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We aimed at establishing the state of the art in fluid restriction practice in our national setting and providing a foundation for future research efforts. A prospective cross-sectional survey was conducted among all 114 Italian Neonatal Units in order to address conservative management of patent ductus arteriosus (PDA) in preterm infants below 29 weeks' gestational age (GA), with specific regard to fluid restriction. Response rate was 80%. Conservative measures for PDA management are provided in the majority of NICUs and 80% of centers reduce fluid intake in neonates with PDA. No relationship can be found among pharmacologically or surgically treated patients per year and the approach to fluid restriction. The minimum intake administered at regimen when fluid restriction is applied is associated to the ratio between the maximum number of neonates managed pharmacologically and number of admitted 29 weeks' GA newborns.Our survey shows an extreme variability among centers in terms of use of fluid restriction as a prophylactic tool but also in terms of its use (both opportunity and modality) when a hemodynamically significant PDA is diagnosed. This variability, that can be also found in randomized trials and observational studies, suggests that further evidence is needed to better understand its potential beneficial effects and its potential harms such as dehydration, hypotension, decreased end-organ perfusion, and reduced caloric intake.• The lack of demonstrable improvement following the treatment of patent ductus arteriosus has recently paved the way to a more conservative approach. • Fluid restriction is the most commonly applied conservative treatment of PDA.• Among Italian NICUs an extreme variability in terms of indications, timing and modalities of application of Fluid restriction can be found. • This variability reflects the lack of standardization of this practice and the contrasting evidence on its efficacy.

Background: Preterm birth alters nephrogenesis and reduces the total nephron number. Intrauterine growth restriction (IUGR) seems to worsen nephron loss, but only a few studies have investigated its role in neonatal kidney impairment. We investigated whether IUGR, defined as reduced estimated fetal growth and/or placental flow alterations and low birth weight z-score, increases the risk of developing acute kidney injury (AKI) in very preterm infants. Methods: We performed a retrospective study including infants born with a birth weight (BW) ≤ 1500 g and/or gestational age (GA) ≤ 32 weeks admitted to our center between January 2016 and December 2021. Neonatal AKI was defined according to the neonatal KDIGO classification based on the decline of urine output and/or creatinine elevation. We used multivariable linear regressions to verify the association between AKI and GA, BW z-score, IUGR definition, and hemodynamically significant patent ductus arteriosus (PDA). Results: We included 282 infants in the analysis, with a median (IQR) GA = 29.4 (27.4, 31.3) weeks, BW = 1150 (870, 1360) g, and BW z-score = − 0.57 (− 1.64, 0.25). AKI was diagnosed in 36 (13%) patients, and 58 (21%) had PDA. AKI was significantly associated with BW z-score (beta (std. error) = − 0.08 (0.03), p = 0.008) and severe IUGR (beta (std. error) = 0.21 (0.08), p = 0.009), after adjusting for GA and PDA. Conclusions: Our data suggest that low BW z-score and IUGR could represent adjunctive risk factors for kidney impairment in preterm babies.

The role of left ventricular (LV) diastolic pressure in the pathophysiology of bronchopulmonary dysplasia (BPD) is unclear. We evaluated the trajectory of echocardiographic parameters of LV diastolic function and the association with respiratory outcomes in preterm infants.We retrospectively analysed measurements of LV diastolic function (E, e', A, Ee' and E/A ratios) in infants below 32 weeks' gestation (GA). We compared infants with and without BPD by two-way RM ANOVA. We considered Ee' ratio as a proxy of LV filling pressure and identified a cut-off value using ROC analysis. We divided infants using such threshold and compared respiratory outcomes between groups by Mann-Whitney or Chi-square tests.We included 72 infants. Ee' ratio at 28 days was significantly associated with the duration of respiratory support (beta (std. error) = 5.32 (1.82), p = 0.005) and BPD (beta = 0.27 (0.10), p = 0.008). Infants with Ee' ratio 12 at 28 days had longer respiratory support, oxygen requirement, and higher BPD rates than infants with Ee' ratio ≤ 12.LV diastolic function associated with elevated LV filling pressure may contribute to the pathophysiology of BPD. Serial echocardiographic measurements could identify infants at risk of worse respiratory outcomes.In very preterm infants, we assessed the trajectory of left ventricular diastolic function by serial echocardiographic evaluations and evaluated its association with respiratory outcomes. On average, infants who developed bronchopulmonary dysplasia had higher Ee' at 28 postnatal days and 36 weeks postmentrual age than infants who did not develop the disease. Infants with elevated Ee' at 28 postnatal days, suggestive of elevated left atrial pressure, required longer respiratory support.

Objectives Mini-puberty is the physiological and transient activation of the hypothalamic–pituitary–gonadal axis occurring during the first months after birth. In preterm infants, the hormonal surge is more pronounced and longer-lasting than in at-term-peers. To date, only few cases of vaginal bleeding in the setting of an exaggerated mini-puberty have been reported. Case presentation At the corrected age of 3 months, an ex-very-preterm girl presented with breast enlargement and recurrent vaginal bleeding. A remarkable increase in gonadotropins and estradiol levels was detected, while pelvic ultrasound highlighted a large right ovarian cyst. As brain and pituitary MRI showed negative findings, an exaggerated mini-puberty was suspected and no additional investigations were undertaken. The subsequent progressive regression of clinical, biochemical and sonographic findings confirmed the diagnosis. Conclusions Although exaggerated mini-puberty of infancy in ex-preterm girls is a rare event, it is important to raise knowledge of this para-physiological condition in order to avoid unnecessary investigations and treatment.

