemoglobin was found in 519 of them (4.34%): the variants identified included HbS, HbC, HbD, HbE and HbX. More specifically, the HbS variant was observed in 347 (2.9%) newborns and the homozygous pattern was identified in 24 (0.2%) cases. The screening also detected two cases of β-thalassemia major., Discussion: We report our experience of 10 years of screening newborns for hemoglobinopathies in the Region of Friuli-Venezia Giulia, in which 7.7% of people come from malaria-endemic areas. Increased mobility and migratory flows bringing in hemoglobinopathy carriers from endemic areas have led to an increase in mutations in non-malarial countries, with a current incidence of around 4% in the newborns we tested. This means that hemoglobinopathies can be described as a rare condition. Our data show that incidence rates are comparable to those of other inherited disorders such as phenylketonuria, thereby justifying the inclusion of the test for hemoglobinopathies into screening programs for rare diseases.

Introduction: Breastfeeding is a fundamental biological function in mammals, allowing the progeny to develop in a physiological way. A physical and emotional dialog between mothers and offspring during breastfeeding has been described as part of the attachment relationship, and a synchronicity between maternal and neonatal brains can be hypothesized. This study aimed to assess if neonatal and maternal cortical areas activated during breastfeeding are functionally synchronized since the second day of life. Materials and Methods: Twenty mothers and their term newborns were enrolled. Cortical activation during breastfeeding was identified by multichannel near-infrared spectroscopy, which detects changes in haemoglobin concentration from multiple cortical regions. Functional activity was simultaneously detected (hyperscanning) in mothers and newborns' frontal and motor/primary somatosensory cortical areas during the first 5 minutes of breastfeeding. Cluster analysis and Student's t test were used to detect oxygenated haemoglobin increase, as cortical activation estimate. Wavelet transform coherence (WTC) analysis was used to identify a possible synchronization between maternal and neonatal activated cortical regions. Results: Mothers showed an activation of the central motor/primary somatosensory cortex, above the sagittal fissure. In newborns, the bilateral frontal cortex was activated. WTC analysis revealed two different cyclical synchronizations between mothers and infants' activated cortical regions. Conclusions: Such evidence may reflect a very early common sharing of experiences, possibly associated with reciprocal dynamic motor adjustments, hormonal coregulation, and somatic stimulations and sensations. The observed cyclical neural synchronization, between the mother and her newborn's cortex during breastfeeding, may play an important role in promoting their bonding.

