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Abstract Topochemistry enables step-by-step conversions of solid-state materials often leading to metastable structures that retain initial structural motifs. Recent advances in this field revealed many examples where relatively bulky anionic constituents were actively involved in redox reactions during (de)intercalation processes. Such reactions are often accompanied by anion-anion bond formation, which heralds possibilities to design novel structure types disparate from known precursors, in a controlled manner. Here we present the multistep conversion of layered oxychalcogenides Sr2MnO2Cu1.5 Ch 2 (Ch = S, Se) into Cu-deintercalated phases where antifluorite type [Cu1.5 Ch 2]2.5- slabs collapsed into two-dimensional arrays of chalcogen dimers. The collapse of the chalcogenide layers on deintercalation led to various stacking types of Sr2MnO2 Ch 2 slabs, which formed polychalcogenide structures unattainable by conventional high-temperature syntheses. Anion-redox topochemistry is demonstrated to be of interest not only for electrochemical applications but also as a means to design complex layered architectures.

Background: The gold standard treatment for periprosthetic joint infections is the two-stage revision that includes the spacer placement before definitive reimplantation. The management of PJI affects patients’ joint function and, subsequently, their mental health. Even though significant advances have been achieved, little to no attention has been paid to the psychological implications. So, based on standardized patient-reported outcome measures (PROMs), this study aimed to clarify the effect of spacer treatment of infected hip and knee arthroplasties on patients’ mental health. Methods: We performed research on the literature on PJIs in the English language using the MEDLINE database with the search strings “spacer” OR “spacers” AND “hip” OR “knee” AND “SF-12” OR “SF-36” OR “EQ-5” OR “mental” OR “depression” OR “anxiety.” The reference lists of selected articles were also hand-searched for any additional articles. Results: A total of 973 published papers were extracted, and 9 papers were finally included. A total of 384 patients who underwent spacer placement for PJI were identified. Of these 384 patients, 54% were female. The mean age ranged from 62 to 78.2 years. Of the11 papers identified for this review, 4 analyzed only hip spacers, including 119 patients; 4 only knee spacers, evaluating 153 patients; while a single study included 112 patients for both joints. Conclusions: Patients with the spacer are living in a state of mental upset, albeit better than the preoperative state. Clinical improvement with the review is not assured. The alteration of mental state turns out not to be transient for all the patients.

Periprosthetic joint infections (PJIs) are a prominent subject of discussion in orthopedics and are frequently debated at conferences and congresses. In the context of PJIs affecting the knee, the decision between following a one-stage or two-stage treatment approach has historically been a pivotal consideration. The first option is limited by indications and potentially devastating complications in case of failure, whereas the second is widely accepted as the gold standard. Initially, the spacer was conceived solely to restore and maintain knee space after removal of the implant. An articulating spacer was introduced to mitigate patient limitations and improve knee function and quality of life. Two main types of articulating spacers are utilized in knee PJI treatment: the mold spacer and the metal-on-poly spacer. This text outlines a technique for metal-on-poly spacer implants. Based on our experience and the existing literature, this approach facilitates early full weight bearing and faster recovery of the knee’s range of motion, ultimately improving the quality of life after surgery, thus allowing the spacer retention for an extended period, as suggested by the 1.5-stage revision.

Sulfur‐deficient SnS thin films for sodium‐ion battery anode application are prepared using aerosol‐assisted chemical vapor deposition. Growth directly onto the metal foil current collector forms sulfur‐deficient SnS microrod structures via a vapor–liquid–solid growth mechanism, with 92 nm average SnS crystallite size and an 800 nm film thickness. The sulfur deficiency is demonstrated with energy‐dispersive X‐ray analysis, powder X‐ray diffraction, and X‐ray absorption near‐edge structure analyses. This sulfur‐deficient SnS material demonstrates a very high capacity in sodium half cells. The first reduction scan at a specific current of 150 mA g−1 shows a capacity of 1084 mAh g−1. At the 50th cycle the specific capacity is 638 mAh g−1 for reduction and 593 mAh g−1 for oxidation. This capacity is demonstrated for tin sulfide itself without the need for a nanostructured carbon support, unlike previous high capacity SnS anodes in the literature. Both the capacity and ex situ characterization experiments indicate a conversion reaction producing tin, followed by alloying with sodium during reduction, and that both of these processes are reversible during oxidation.

Over 50 million people in South Asia are exposed to groundwater contaminated with carcinogenic arsenic(III). Photocatalyst-adsorbent composite materials are popularly developed for removing arsenic in a single-step water treatment. Here, As(III) is oxidised to As(V), which is subsequently removed via adsorption. We previously developed a component additive surface complexation model (CA-SCM) to predict the speciation of arsenic adsorbed onto TiO2/Fe2O3 under different environmental conditions, using surface complexes taken from studies of single-phase minerals. In this work, we critically evaluate this approach, using experimental observations of the surface structures of arsenic adsorbed onto TiO2/Fe2O3. Extended X-ray absorption fine structure spectroscopy (EXAFS) indicates significant As(III) surface precipitation, and the possible formation of tridentate 3C complexes. EXAFS was unable to identify As binding modes for TiO2 and Fe2O3 surface complexes simultaneously, highlighting the challenge of analysing composite surfaces. FTIR and zeta potential analysis indicate that As(III)-Fe2O3 surface complexes are protonated at neutral pH, whilst As(III)-TiO2, As(V)-Fe2O3 and As(V)-TiO2 surface complexes are negatively charged. Our study confirms the speciation predicted by CA-SCM, particularly As(III) surface precipitation, but also introduces the possibility of tridentate As(III) at acidic pH. This study highlights how experiment and modelling can be combined to assess surface complexation on composite surfaces.

