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IntroductionAlthough neonatal breathing patterns vary after perinatal asphyxia, whether they change during therapeutic hypothermia (TH) remains unclear. We characterized breathing patterns in infants during TH for hypoxic-ischemic encephalopathy (HIE) and normothermia after rewarming.MethodsIn seventeen spontaneously breathing infants receiving TH for HIE and in three who did not receive TH, we analyzed respiratory flow and esophageal pressure tracings for respiratory timing variables, pulmonary mechanics and respiratory effort. Breaths were classified as braked (inspiratory:expiratory ratio ≥1.5) and unbraked (

High-flow nasal cannula (HFNC) is becoming the gold standard to treat respiratory distress at any age since it potentially provides several significant clinical advantages. An obstacle to the diffusion of this simple and effective system of oxygen therapy is the impossibility to know the optimal flow rate leading to such advantages that allows the reduction in the respiratory effort without causing hyperinflation. To assist clinicians during HFNC treatment in setting the optimal flow rate and in determining the most relevant parameters related to respiratory mechanics and the effort of the patient, we developed a new programmable data monitoring, acquisition, and elaborating system (Pro_HFNC). The application of Pro_HFNC is fully compatible with HFNC as it is interfaced with patient through a facial mask and two specific catheters. The unavoidable and unpredictable loss of air flow occurring around the contour of the mask is evaluated and compensated by a specific algorithm implemented by Pro_HFNC. Our preliminary clinical trials on pediatric patients treated with HFNC show that Pro_HFNC is actually capable to detect for any specific patient both the lower threshold of the delivered flow beyond which the benefits of HFNC application are reached and all the parameters useful for a complete evaluation of the respiratory profile. Pro_HFNC can really help physicians in setting the optimal flow rate during HFNC treatment, thus allowing for the most effective HFNC performance.

Recent developments, results, and perspectives arising from double beta decay experiments at the Gran Sasso National Laboratory (LNGS) of the INFN by using HPGe detectors and crystal scintillators and by exploiting various approaches and different isotopes are summarized. The measurements here presented have been performed in the experimental set-ups of the DAMA collaboration. These setups are optimized for low-background studies and operate deep underground at LNGS. The presented results are of significant value to the field, and the sensitivity achieved for some of the considered isotopes is one of the best available to date.

The first results obtained by the DAMA/LIBRA⁻phase2 experiment are presented. The data have been collected over six independent annual cycles corresponding to a total exposure of 1.13 ton × year, deep underground at the Gran Sasso National Laboratory. The DAMA/LIBRA⁻phase2 apparatus, about 250 kg highly radio-pure NaI(Tl), profits from a second generation high quantum efficiency photomultipliers and of new electronics with respect to DAMA/LIBRA⁻phase1. The improved experimental configuration has also allowed to lower the software energy threshold. The DAMA/LIBRA⁻phase2 data confirm the evidence of a signal that meets all the requirements of the model independent Dark Matter annual modulation signature, at 9.5 σ C.L. in the energy region (1⁻6) keV. In the energy region between 2 and 6 keV, where data are also available from DAMA/NaI and DAMA/LIBRA⁻phase1, the achieved C.L. for the full exposure (2.46 ton × year) is 12.9 σ .

The results obtained with the total exposure of 1.04 ton × yr collected by DAMA/LIBRA-phase1 deep underground at the Gran Sasso National Laboratory (LNGS) of the I.N.F.N. during 7 annual cycles are summarized. The DAMA/LIBRA-phase1 and the former DAMA/NaI data (cumulative exposure 1.33 ton × yr, corresponding to 14 annual cycles) give evidence at 9.3 σ C.L. for the presence of Dark Matter (DM) particles in the galactic halo, on the basis of the exploited model independent DM annual modulation signature by using highly radiopure NaI(Tl) target. The modulation amplitude of the single-hit events in the (2–6) keV energy interval is 0.0112±0.0012 cpd/kg/keV; the measured phase is 144±7 days and the measured period is 0.998±0.002 yr; values are in a good well in agreement with those expected for DM particles. No systematic or side reactions able to mimic the exploited DM signature have been found or suggested by anyone over more than a decade. Some of the perspectives of the presently running DAMA/LIBRA-phase2 are outlined.

This manuscript describes the experience of our team in developing a flow-triggered nasal respiratory support for the neonate and its related clinical applications. Although mechanical ventilation (MV) via an endotracheal tube has undoubtedly led to improvement in neonatal survival in the last 40 years, the prolonged use of this technique may predispose the infant to the development of many possible complications, first of all, bronchopulmonary dysplasia (BPD). Avoiding mechanical ventilation is thought to be a critical goal, and different modes of non invasive respiratory support may reduce the intubation rate: nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV) and its more advantageous form, synchronized nasal intermittent positive pressure ventilation (SNIPPV). SNIPPV was initially performed by a capsule placed on the baby’s abdomen. To overcome the disadvantages of the abdominal capsule, our team decided to create a flow-sensor that could be interposed between the nasal prongs and the Y piece. Firstly we developed a hot-wire flow-sensor to trigger the ventilator and we showed that flow-SNIPPV can support the inspiratory effort in the post-extubation period more effectively than NCPAP. But, although accurate, the proper functioning of the hot-wire flow-sensor was easily compromised by secretions or moisture, and therefore we started to use as flow-sensor a simpler differential pressure transducer. In a following trial using the new device, we were able to demonstrate that flow-SNIPPV was more effective than conventional NCPAP in decreasing extubation failure in preterm infants who had been ventilated for respiratory distress syndrome (RDS). More recently we used flow-SNIPPV as the primary mode of ventilation, after surfactant replacement, reducing MV need and favorably affecting short-term morbidities of treated premature infants. We also successfully applied SNIPPV to treat apnea of prematurity (AOP). Finally, we developed a new shaped flow-sensor, which is smaller and lighter of the previous one and its reliability was tested using a simulated neonatal model. Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy) · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research