Background: Studies comparing the frequency of different mental health conditions across different settings and evaluating their association with parental participation in newborn care are lacking. We aimed at evaluating the frequency of parental stress, anxiety and depression, along with the level of participation in newborn care, among parents of newborns in Italy, Brazil and Tanzania., Methods: Parental stress, anxiety, depression and participation in care were assessed prospectively in parents of newborns in eight neonatal intensive care units (NICUs) utilising: the Parental Stressor Scale in NICU (PSS:NICU); the Edinburgh Postnatal Depression Scale (EPDS) and EPDS-Anxiety subscale (EPDS-A); the Index of Parental Participation in NICU (IPP-NICU). Univariate and multivariate analyses were conducted., Results: Study outcomes were assessed on 742 parents (Brazil=327, Italy=191, Tanzania=224). Observed scores suggested a very high frequency of stress, anxiety and depression, with an overall estimated frequency of any of the mental health condition of 65.1%, 52.9% and 58.0% in Brazil, Italy, Tanzania, respectively (p<0.001). EPDS scores indicating depression (cut-off: ≥13 for Brazil and Tanzania, ≥12 for Italy) were significantly more frequent in Tanzania (52.3%) when compared with either Brazil (35.8%) and Italy (33.3%) (p<0.001). Parental participation in care was also significantly higher in Tanzania (median IPP-NICU=24) than in the other two countries (median=21 for Brazil, 18 for Italy, p<0.001). Severe stress (PSS:NICU ≥4) was significantly more frequently reported in Brazil (22.6%), compared with Italy (4.7%) and Tanzania (0%, p<0.001). Factors independently associated with either parental stress, anxiety or depression varied by country, and a significant association with parental participation in care was lacking., Conclusions: Study findings suggest that parental stress, anxiety and depression are extremely frequent in NICUs in all countries despite diversity in the setting, and requiring immediate action. Further studies should explore the appropriate level of parental participation in care in different settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This study aimed at documenting the levels of stress, depression, anxiety and participation in care among mothers versus fathers of newborns hospitalised in a third-level neonatal intensive care unit (NICU) in Northern Italy., Methods: Parental stress, depression and anxiety were assessed by the Parental Stressor Scale in NICU (PSS:NICU), the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Participation in care was evaluated with the Index of Parental Participation. Differences between mothers and fathers were assessed with the Mood's median test and z-test, respectively for continuous and discrete variables. Multivariate analyses controlling for potential confounders were performed to confirm gender differences., Results: 191 parents (112 mothers and 79 fathers) were enrolled. Mothers reported significantly higher median scores for stress (2.9 vs 2.2, p<0.001) and trait anxiety (37 vs 32, p=0.004) and higher depression rates (EPDS ≥12: 43.8% vs 19.0%, p<0.001). 'High stress' (PSS:NICU ≥3) was reported by 45.5% of mothers compared with 24.1% of fathers (p=0.004). The frequency of the three conditions simultaneously was significantly higher among mothers (20.0% vs 3.8%, p=0.016), with the vast majority of mothers (76.0%) suffering from at least one condition compared with less than half of fathers (45.3%, p<0.001). Participation in care was more frequent in mothers (median score: 19 vs 15, p<0.001), with the exception of activities related to advocacy (median 5 vs 4, p=0.053). In a multivariate analysis, gender differences in mental health outcomes did not change., Conclusions: Routine screening of mental distress among parents of infants in NICU is warranted, and gender differences need to be acknowledged in order to deliver tailored support and to promote collaboration with the family of vulnerable newborns. Knowledge and skills on how to prevent and cope with mental distress of parents should be part of the core curriculum of staff working in NICU., Competing Interests: Competing interests: No, there are no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In this article we reconsider Homer's poetry in the light of modern achievements in neuroscience. This perspective offers some clues for examining specific patterns of brain functioning. Homer's epics, for instance, painted a synthetic picture of the human body, emphasizing some parts and neglecting others. This led to the formation of a body schema reminiscent of a homunculus, which we call the "Homeric homunculus." Both poems were largely the product of centuries of oral tradition, in which the prodigious memory of courtly rhapsodists was essential to the performance of the epics. The underlying cognitive functions required a close interplay of memory and language skills, supported by the musical and rhythmic cadence of Homeric verse., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The availability of an appropriate newborn feeding policy is an essential component of the promotion of breastfeeding in health facilities. The Italian Society of Neonatology (SIN) and the Italian Society of Paediatrics (SIP) have run an online survey among Maternity Hospitals to explore the existing breastfeeding policies and their characteristics., Methods: Between February and April 2023, an online survey was carried out among 110 Italian maternity hospitals with a Neonatal Intensive Care Unit (NICU)., Results: Forty-nine Maternity Hospitals completed the online questionnaire. Twenty out of 49 (40.8%) reported to have a breastfeeding policy. When a policy is available, its quality appears to be suboptimal because of lack of inclusion of a family representative in the policy working group, limited options for translating breastfeeding policy into minority languages, lack of periodic assessment of their implementation., Conclusion: Currently, only a limited number of Italian Maternity Hospitals have developed a breastfeeding policy. Additional efforts are needed for their improvement as well as implementation., (© 2024. The Author(s).)

Objective: The septum pellucidum is a virtual cavity located at the anterior part of the brain midline, which only in fetal life has a certain amount of fluid inside. The presence of an obliterated cavum septi pellucidi (oCSP) in the prenatal period is poorly described in the literature but, nevertheless, it constitutes an important clinical dilemma for the fetal medicine specialist in terms of significance and prognosis. Moreover, its occurrence is increasing maybe because of the widespread of high-resolution ultrasound machine. The aim of this work is to review the available literature regarding the oCSP along with the description of a case-report of oCSP with an unexpected outcome., Methods: A search of the literature through Pubmed was performed up to December 2022 with the aim to identify all cases of oCSP previously described, using as keywords "cavum septi pellucidi," "abnormal cavum septi pellucidi," "fetus," and "septum pellucidum." Along with the narrative review, we describe a case-report of oCSP., Results: A 39 years old woman was diagnosed with a nuchal translucency between the 95° and 99° centile in the first trimester and an oCSP and "hookshaped" gallbladder at 20 weeks. Left polymicrogyria was found at fetal magnetic resonance imaging (MRI). Standard karyotype and chromosomal microarray analysis (CMA) were normal. After birth, the newborn presented signs of severe acidosis, untreatable seizures and multiorgan failure leading to death. A targeted gene analysis of the epilepsy panel revealed the presence of a de novo pathogenic variant involving the PTEN gene. The literature review identified four articles reporting on the oCSP of which three were case report and one was a case-series. The reported rate of associated cerebral findings is around 20% and the rate of adverse neurological outcome is around 6%, which is higher than the background risk of the general population., Conclusions: This case-report and review of the literature shows that oCSP is a clinical entity poorly described so far and that, despite the generally good prognosis, it requires caution in counseling. The diagnostic work-up should include neurosonography while fetal MRI may be always indicated for non-isolated cases only, depending on local facilities. Targeted gene analysis or whole exome sequencing may be indicated for non-isolated cases.

