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Item does not contain fulltext, The COVID-19 pandemic had a major psychological impact on society, particularly affecting its vulnerable members including pregnant women and their (un)born children. Moreover, accumulating evidence indicates that maternal stress can have lifelong effects on the unborn child. Accordingly, pregnant women's vulnerability for mental health problems has become a concern during the COVID-19 pandemic. This chapter highlights the psychological impact of the COVID-19 pandemic on pregnant women and the potential short- and long-term consequences for their offspring. An overview is provided of the effects of prenatal maternal stress caused by previous disasters. Moreover, potential mechanisms are discussed of fetal programming and transgenerational effects of maternal prenatal stress. We conclude that the lessons learned from experiences with previous disasters should quickly be applied to the current COVID-19 pandemic. Close monitoring of offspring after prenatal stress due to the COVID-19 pandemic is necessary to detect and effectively target vulnerable developmental windows and divert adverse outcomes later during the life course.

BACKGROUND: The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic. METHODS: Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the 'EsPnIC Covid paEdiatric NeonaTal REgistry' (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines. FINDINGS: 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March-June 2020 to 74% in January-March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March-June 2020 and January-March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth. INTERPRETATION: This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed. FUNDING

Pregnancy represents a critical and potentially stressful event that can negatively impact on prospective mothers’ psychological well-being. Indeed, a growing body of studies reported high rates of clinical conditions such as anxiety, depression, and severe fear of childbirth during pregnancy across countries. Several variables, both at an individual and interpersonal level, have been found to be associated with pregnant women’s mental health, representing important risk or protective factors. Specifically, many studies have progressively highlighted the association between expectant mothers’ psychological well-being and practical and emotional social support, both from the partner, the extended formal, and informal network. The Covid-19 pandemic and the restrictive measures adopted to contain the virus’ spread may act as additional stressor on pregnant women, thus increasing the physiological vulnerability of an already fragile population and causing disruptive effects on both pregnancy outcomes as well as expectant mothers’ mental health. In particular, the outbreak shrunk women’s social and support networks and hindered their access to both pregnancy as well as mental health care facilities. Moreover, both care provision and care seeking behaviors have changed dramatically, for example leading to an increase in telehealth consultations and to the exclusion of birth companions from maternal units. In this chapter, after summarizing the state of the art regarding mental health in pregnant women and outlining the main effects of the pandemic on expectant mothers’ psychological well-being, we discuss the changes in maternal settings and the consequent behaviors adopted by prospective mothers. The final paragraph of the chapter is devoted to the discussion of guidelines and implications for clinical practice and mainly provides guidance of four areas: information, promotion, care, and coordination.

Pregnancy represents a critical and potentially stressful event that can negatively impact on prospective mothers’ psychological well-being. Indeed, a growing body of studies reported high rates of clinical conditions such as anxiety, depression, and severe fear of childbirth during pregnancy across countries. Several variables, both at an individual and interpersonal level, have been found to be associated with pregnant women’s mental health, representing important risk or protective factors. Specifically, many studies have progressively highlighted the association between expectant mothers’ psychological well-being and practical and emotional social support, both from the partner, the extended formal, and informal network. The Covid-19 pandemic and the restrictive measures adopted to contain the virus’ spread may act as additional stressor on pregnant women, thus increasing the physiological vulnerability of an already fragile population and causing disruptive effects on both pregnancy outcomes as well as expectant mothers’ mental health. In particular, the outbreak shrunk women’s social and support networks and hindered their access to both pregnancy as well as mental health care facilities. Moreover, both care provision and care seeking behaviors have changed dramatically, for example leading to an increase in telehealth consultations and to the exclusion of birth companions from maternal units. In this chapter, after summarizing the state of the art regarding mental health in pregnant women and outlining the main effects of the pandemic on expectant mothers’ psychological well-being, we discuss the changes in maternal settings and the consequent behaviors adopted by prospective mothers. The final paragraph of the chapter is devoted to the discussion of guidelines and implications for clinical practice and mainly provides guidance of four areas: information, promotion, care, and coordination.

