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Conservation actions (as Marine Protected Areas) are key tools to maintain coastal ecosystems. However, many reserves are characterized by several problems related to inadequate zonings that preclude important areas from economic activities, determining a strong hostility by local populations. Thus, estimations of marine economic values-in-use are needed for protection of marine ecosystem in order to find the best compromise between conservation priorities and local population needs. Algorithms to estimate monetary values of the main human activities in marine territories (large scale and small scale fishings, aquaculture, beach resorts, yachting, diving and commercial shipping) are here implemented using Gulf of Naples (centre Tyrrhenian sea, Italy) as study area example. These algorithms are based on different sources data (questionnaires, monitoring activities, official local authority reports, web and scientific literature). They can also be compared with each other being their outputs all expressed in the same measure unit. During the models development process a new flexible approach, called “Systematic Costs Assessment” (SCA), to assess opportunity costs in systematic conservation planning process was developed and applied. Results show that the total turnover in the Gulf of Naples is 3,950,753,487 € per year and 747,647,887 € per year excluding small scale fishing estimation, and one hectare of marine territory is worth 40,672 € and 7696 € per year excluding small scale fishing activity. In particular, excluding small scale fishing activity, beach resort and yachting show the highest values referred to one hectare of marine territories. In conclusion, SCA is a flexible approach where no long and costly sampling campaigns are always needed, provided that two assumptions have to be taken into account, in order to estimate credible values-in-use costs: i) do not use economic activities data and ecosystem services data in the same assessment layer, since it could lead to costs overestimation and ii) SCA method are efficient when used by operators with strong knowledge of the study area, since they are able to recognize parameters affecting economic activities of local population.

Objective: To investigate whether exposure to inhibitors of gastric acidity, such as H2 blockers or proton pump inhibitors, can independently increase the risk of infections in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit. Study design: This is a secondary analysis of prospectively collected data from a multicenter, randomized controlled trial of bovine lactoferrin (BLF) supplementation (with or without the probiotic Lactobacillus rhamnosus GG) vs placebo in prevention of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in preterm infants. Inhibitors of gastric acidity were used at the recommended dosages/schedules based on the clinical judgment of attending physicians. The distribution of days of inhibitors of gastric acidity exposure between infants with and without LOS/NEC was assessed. The mutually adjusted effects of birth weight, gestational age, duration of inhibitors of gastric acidity treatment, and exposure to BLF were controlled through multivariable logistic regression. Interaction between inhibitors of gastric acidity and BLF was tested; the effects of any day of inhibitors of gastric acidity exposure were then computed for BLF-treated vs -untreated infants. Results: Two hundred thirty-five of 743 infants underwent treatment with inhibitors of gastric acidity, and 86 LOS episodes occurred. After multivariate analysis, exposure to inhibitors of gastric acidity remained significantly and independently associated with LOS (OR, 1.03; 95% CI, 1.008-1.067; P = .01); each day of inhibitors of gastric acidity exposure conferred an additional 3.7% odds of developing LOS. Risk was significant for Gram-negative (P < .001) and fungal (P = .001) pathogens, but not for Gram-positive pathogens (P = .97). On the test for interaction, 1 additional day of exposure to inhibitors of gastric acidity conferred an additional 7.7% risk for LOS (P = .003) in BLF-untreated infants, compared with 1.2% (P = .58) in BLF-treated infants. Conclusion: Exposure to inhibitors of gastric acidity is significantly associated with the occurrence of LOS in preterm VLBW infants. Concomitant administration of BLF counteracts this selective disadvantage. Trial registration: isrctn.org: ISRCTN53107700.