Objectives: The primary outcomes of this study were to evaluate the diameters of the inferior vena cava (IVC) in a cohort of newborns and the correlation between newborn weight and IVC diameter. The secondary outcome was to evaluate the concordance between the measurements performed by the two investigators., Methods: Two blind examiners performed an ultrasonographic (US) evaluation of the IVC diameter in neonates with a weight ranging from 2 to 4 kg. The exclusion criteria included hemodynamic instability, known vascular malformations, and major congenital malformations., Results: A total of 143 neonates were enrolled between June 2019 and January 2021. All the US examinations were performed in the first 3 days of life. After dividing the patients into two groups according to their weight at the time of examination (2.0-2.99 kg and 3.0-4.0 kg), the median IVC diameters measured by examiner 1 were 3.1 mm (interquartile range 2.8-3.4) and 3.4 mm (interquartile range 2.9-3.8) ( p  = 0.003) for the two groups, respectively. The median IVC diameters measured by examiner 2 were 3.1 mm (interquartile range 2.6-3.3) and 3.3 mm (interquartile range 2.8-3.8) ( p  = 0.004) for the two groups, respectively. The intraclass correlation coefficient was 0.93 (95% CI: 0.90-0.95)., Conclusion: The IVC diameter values varied widely from 1.2 to 5.2 mm in newborns weighing 2-4 kg, and a low correlation between newborn weight and IVC diameter was found, so measuring IVC diameter may be a recommended step prior to inserting a umbilical venous catheter (UVC). The concordance between operators was good. We contemplated that the IVC diameter could be a potentially useful tool to identify the most appropriate UVC, thus reducing the risk of catheter-related thrombosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Galdo, Trappan, Cossovel, Rodriguez-Perez, Ronfani, Montaldo, Bibalo, Travan and Risso.)

Background: Beckwith-Wiedemann syndrome (BWS, OMIM #130,650) is a pediatric overgrowth disorder involving a predisposition to tumor development. Although the clinical management of affected patients is well established, it is less clear how to handle with the cases of siblings of affected patients, since the prevalence of the condition in twins (1:1000) is ten times higher than in singletones (1:10000)., Case Presentation: We report the case of a premature twin patient who during her follow-up develops a clinical phenotype compatible with BWS, genetically confirmed in blood. However, the methylation alteration characteristic of the condition was also found in the almost phenotypically normal sibling, making it challening her management., Conclusion: Through our case report we highlight how the diagnosis of BWS can be made without any prenatal suspicion and we propose a review of the literature on how to manage siblings of affected patients in twinning situation., (© 2023. Società Italiana di Pediatria.)