Backgrounds: Pediatric noninvasive neurally adjusted ventilatory assist (NIV-NAVA) has been shown to improve patient-ventilator interaction but no data on clinical outcomes are available. Aim of this study was to compare NIV-NAVA with noninvasive pressure support (NIV-PS) in children with acute hypoxemic respiratory failure (AHRF), in a single-center before-after study. A cohort of thirty-four NIV-PS patients (before group) admitted to our PICU within the 2 years prior NAVA introduction was compared with a cohort of thirty children treated with NIV-NAVA during implementation phase (after group). The primary end-point was intubation rate between groups. Days on mechanical ventilation, number of invasive devices, nosocomial infections, PICU/hospital length of stay (LOS), and physiological parameters at 2 and 24 h after admission were considered. Results: Intubation rate was lower in the NIV-NAVA group as compared to the NIV-PS group (p = 0.006). Patients treated with NIV-NAVA required fewer invasive devices (p = 0.032) and had lower incidence of ventilator-acquired pneumonia (p = 0.004) and shorter PICU (p = 0.032) and hospital LOS (p = 0.013). At 2 h, NIV-NAVA compared with NIV-PS resulted in higher paO2:FIO2 (p = 0.017), lower paCO2 (p = 0.002), RR (p = 0.026), and HR (p = 0.009). Conclusions: Early NIV-NAVA vs NIV-PS was associated to lower intubation rate and shorter PICU and hospital LOS. Further studies are needed in order to confirm these preliminary data.

Street art murals are an artistic expression strictly interwoven in the urban landscape, and in recent years have received increasing attention as cultural heritage at risk. Today there is intense debate regarding the value assessment and choices related to the conservation of urban art; however, the evaluation of the stability of modern paint materials in outdoor environment is preliminary to any possible preservation strategy. In particular, the identification of the materials constituting a street artwork is critical for the preservation of these non-permanent heritage elements and to define the best restoration approaches. In this work, we performed a set of analyses of microsamples based on spectroscopy, analytical pyrolysis, gas and liquid chromatography, and mass spectrometry to identify paint materials (binders, pigments, additives, degradation products and conservation/restoration materials) of a selection of mural paintings, covering 60 years of history (1953–2014). The goal of this work was to identify the materials used to produce different mural paintings and to relate and compare their different compositions with previous studies in order to describe the evolution of the materials during the last 60 years. The collected knowledge and the limited data available in literature were exploited to increase the scientific background on the materials used by street artists, and to fill the lack of knowledge on this emerging topic.

Use of extracorporeal membrane oxygenation (ECMO) in children receiving haematopoietic cell transplantation (HCT) and immune effector cell therapy is controversial and evidence-based guidelines have not been established. Remarkable advancements in HCT and immune effector cell therapies have changed expectations around reversibility of organ dysfunction and survival for affected patients. Herein, members of the Extracorporeal Life Support Organization (ELSO), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (HCT and cancer immunotherapy subgroup), the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT), the supportive care committee of the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC), and the Pediatric Intensive Care Oncology Kids in Europe Research (POKER) group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) provide consensus recommendations on the use of ECMO in children receiving HCT and immune effector cell therapy. These are the first international, multidisciplinary consensus-based recommendations on the use of ECMO in this patient population. This Review provides a clinical decision support tool for paediatric haematologists, oncologists, and critical care physicians during the difficult decision-making process of ECMO candidacy and management. These recommendations can represent a base for future research studies focused on ECMO selection criteria and bedside management.

A modern painting is characterized by multi-material bases extremely exposed to biodeteri-ogenic attacks. The aim of this work was to test the antifungal effectiveness of a natural, eco-friendly, and safe emulsion based on Citrus aurantium L. var. amara hydrolate and Cinnamomum zeylanicum Blume (from bark) essential oil, named “Zeylantium green emulsion” (Zege), on modern paintings. Colored unaged and aged canvas samples, performed with modern techniques (acrylic, vinylic and alkyd), were used to test in vitro both the antifungal effectiveness of Zege and its impact on the chemical–physical characteristics. Microbiological tests were performed according to the EUCAST international guidelines. pH measurements and colorimetric analysis were performed on unaged and aged canvases before and after Zege spray treatment. Finally, in situ tests were performed using the spray emulsion on canvas samples obtained from Ilaria Margutti’s modern artwork, which had been colonized by molds. Microbiological tests on canvas prototypes showed a time-and dose-dependent effectiveness of the Zege spray. None of the techniques underwent relevant changes in pH. Only the acrylic colors were unaffected in the colorimetric analysis, among all colored unaged or aged canvases. Tests made with modern artwork samples confirmed the in situ antifungal effectiveness. The Zege spray showed encouraging results in regard to the use of this formulation in the restoration of modern paintings.