Fungal colonisation by Candida spp. affects a high proportion of VLBW neonates in NICU. However, few data are available on the clinical characteristics of colonisation in preterm infants who are colonised at baseline via vertical transmission, compared to preterms who become colonised during their stay in NICU via horizontal transmission.We reviewed the database of a multicentre, randomised trial of prophylactic fluconazole in VLBW neonates conducted in 8 Italian NICUs in the years 2004 and 2005 (Manzoni et al., NEJM 2007;356(24):2483-95). Per the protocol, all enrolled infants underwent weekly surveillance cultures from birth till discharge. We investigated the frequency of the two different modalities of Candida colonisation in this population, as well as the clinical and outcome characteristics possibly related to them.Overall, Candida colonisation affected 54 of 336 infants (16.1%). Baseline (i.e., detected3(rd) day of life) colonisation affected 16 (4.7%), and acquired 38 (11.4%), of the 54 colonised preterms. Infants with baseline colonisation had significantly higher birth weight (1229 ± 28 g vs. 1047 g ± 29, p = 0.01) and gestational age (30.2 wks ± 2.7 vs. 28.5 wks ± 2.6, p = 0.01), and were significantly more likely to limit progression from colonisation to invasive Candida infection when fluconazole prophylaxis was instituted (21.6% vs. 42.7%, p = 0.009). Isolation of C. parapsilosis was significantly more frequent in infants with acquired colonisation.Infants with baseline and acquired colonisation differ for demographics characteristics and for their response to fluconazole prophylaxis. This information may be useful for targeting more accurate management strategies for these two different groups of colonised preterms in NICU.

Bronchopulmonary dysplasia is a common adverse outcome of very premature babies treated with long-lasting ventilation and oxygen therapy. Infants with bronchopulmonary dysplasia may develop pulmonary arterial hypertension. We report on severe bronchopulmonary dysplasia in a preterm infant who developed secondary, symptomatic and progressively severe pulmonary arterial hypertension. He was treated with sildenafil for 12 months, with complete resolution of pulmonary arterial hypertension. Eighteen months after therapy discontinuation, the patient was asymptomatic, and his systolic pulmonary artery pressure was normal. Routine use of sildenafil in preterm infants with bronchopulmonary dysplasia and secondary pulmonary arterial hypertension could be the future; large studies should confirm this report.

Hydrops fetalis (i.e., fetal hydrops) (HF) is a serious condition defined as an abnormal accumulation of fluid in two or more fetal compartments. It presents as ascites, pleural effusion, pericardial effusion and skin edema. In some patients, it may also be associated with polyhydramnios and placental edema. In 1943, Potter was the first to distinguish non-immune hydrops fetalis (NIHF) from immune hydrops [1].

Invasive candida infections are a major cause of morbidity and mortality in preterm infants. We performed a multicenter, randomized, double-blind, placebo-controlled trial of fluconazole for the prevention of fungal colonization and infection in very-low-birth-weight neonates.During a 15-month period, all neonates weighing less than 1500 g at birth from eight tertiary Italian neonatal intensive care units (322 infants) were randomly assigned to receive either fluconazole (at a dose of either 6 mg or 3 mg per kilogram of body weight) or placebo from birth until day 30 of life (day 45 for neonates weighing1000 g at birth). We performed weekly surveillance cultures and systematic fungal susceptibility testing.Among infants receiving fluconazole, fungal colonization occurred in 9.8% in the 6-mg group and 7.7% in the 3-mg group, as compared with 29.2% in the placebo group (P0.001 for both fluconazole groups vs. the placebo group). The incidence of invasive fungal infection was 2.7% in the 6-mg group and 3.8% in the 3-mg group, as compared with 13.2% in the placebo group (P=0.005 for the 6-mg group and P=0.02 for the 3-mg group vs. the placebo group). The use of fluconazole did not modify the relationship between colonization and the subsequent development of invasive fungal infection. Overall mortality was similar among groups, as was the incidence of cholestasis. No evidence for the emergence of resistant candida species was observed, but the study did not have substantial power to detect such an effect.Prophylactic fluconazole reduces the incidence of colonization and invasive candida infection in neonates weighing less than 1500 g at birth. The benefit of treating candida colonization is unclear. (Current Controlled Trials number, ISRCTN85753869 [controlled-trials.com]).