Aim: This study aimed to assess the functional activation of preterm newborns' cerebral cortex during kangaroo mother care. Possible effects of gestational age and previous kangaroo mother care experience were also considered., Methods: Fifteen preterm newborns were recruited (gestational age: 24-32 weeks). Cortical activation was assessed in frontal, motor and primary somatosensory cortices after 15 and 30 min of kangaroo mother care by multichannel near-infrared spectroscopy (gestational age at assessment: 30-36 weeks). Both oxy- and deoxy-haemoglobin variations were analysed by t-test. Possible effects of gestational age and previous kangaroo mother care experience on cortical activation were studied by regression analysis., Results: After 15 min, bilateral activations (oxy-haemoglobin increase) were observed in frontal, somatosensory and motor cortices. After 30 min, the right motor and primary somatosensory cortices were found activated. Deoxy-haemoglobin increased after 15 min, returning to baseline at 30 min. After 15 min, there was a positive effect of gestational age at the assessment on both haemoglobin concentrations and a negative effect of previous kangaroo mother care on deoxy-haemoglobin increase., Conclusion: Motor and somatosensory cortices, particularly on the right side, showed significant activation during kangaroo mother care. Kangaroo mother care seems to benefit activated cortical areas by improving oxygen supply., (© 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Background: Extrauterine growth restriction (EUGR) is common among very low birth weight (VLBW) infants and associated with poor neurodevelopmental outcomes. There are two types of EUGR definitions (cross-sectional and longitudinal) and many growth charts for monitoring postnatal growth. Aims of our study were 1) to compare the rate of small for gestational rate (SGA) and EUGR in a population of VLBW infants, both according to different growth charts (Fenton, INeS charts and Intergrowth-21) and different definitions; 2) to identify risk factors for EUGR., Methods: This is a single centre retrospective observational study, including all VLBW infants born between January 2009 and December 2018. Anthropometric measures were obtained at birth and at discharge and presented as z-scores according to three growth charts (Fenton, INeS charts, Intergrowth-21). Maternal, clinical and nutritional data were retrieved from clinical records., Results: 228 VLBW were included. Percentage of SGA did not change significantly according to the three different growth charts (Fenton 22.4%, INeS charts 22.8%, Intergrowth 28.2%, p 0.27). Prevalence of EUGR was significantly higher when INeS and Fenton charts were used, compared to Intergrowth charts regardless of EUGR-definition (cross sectional-EUGR: Fenton 33.5%, INeS charts 40.9%, Intergrowth-21 23.8%, p 0.001; longitudinal-EUGR (loss of 1SDS): Fenton 15%, INeS charts 20.4%, Intergrowth 4%, p <0.001). In our population a longer time to reach 100 ml/kg/day of enteral feeding increased of 18% the risk of longitudinal EUGR. Late onset sepsis and retinopathy of prematurity were associated with an increased risk of longitudinal EUGR, although not significantly, while having a preeclamptic mother was associated with a reduced risk., Conclusions: We confirmed a wide variability of EUGR rates when using different charts and definitions, highlighting that Intergrowth-21 charts identify less EUGR when compared to INeS and Fenton charts. Standardized criteria for defining EUGR are warranted in order to facilitate comparisons between studies and to improve the nutritional management of VLBW infants., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Starc et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: There is increasing concern that infants with mild hypoxic-ischaemic encephalopathy (HIE) may develop seizures and progress to moderate HIE beyond the therapeutic window for cooling., Objective: The aim of this study was to examine the effect of therapeutic hypothermia on magnetic resonance imaging (MRI) biomarkers and neurological outcomes in infants with mild HIE and seizures within 24 h after birth., Methods: This study shows an observational cohort study on 366 (near)-term infants with mild HIE and normal amplitude-integrated electroencephalography background., Results: Forty-one infants showed progression (11.2%); 29/41 (70.7%) were cooled. Infants with progression showed cerebral metabolite perturbations and higher white matter injury scores compared to those without in both cooled and non-cooled groups (p = 0.001, p = 0.02). Abnormal outcomes were seen in 5/12 (42%) non-cooled and 7/29 (24%) cooled infants with progression (p = 0.26)., Conclusions: Early biomarkers are needed to identify infants with mild HIE at risk of progression. Mild HIE infants with progression showed a higher incidence of brain injury and abnormal outcomes., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Background: Collyrium administration is a common procedure in the neonatal ward, both in preterm and at term babies. Various molecules are used to induce mydriasis and cycloplegia: among them, phenylephrine and tropicamide are the most popular, and their administration is generally considered safe., Case Presentation: A 35 + 2 weeks-old, 2510 g, well-appearing male newborn required an ophthalmologic evaluation after a doubtful red reflex test. A collyrium with 1% phenylephrine and 0.95% tropicamide was administered prior to the consult, one drop per eye. Two minutes after the administration, the baby developed a severe apnea that required tactile stimulation. Moreover, the area around his eyes became visibly pale. Three minutes later, the baby became severely bradycardic (59 bpm), but remained in good general condition, so that resuscitation maneuvers were not required. Bradycardia lasted for almost three hours and then gradually resolved., Conclusions: Cardiopulmonary manifestations, such as bradycardia and even cardiopulmonary arrest, are severe complications that can happen after phenylephrine collyrium administration in preterm newborns. However, they have been described in babies below 1500 g or with concurrent respiratory manifestations. Our patient, on the other hand, was late preterm, and never required a ventilatory support prior to the collyrium administration. Practitioners who deal with premature babies, even if late preterm, must be aware of these possible complications and administer phenylephrine collyrium carefully, where cardiopulmonary resuscitation equipment and personnel are available., (© 2022. The Author(s).)

Background: Loeys-Dietz syndrome (LDS) is a rare connective tissue disorder characterized by cardiovascular manifestations, especially aortic dilatations and arterial tortuosity, craniofacial and skeletal features, joint laxity or contractures, skin abnormalities, hypotonia and motor delay. Its diagnosis is established by the identification of a pathogenic variant in TGFBR1, TGFBR2, SMAD2, SMAD3, TGFB2 or TGFB3 genes. In newborns and toddlers, vascular complications such as aneurism rupture, aortic dissection, and intracerebral incidents, can occur already in the weeks of life. To avoid these events, it is crucial to precociously identify this condition and to start an apunderwent a surgical procedurepropriate treatment which, depending on the severity of the vascular involvement, might be medical or surgical., Case Presentation: We report two cases of Loeys-Dietz syndrome precociously diagnosed. The first describes a male, born at 38 + 1 weeks of gestation, with hypotonia, joint hypermobility, arachnodactyly, and fingers joint contractures, as well as senile appearance and facial dysmorphisms. In the suspect of a connective tissue disorder, an echocardiography was performed and revealed an aortic root dilatation of 13 mm (Z score + 3). A trio based Whole Exome Sequencing found a novel de novo variant in the TGFBR2 gene. Despite the onset of a low-dose angiotensin receptor blocker therapy, the aneurysm progressed. The second case describes a female, born at 41 + 3 weeks of gestation. During the neonatal examination a cleft palate was noticed, as well as minor dysmorphisms. Since the family history was suspicious for connective tissue disorders, a genetic panel was performed and identified a pathogenetic variant in TGFB3 gene. In this case, the echocardiography revealed no abnormalities., Conclusions: In addition to our cases, we identified 14 subjects with neonatal LDS in the medical literature. All of them had aortic involvement. Skeletal and face abnormalities, including eyes and palate malformations, were also highly frequent. Overall, 10 subjects required medical therapy to avoid aneurysm progression, and 8 patients underwent surgical procedures. Benefits of an early diagnosis of LDS are various and imply a potential modification of the natural history of the disease with early interventions on its complications., (© 2022. The Author(s).)