Preserving artworks from the attacks of biodeteriogens is a primary duty of humanity. Nowadays, restorers use chemicals potentially dangerous for both artworks and human health. The purpose of this work was to find a green and safe formulation based on natural substances with fungicidal activity to restore ancient oil paintings, particularly “Il Silenzio” (by Jacopo Zucchi) preserved at the Uffizi Museum in Florence, Italy. The study was divided into two phases. First phase (in vitro study): three essential oils (EOs) and four hydrolates (Hys) were analysed by GC-mass spectrometry and in vitro tested against six ATCC strains of molds. An emulsion based on the more active natural compounds was tested on aged and unaged canvases samples to evaluate both their fungicidal activity and the impact on chemical-physical parameters. Finally, an in vivo toxicity test performed on the Galleria mellonella model assessed the safety for health. Second phase (in situ application): the emulsion was sprayed on the back of the painting and left to act for 24 h. Biodeteriogens present on the “Il Silenzio” painting were microbiologically identified before and after the treatment. The emulsion formulated with C. zeylanicum EO and C. aurantium var. amara Hy showed the best antifungal activity both in vitro and in situ without altering the chemical-physical characteristics of paintings. Furthermore, no in vivo toxicity was shown. For the first time, a green antimicrobial emulsion based on Hy and EO, safe for operators, was used to decontaminate an artwork colonised by fungi before the restoration practices.

Objective: To determine whether non-invasive ventilation (NIV) can avoid the need for tracheal intubation and/or reduce the duration of invasive ventilation (IMV) in previously intubated patients admitted to the pediatric intensive care unit (PICU) and developing acute hypoxemic respiratory failure (AHRF) after major traumatic injury. Study Design: A single center observational cohort study. Setting: Pediatric ICU in a University Hospital (tertiary referral Pediatric Trauma Centre) Population: During the 48-month study period, 276 patients (median age 6.4 years) with trauma were admitted to PICU; among 86 of them, who suffered from AHRF and received ventilation (IMV and/or NIV) for more than 12 hrs, 32 patients (median age 8.5 years) were treated with NIV. Inclusion/Exclusion Criteria: Inclusion criteria: at least 12 hours of NIV; exclusion criteria: patients with facial trauma or congenital malformations; patients receiving IMV <12 hours or perioperative ventilation. Measurements and Results: Among NIV patients, 27 (84,3%) were previously on IMV, while 5 (15,6%) could be managed exclusively with NIV. In patients with post-extubation respiratory distress, NIV was successful in 88.4% of cases. Before starting NIV, P/F ratio was 242.7 ± 71. After 8 hours of NIV treatment, a significant oxygenation improvement (PaO2/FiO2 = 354.3 ± 81; p = 0.0002) was found, with no significant changes in carbon dioxide levels. A trend toward increasing ventilation-free time has been evidenced; NIV resulted feasible and generally well tolerated. Conclusions: AHRF in trauma patients is multifactorial and may be due to many reasons, such as lung contusion, aspiration of blood or gastric contents. Systemic inflammatory response and transfusions may also contribute to hypoxia. Our pilot study strongly suggests that NIV can be applied in post-traumatic AHRF: it may successfully reduce the time of both invasive ventilation and deep sedation. Further data from controlled studies are needed

To illustrate our experience with two cases of neonatal life-threatening hyperkalemia during therapeutic hypothermia (TH) despite a normal acid-base status, urine output, and preserved renal function. Clinical cases are presented from Pediatric Intensive Care Unit (PICU) admission to the onset of the hyperkalemia, with related complications and after resolution. Similar cases were not retrieved from a critical review of pertinent literature. Severe hyperkalemia pathophysiology and risk factors have been debated. Two full-term adequate for weight female neonates were admitted to PICU because of perinatal asphyxia who underwent TH. Prenatal history was completely uneventful, nor hereditary genetic conditions were reported; moreover, long-term follow-up ruled out any metabolic or renal disease. Despite an accurate evaluation of previous clinical series and literature on TH and perinatal asphyxia, these hyperkalemic episodes remain unexplained. The hypoxic-ischemic insult may affect multiple organs, mainly central nervous system, heart, lung, and kidneys; acute muscle breakdown and consequent rising of myoglobin may also have a precipitating role in acute kidney failure (AKF) and hyperkalemia. Electrolyte imbalance is a possible finding as a consequence of combined cell injury and AKF. In contrast, an isolated severe hyperkalemia is exceedingly rare in nonoliguric neonates.