Background Transition from intrauterine to extrauterine life is a critical phase during which several changes occur in cardiovascular system. In clinical practice, it is important to have a method that allows an easy, rapid and precise evaluation of hemodynamic status of a newborn for clinical management. We here propose a rapid, broadly applicable method to monitor cardiovascular function using ultrasonic cardiac output monitoring (USCOM). Methods We here present data obtained from a cohort of healthy term newborns (n = 43) born by programmed cesarean section at Fondazione MBBM, Ospedale San Gerardo. Measurements were performed during the first hour of life, then at 6 + 2, at 12–24, and 48 h of life. We performed a screening echocardiography to identify a patent duct at 24 h and, if patent, it was repeated at 48 h of life. Results We show that physiologically, during the first 48 h of life, blood pressure and systemic vascular resistance gradually increase, while there is a concomitant reduction in stroke volume, cardiac output, and cardiac index. The presence of patent ductus arteriosus significantly reduces cardiac output (p = 0.006) and stroke volume (p = 0.023). Furthermore, newborns born at 37 weeks of gestational age display significantly lower cardiac output (p p = 0.045) and stroke volume (p p = 0.0349), stroke volume (p p p = 0.0004). In particular, LGA infants display a transient increase in cardiac index, cardiac output and stroke volume up to 24 h of life; showing a different behavior from AGA and SGA infants. Conclusions Compared to previous studies, we expanded measurements to longer time-points and we analyzed the impact of commonly used clinical variables on hemodynamics during transition phase thus making our data clinically applicable in daily routine. We calculate reference values for each population, which can be of clinical relevance for quick bedside evaluation in neonatal intensive care unit.

Neonatal myocardial infarction (MI) is a very rare but potentially life-threatening condition with an approximated mortality rate of 80%. Congenital heart disease, anomalous coronary artery anatomy, thromboembolism, coagulopathy, birth asphyxia or myocarditis have been suggested as possible causes of MI. Here we report the case of a premature infant who died at about 40 h of life from a massive MI. Autopsy revealed an occlusive thrombus in the right coronary artery. An isolated prothrombotic status, characterized by a double copy variant of the MTHFR A1298C mutation, was identified at the postmortem genetic studies as a possible explanation for the coronary artery thrombosis. No other risk factors were detected.

Objective To characterize changes in lung mechanics and right ventricular output (RVO) during incremental/decremental continuous distending pressure (CDP) maneuvers in newborn infants receiving high-frequency oscillatory ventilation, with the aim of evaluating when open lung maneuvers are needed and whether they are beneficial. Study design Thirteen infants on high-frequency oscillatory ventilation were studied with a median (IQR) gestational age of 26 1 (25 3 -29 1 ) weeks and median (IQR) body weight of 810 (600-1020) g. CDP was increased stepwise from 8 cmH 2 O to a maximum pressure and subsequently decreased until oxygenation deteriorated or a CDP of 8 cmH 2 O was reached. The lowest CDP that maintained good oxygenation was considered the clinically optimal CDP. At each CDP, the following variables were evaluated: oxygenation, respiratory system reactance (Xrs), and RVO by Doppler echocardiography. Results At maximal CDP reached during the trial, 19 [1] cmH 2 O (mean [SEM]), oxygenation markedly improved, and Xrs and RVO decreased. During deflation, oxygenation remained stable over a wide range of CDP settings, Xrs returned to the baseline values, and RVO increased but the baseline values were not readily restored in all patients. Conclusion These results suggest that Xrs and RVO are more sensitive than oxygenation to overdistension and they may be useful in clinical practice to guide open lung maneuvers.

Background: BPD is a chronic lung disease often occuring in ventilator treated VLBW infants. Several studies demonstrate the role of pro-inflammatory cytokines and their reduction after corticosteroid treatment. Because of adverse effects of dexamethasone, we tried a new therapeutic approach using ACTH, that seems to imply less severe side effects.Aim: To compare the antiinflammatory action and side effects of ACTH and dexamethasone in VLBW infants by measuring IL6 and a-MSH, known as an endogenous anti-inflammatory agent. Population: We enrolled 14 VLBW infants, mean GA 29.2 wks (range 26-32 wks) and mean BW 1135 g (range 570-1810), mechanically ventilated for RDS. At 6th day of life neonates were randomized into 2 groups: group A (n=7) received dexamethasone (0.5mg/kg per day for 3 days) and group B (n=7) received ACTH (Synacthen 150 mcg/m2 per day for 3 days). The 2 groups had similar clinical characteristics before treatment (GA, BW, OI, AaDO2) (p=NS). Blood levels of IL6 and a-MSH were evaluated in 1st, 3rd, 6th, 10th and 15th day of life. Results: IL6 maximum levels were observed on the 1st day of life in group A (67.68±71.6 pg/ml) and on the 3rd day of life in group B (53.17±82 pg/ml). On the 10th day of life IL-6 reached minimum levels in both groups(A:10.82±18.1 pg/ml; B:5.94±5.9 pg/ml), while a-MSH reached maximum levels (A: 26.38±10.8 pg/ml; B:22.71±5.4 pg/ml). Both groups showed a significant (p

Role Of Tumor Necrosis Factor (Tnf) And Interleukin-6 (Il-6) In The Early Diagnosis Of Neonatal Infections 1459

Introduction Contrasting evidences exist regarding the possible effects of surfactant administration on cerebral perfusion. Aim of this study was to compare changes in cerebral hemodynamics and oxygenation following a 100 mg/kg and 50 mg/kg dose of bovine surfactant.

LEFT VENTRICULAR DYSFUNCTION (LVD) IN PRETERM NEWBORNS: DIAGNOSTIC VALUE OF FRACTIONAL SHORTENING (FS) AND ABNORMAL WALL MOTION DETECTION. 217