Objectives: To investigate the umbilical vein and uterine arteries blood flow volume (UV-Q, UtA-Q) in late-term pregnancies., Study Design: This was a prospective observational cohort study of singleton pregnancies ≥40 + 0 weeks in which UV-Q and UtA-Q, both absolute and normalized for estimated fetal weight (EFW) values, were evaluated in relation to AC drop of ≥20 percentiles from 20 weeks to term, Doppler signs of fetal cerebral blood flow redistribution and composite adverse perinatal outcome. The presence of neonatal hypoglycaemia and the need of formula milk supplementation were also examined., Results: The study population comprised 200 women. Fetuses with AC drop (n = 34) had a significantly lower UV-Q and UV-Q/EFW than fetuses without AC drop (n = 166): median UV-Q 184 ml/min (IQR 143-225) vs 233 ml/min (IQR 181-277), p = 0.0006; median UV-Q/EFW 55 ml/min/kg (IQR 42-66) vs 63 ml/min/kg (IQR 48-74), p = 0.03. Fetuses with cerebral blood flow redistribution (n = 48) had a significantly lower UV-Q and UV-Q/EFW than those without (n = 134): median UV-Q 210 ml/min (IQR 155-263) vs 236 ml/min (IQR 184-278), p = 0.04; median UV-Q/EFV 58 ml/min/kg (IQR 45-70) vs 65 ml/min/kg (IQR 50-76), p = 0.04. There was a significant moderate correlation between middle cerebral artery pulsatility index (MCA-PI) and UV-Q and UV-Q/EFW (Spearman Rho -0.20 and -0.20; p = 0.008 and p = 0.006)., Conclusions: The umbilical vein blood flow volume might have a potential role to identify fetuses with stunted growth in late-term pregnancies., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The bony components of the craniovertebral junction (CVJ) have been investigated in 172 skeletons, dug up from several archaeological sites, to define the frequency of developmental dysmorphisms, and to acquire qualitative and quantitative data about their morphology. A review of the pertinent literature is also presented. Twenty-five individuals (14.5%) exhibited at least one dysmorphism, which ranged from a condition of simple variant to a true malformation. Four individuals presented two or more anomalies at the same time (2.3% of the whole sample, 16% of the affected individuals). The most frequently observed abnormalities were: (i) the presence of a complete bony bridge in the atlas, forming a canal surrounding the vertebral artery (arcuate foramen, supertransverse foramen, and the simultaneous occurrence of arcuate foramen and supertransverse foramen); (ii) the presence of basilar processes. Basilar processes displayed a great variety in shape and dimension. They also differed with respect to their relationship with atlas and axis. The less frequently detected anomalies were: (i) complete absence of the posterior arch of C1, (ii) fusion of C2 and C3, and (iii) irregular segmentation of C2. A broad array of structural defects has been described at the CVJ. They may occur either isolated or as part of complex multisystem syndromes. Although harmless in many cases, they can notwithstanding cause severe, even life-threatening complications. When unrecognized, they may generate trouble during surgery. Hence, accurate knowledge of CVJ arrangement, including its multifarious variations, is a critical issue for radiologists, clinicians, surgeons, and chiropractors., (© 2021. The Author(s), under exclusive licence to Japanese Association of Anatomists.)

