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Most medications are not labeled for use in the pediatric population because they have not been formally studied in children. Data on off-label use of cardiovascular (CV) drugs in the home therapy of children with CV disease are scanty. The study included 325 pediatric patients with CV disease and on ≥1 CV medication who underwent ≥1 visit during 2019 at the Pediatric Cardiology outpatient clinic of Giovanni XXIII Pediatric Hospital in Bari, Italy. A total of 287 patients (88.3%) received ≥1 off-label medication, whereas 113 patients (34.7%) received ≥2 off-label medications, and 22 patients (6.7%) ≥3 off-label medications. In CV medications (n = 27) 85% were used off-label in all cases, and 92.5% were used off-label in ≥50% of patients. Adverse events occurred in 8 patients, leading to drug discontinuation in 2 of them. In all 8 cases, medications were used off-label. In multivariate analysis, congenital heart disease patients with single-ventricle physiology (odds ratio 8.4, 95% confidence interval 2.25 to 54.4) and those with heart failure (odds ratio 2.0, 95% confidence interval 1.1 to 3.6) were at higher risk for receiving ≥2 off-label drugs. The off-label use of CV drugs in the home therapy of children with congenital or acquired heart disease is common and adverse events may occur. Patients with congenital heart disease with single-ventricle physiology and those with heart failure have a higher probability to receive ≥2 off-label medications. This study highlights the need for larger safety and efficacy trials in this specific cohort of pediatric patients., Competing Interests: Disclosures The authors have no conflicts of interest to declare., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: It is not known whether antenatal corticosteroids (ANS) can reduce the risk of retinopathy of prematurity (ROP). The aim of this study was to evaluate in a prospective cohort study the effect of ANS on ROP development and severity., Methods: All infants consecutively admitted to 14 centres from 1.1.1992 to 31.12.1993, with a gestational age < or = 30 weeks, no congenital anomalies, and who survived to 6 months, were enrolled (N = 380). Mean birth weight of the cohort was 1157 g; mean gestational age was 28.4 weeks. ROP stage 1-2 developed in 82 neonates; ROP stage 3-3+ in 57. Only 70 neonates (18.4%) received ANS prophylaxis., Results: ANS prophylaxis highly significantly reduced the risk of developing ROP [Odds ratio, (OR), 0.35; 95% confidence interval 0.17-0.71, logistic regression analysis], and that of severe (stage 3-3+) ROP (OR 0.07; 95% confidence interval: 0.02-0.34). Short gestation, low birth weight, bronchopulmonary dysplasia also were significantly associated with ROP development and severity; respiratory distress syndrome and not being treated with surfactant were significant risk factors for ROP severity., Conclusions: ANS prophylaxis protected both against ROP development and against severe forms of ROP. Prematurity and respiratory morbidity still represent independent risk factors for ROP.

The AA describe a case of neonatal sepsis caused by Listeria monocytogenes observed in their Intensive Care Unit. The preterm neonate, born at the 30th week of gestational age, died after three days, showing clinical signs of sepsis and severe respiratory distress. Although the anamnesis of the mother revealed an episode of fever one month before delivery, the origin of which was not identified, it was not possible to isolate the Listeria in the mother. The AA discuss some clinical and therapeutical aspects of listeriosis; this infection is not very frequent in Italy, nevertheless it should not be underestimated either in the mother or in the neonate.

The work describes an epidemic infection by Methicillin-Resistant S. aureus in a N.I.C.U. which took place during the first six months of 1986. Hospital systemic infection supported by M.R.S.A. are frequently noticed in N.I.C.U. This is related, on the one side with a selection of antibiotic resistant bacterial strains inside the hospital premises and, on the other side with increased survival of high infectious risk neonates who are subjected to invasive medical manoeuvres. The cases reported include 7 neonates (5 of which were preterms) who were affected by a severe sepsis. From an epidemiological study it appeared that M.R.S.A. strain was introduced in N.I.C.U. by a neonate coming from the surgery after being operated for a diaphragmatic hernia. The isolation and the treatment of the carriers, the severe asepsis and the systematic disinfection of the Unit made it possible to eradicate the infectious strain. The infected neonates have been treated with an aimed antibiotic therapy, especially with Vancomycin, administration of blood and/or fresh plasma and/or immunoglobulins and/or concentrated granulocytes. The outcome was favourable for 3 neonates; of the others, 1 showed post-infectious neurological sequelae and 3 died (they were however affected by other severe associated diseases).

A new case of Cutis marmorata telangiectatica congenita is reported. This disease is characterized by a persistent vascular mottling of the skin generally on the limbs. In our case the lesions were present on almost the entire body even if one side was more affected, this one was also lipotropic. The face of the child was asymmetric because of the jaw's hypoplasia and nose curvature. The examination of the deep vessel did not show any abnormality but the possibility of future vascular defects as varicosities must be considered. The nosological entity of this disease is discussed.