Early neonatal relation with the caregiver is vital for newborn survival and for the promotion of an appropriate neural development. The aim of this study was to assess if the empathic cortical response of a mother to her baby's pain is synchronized with the neonatal cortical response to the painful stimulation. We used hyperscanning, a functional neuroimaging approach that allows studying functional synchronization between two brains. Sixteen mother-newborn dyads were recruited. Maternal and neonatal cortical activities were simultaneously monitored, by near-infrared spectroscopy, during a heel prick performed on the baby and observed by the mother. Multiple paired t test was used to identify cortical activation, and wavelet transform coherence method was used to explore possible synchronization between the maternal and neonatal cortical areas. Activations were observed in mother's parietal cortex, bilaterally, and in newborn's superior motor/somatosensory cortex. The main functional synchronization analysis showed that mother's left parietal cortex activity cross-correlated with that of her newborn's superior motor/somatosensory cortex. Such synchronization dynamically changed throughout assessment, becoming positively cross-correlated only after the leading role in synchronizing cortical activities was taken up by the newborn. Thus, maternal empathic cortical response to baby pain was guided by and synchronized to the newborn's cortical response to pain. We conclude that, in case of potential danger for the infant, brain areas involved in mother-newborn relationship appear to be already co-regulated at birth., (© 2022 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Background: Problem-Based Learning (PBL) is extensively used in pre- and post-graduate teaching programmes. However, it has been seldom used for in-service training and continuing medical education. We aimed to develop a PBL curriculum for a short in-service training on breastfeeding for maternal and child health professionals, and to assess the effect of these courses on their knowledge and skills. Also, the project aimed at increasing exclusive breastfeeding rates and duration in an Italian region., Methods: After initial training on PBL and an assessment of the learning needs of about 400 health professionals, a small working group developed learning objectives, designed a curriculum, produced manuals, and shaped assessment tools for a new PBL course on breastfeeding. The field test of the new course allowed selection of the tutors for the scaling up of the training to the whole region. During this extension phase, participants were asked to complete an evaluation questionnaire. In addition, the health professionals who attended the PBL courses in 2019 were asked to complete an online survey to assess knowledge, attitudes and practices (KAP) just before, soon after the course, and 4-6 months later., Results: The new 29 - hour PBL course, to be delivered in four days over four consecutive weeks, gives priority to tutorial groups and practical activities (71% of the total time). Supervised clinical practices absorb 16% of time. Ethics, communication and woman-centred clinical management content run throughout the four days and all activities. The three manuals, for tutors, participants and practical activities, facilitate the tasks and performance of tutors and participants. After the field test, 32 regional tutors ran courses for 562 health professionals. The analysis of the evaluation showed a high level of satisfaction for perceived effectiveness, relevance to practice, and educational quality. The KAP questionnaires indicated a general improvement after the course and retention after 4-6 months., Conclusions: Despite some predictable shortcomings, this new PBL approach for short in-service training courses on breastfeeding showed encouraging results as far as participants' satisfaction and KAP are concerned. The possible effects on rates and duration of exclusive breastfeeding need further research., (© 2021. The Author(s).)

Background: Recent studies reported, during the COVID-19 pandemic, increased mental distress among the general population and among women around the childbirth period. COVID-19 pandemic may undermine the vulnerable well-being of parents in Neonatal Intensive Care Units (NICUs). Objective: Our study aimed to explore whether parental stress, depression, and participation in care in an Italian NICU changed significantly over three periods: pre-pandemic (T 0 ), low (T 1 ), and high COVID-19 incidence (T 2 ). Methods: Enrolled parents were assessed with the Parental Stressor Scale in the NICU (PSS:NICU), Edinburgh Postnatal Depression Scale (EPDS), and Index of Parental Participation (IPP). Stress was the study primary outcome. A sample of 108 parents, 34 for each time period, was estimated to be adequate to detect a difference in PSS:NICU stress occurrence level score (SOL) of 1.25 points between time periods. To estimate score differences among the three study periods a non-parametric analysis was performed. Correlation among scores was assessed with Spearman rank coefficient. Results: Overall, 152 parents were included in the study (62 in T 0 , 56 in T 1 , and 34 in T 2 ). No significant differences in the median PSS:NICU, EPDS, and IPP scores were observed over the three periods, except for a slight increase in the PSS:NICU parental role sub-score in T 2 (T 0 3.3 [2.3-4.1] vs. T 2 3.9 [3.1-4.3]; p = 0.038). In particular, the question regarding the separation from the infant resulted the most stressful aspect during T 2 (T 0 4.0 [4.0-5.0] vs. T 2 5.0 [4.0-5.0], p = 0.008). The correlation between participation and stress scores ( r = 0.19-022), and between participation and depression scores ( r = 0.27) were weak, while among depression and stress, a moderate positive correlation was found ( r = 0.45-0.48). Conclusions: This study suggests that parental stress and depression may be contained during the COVID-19 pandemic, while participation may be ensured., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bua, Mariani, Girardelli, Tomadin, Tripani, Travan and Lazzerini.)

Late fetal growth restriction has increasingly gain interest. Differently from early fetal growth restriction, the severity of this condition and the impact on perinatal mortality and morbidity is less severe. Nevertheless, there is some evidence to suggest that fetuses exposed to growth restriction late in pregnancy are at increased risk of neurological dysfunction and behavioral impairment. The aim of our review was to discuss the available evidence on the neurodevelopmental outcome in fetuses exposed to growth restriction late in pregnancy. Cerebral blood flow redistribution, a Doppler hallmark of late fetal growth restriction, has been associated with this increased risk, although there are still some controversies. Currently, most of the available studies are heterogeneous and do not distinguish between early and late fetal growth restriction when evaluating the long-term outcome, thus, making the correlation between late fetal growth restriction and neurological dysfunction difficult to interpret. The available evidence suggests that fetuses exposed to late growth restriction are at increased risk of neurological dysfunction and behavioral impairment. The presence of the cerebral blood flow redistribution seems to be associated with adverse neurodevelopmental outcome, however, from the present literature the causality cannot be ascertained.

Objective: 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., Study Design: 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., Results: 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., Conclusions: In our study FFM at term equivalent age was associated with higher Bayley composite motor and language scores at 2 years., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Competing Interests: Competing interests: None declared.

Aim: To compare body composition (BC) of premature infants at parenteral nutrition (PN) suspension and at term equivalent age (TEA)., Methods: Body weight, fat mass (FM), fat free mass (FFM) and FM as % of body weight were measured in infants born at <32 gestational weeks by air-displacement plethysmography at PN suspension and at TEA in a tertiary level hospital. Z-scores were calculated for BC and anthropometric measurements. Nutritional and clinical data were obtained during hospital stay. BC, weight and length were measured at birth in a sample of infants born at term for comparison., Results: Thirty premature infants with birth weight of 1198 ± 270 g and gestational age of 29.8 ± 1.8 weeks were included. At PN suspension, at 32.6 ± 1.6 postconceptional weeks, FFM z-score was similar to FFM z-score measured at TEA, at 39.8 ± 0.7 postconceptional weeks (-1.43 ± 1.27 vs -1.78 ± 1.64, p = 0.26), while FM z-score and %FM z-score at PN suspension were lower than those measured at TEA (FM z-score: 0.23 ± 0.62 versus 2.04 ± 1.00, p < 0.0001 and %FM z-score: 0.66 ± 0.76 versus 2.08 ± 1.07, p < 0.0001). At TEA, weight and length of premature infants were similar to those of term-born infants (3130 ± 340 g vs 3350 ± 340 g; 49.2 ± 2.4 cm vs 50.2 ± 2.5 cm, respectively), but %FM was higher (21.3 ± 4.2% vs 9.2 ± 4.4%, p < 0.001); higher exclusive enteral caloric and protein intakes were associated with a decrease in FM z-scores from PN suspension to TEA., Conclusion: In our sample of premature infants, fat free mass z-score was similar, while fat mass and % fat mass z-scores increased substantially from parenteral nutrition suspension to term-equivalent age. Nutritional intakes during exclusive enteral nutrition did not seem to contribute to such increase., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To evaluate the association of first-trimester absent nasal bone (NB) and genetic abnormalities at G-banding karyotype and chromosomal microarray analysis (CMA) according to the nuchal translucency (NT) thickness., Methods: This is a retrospective cohort study of fetuses that underwent the first-trimester scan for the combined test at 11 +0 to 13 +6 weeks' gestation. Invasive test with G-banding karyotype and/or CMA was performed based on the result of the combined test or if fetal defects were detected or for patient's choice, after genetic counseling. All cases with absent NB in the first and second trimester underwent a detailed anomaly scan with echocardiography in the second trimester, had a longitudinal ultrasound, and postnatal follow-up up to at least 1 year., Results: Between 2013 and 2018, 7228 women underwent the first-trimester scan at 11 +0 to 13 +6 weeks. Overall prevalence of absent NB was 1.3% (96/7228). Of those, in 86 pregnancies (1.2%), the absence of NB was confirmed also in the second trimester: 0.58% (40/6909) in the group with NT <95th centile; 6%(14/233) in the group with NT between 95 and 99th centile; and 37.2% (32/86) in the group with NT >99th centile, respectively. CMA pathogenic variants were found only in the group with NT >99th centile with a diagnostic yield of 9.4%. Fetuses with absent NB and NT between 95 and 99th centile had in 57% (8/14) a major chromosomal anomaly, while in the NT <95 centile group, there were 5% (2/40) of chromosomal abnormalities (one inherited from the father)., Conclusion: In the first trimester, the risk for genetic syndromes detectable by CMA is related mainly to the NT thickness rather than to the absence of NB per se. In fetuses with absent NB and NT >99th centile, CMA should be performed after karyotype analysis, while for NT between 95 and 99th centile, a karyotype should be proposed as first-line procedure. Data provided by our study may be helpful in counseling women/couples when an absent NB is identified in the first trimester., (© 2020 John Wiley & Sons Ltd.)

Objectives: Facial muscle activity is crucial to controlling musical performance in wind instrument playing. Facial muscle dysfunctions are common in wind instrument players, dramatically affecting their professional musical activity and potentially leading to disabling symptoms.The aim of this pilot study on a cohort of healthy clarinetists was to use surface electromyography to identify the facial muscle activity patterns involved in stabilizing the mouthpiece, controlling emission and articulation during musical tasks in physiological conditions, also comparing muscle activity between less and more experienced clarinetists (students vs postgraduates/professionals)., Methods: Surface electromyographic measures of the sternocleidomastoid, masseter, mentalis, mylohyoid and buccinator muscles were obtained from eight healthy clarinet players (four students and four postgraduates/professionals) performing two standardized musical tasks., Results: Overall, mean IEMG activity was significantly lower for the sternocleidomastoid than for the other muscles ( P  = .000), and for the mouthpiece-stabilizing muscles (masseter and mentalis) than for those directly involved in controlling emission and articulation (buccinator and mylohyoid muscles) ( P  = .000).Regardless of the musical task, the mean IEMG values were significantly higher in the students for the masseter ( P  = .0007), buccinator ( P  = .0001) and mylohyoid (0.000), while they were significantly higher in the postgraduates/professionals for the mentalis ( P  = .000). No significant differences emerged between the two groups for the sternocleidomastoid ( P  = .207)., Conclusions: These preliminary data reflect a significantly higher overall facial muscle activity in the less-experienced group, potentially resulting in an overload, whereas the more expert players had more optimized muscle activity patterns.

Background: Biological nurturing is a neurobehavioral approach to breastfeeding support that encourages women to breastfed in a relaxed, laidback position. This approach has the potential to reduce breast problems (e.g., sore nipples), making good latch easier and thus facilitating the initiation of exclusive breastfeeding. However, its effects have not been adequately investigated in a real-life situation. The aim of this randomized controlled trial was to assess the effectiveness of biological nurturing, compared to usual hospital practices, on the frequency of breast problems and on the prevalence of exclusive breastfeeding at discharge from the maternity ward, after 1 week, and at one and 4 months., Methods: Open randomized parallel controlled trial carried out in a third level maternity ward (IRCCS Burlo Garofolo, Trieste, Italy) between March and December 2018. Two-hundred eight women who planned to give birth at the hospital and who expressed the intention to breastfeed were enrolled during pregnancy and randomized to receive breastfeeding support following either the biological nurturing approach or the usual care protocol based on the WHO/UNICEF 20-h course, in use at the hospital. The primary study outcome was the incidence of breast problems during hospital stay, defined as the presence of one or more of the following outcomes, collected separately: sore nipples, cracked nipples, engorgement and mastitis. The primary analysis was performed by intention to treat. The follow up lasted 4 months., Results: One hundred eighty eight out of 208 women (90.3%) were included in the analysis, 90 allocated to the biological nurturing group and 98 to the usual care group. At discharge from the maternity ward, biological nurturing significantly reduced the risk of breast problems (Relative risk [RR] 0.56, 95% Confidence Interval [CI] 0.40, 0.79), including cracked (RR 0.42, 95% CI 0.24, 0.74) and sore nipples (RR 0.59, 95% CI 0.40, 0.88). No statistically significant difference was observed for exclusive breastfeeding at discharge and up to 4 months. No adverse events occurred., Conclusions: The biological nurturing approach applied in the real-life situation of a third level hospital was effective in preventing breast problems., Trial Registration: Clinicaltrials.gov NCT03503500. Date of First Submission: 28 March 2018.

Anatomical variations of the mandibular canal as well as the presence of accessory canals and foramina are common findings in the human mandible. Here, we present a previously unreported type of anatomical variation, consisting of a large full-thickness bone defect of the right mandibular ramus, observed in a young male unearthed from a mediaeval cemetery located in North-Eastern Italy. The defect was located very close to, yet not directly connected with, the mandibular canal. Awareness of the existence of deviations from the anatomical norm such as that we describe here is strategic to avoid diagnostic misinterpretations, minimise technical hitches, and prevent clinical complications during invasive procedures in the region of the mandible.

Background: osteochondritis dissecans (OCD) is an ancient disease with few well-described cases in paleopathological records. Here, we report a very rare case of OCD on both lateral femoral condyles and on the lateral condyle of the right tibia in an early medieval human skeleton., Methods: macroscopic examination of the bone vestiges of a young male unearthed from a 6th-8th Lombard cemetery in the northeast Italy was perform., Results: We observed a circular crater-like depression with well-defined smooth margins and exposure of the trabecular bone on both lateral femoral condyles and in the lateral condyle of the right tibia. The left tibia was fragmented and the lateral condyle was lacking. Findings are consistent with the diagnosis of multifocal juvenile osteochondritis dissecans of the knee., Conclusion: Research in past and modern skeletal remains can contribute to define the nature and distribution of OCD., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Abstract: The wooden Crucifix of the Santa Maria dei Servi Church in Padua was recently attributed to the great sculptor Donatello. This crucifix recently underwent a demanding restoration. In the context of a multidisciplinary study of this sculpture, several analyses were carried out (Digital Rx, 3D scanning, CT scanning and micro-stratigraphic analysis) and the anatomical study was performed. Donatello sculpted the anatomy of this Christ realistically reproducing the human body, emphasizing some particulars, with less attention to details in the regions of the body hidden by the Crux. A swelling is well appreciable just below the lateral portion of the inguinal ligament, on the right thigh. It is a six cm wide bulge and it could be the consequence of the beating suffered by Christ before the crucifixion.