The authors report in-situ formation of jarosite witin the Talos Dome ice core (East Antarctica) and show that this ferric-potassium sulfate mineral is present in ice deeper than 1000 meters and progressively increases with depth. This has implications for the presence and formation mechanisms of jarosite observed on Mars.

Renewable hydrogen production from water will require understanding and improving the oxygen evolution reaction (OER) on catalyst surfaces. Here, authors report α-Li2IrO3 to transform into a hydrated birnessite phase under OER conditions that exhibits enhanced OER performances and durabilities.

Limonitic layers of the regolith, which are often stockpiled as waste materials at laterite mines, commonly contain significant concentrations of valuable base metals, such as nickel, cobalt, and manganese. There is currently considerable demand for these transition metals, and this is projected to continue to increase (alongside their commodity values) during the next few decades, due in the most part to their use in battery and renewable technologies. Limonite bioprocessing is an emerging technology that often uses acidophilic prokaryotes to catalyse the oxidation of zero-valent sulphur coupled to the reduction of Fe (III) and Mn (IV) minerals, resulting in the release of target metals. Chromium-bearing minerals, such as chromite, where the metal is present as Cr (III), are widespread in laterite deposits. However, there are also reports that the more oxidised and more biotoxic form of this metal [Cr (VI)] may be present in some limonites, formed by the oxidation of Cr (III) by manganese (IV) oxides. Bioleaching experiments carried out in laboratory-scale reactors using limonites from a laterite mine in New Caledonia found that solid densities of ∼10% w/v resulted in complete inhibition of iron reduction by acidophiles, which is a critical reaction in the reductive dissolution process. Further investigations found this to be due to the release of Cr (VI) in the acidic liquors. X-ray absorption near edge structure (XANES) spectroscopy analysis of the limonites used found that between 3.1 and 8.0% of the total chromium in the three limonite samples used in experiments was present in the raw materials as Cr (VI). Microbial inhibition due to Cr (VI) could be eliminated either by adding limonite incrementally or by the addition of ferrous iron, which reduces Cr (VI) to less toxic Cr (III), resulting in rates of extraction of cobalt (the main target metal in the experiments) of >90%.

Trapping carbon dioxide within usable chemicals is a promising means to mitigate climate change, yet electrochemical C–C couplings are challenging to perform. Here, the authors prepared iron oxyhydroxides on nitrogen-doped carbon that efficiently convert carbon dioxide to acetic acid.

Airborne dust extracted from deep ice core perforations can provide chemical and mineralogical insight into the history of the climate and atmospheric conditions, with unrivalled temporal resolution, time span and richness of information. The availability of material for research and the natural complexity of the particulate, however, pose significant challenges to analytical methods. We present the developments undertaken to optimize the experimental techniques, materials and protocols for synchrotron radiation-based analysis, in particular for the acquisition of combined Synchrotron Radiation X-Ray Fluorescence and X-ray Absorption Spectroscopy data.

Structural changes of MoO3 thin films deposited on thick copper substrates upon annealing at different temperatures were investigated via ex situ X-Ray Absorption Spectroscopy (XAS). From the analysis of the X-ray Absorption Near-Edge Structure (XANES) pre-edge and Extended X-ray Absorption Fine Structure (EXAFS), we show the dynamics of the structural order and of the valence state. As-deposited films were mainly disordered, and ordering phenomena did not occur for annealing temperatures up to 300 °C. At ~350 °C, a dominant α-MoO3 crystalline phase started to emerge, and XAS spectra ruled out the formation of a molybdenum dioxide phase. A further increase of the annealing temperature to ~500 °C resulted in a complex phase transformation with a concurrent reduction of Mo6+ ions to Mo4+. These original results suggest the possibility of using MoO3 as a hard, protective, transparent, and conductive material in different technologies, such as accelerating copper-based devices, to reduce damage at high gradients.

Iron is thought to limit the biomass of phytoplankton populations in extensive regions of the ocean, which are referred to as high-nutrient low-chlorophyll (HNLC) regions. Iron speciation in soils is still poorly understood. We have investigated inorganic and organic standard substances, diluted mixtures of common Fe minerals in insoluble dust in snow from the Laohugou No.12 glacier, and sand (including soil and moraine) samples that were collected from western China. The speciation of iron (Fe) in insoluble dust and sand was determined by X-ray absorption near-edge structure (XANES) spectroscopy. A linear fit combination (LCF) analysis of the experimental spectra compared to a large set of reference compounds showed that all spectra can be fitted by only four species: Fe2O3, Fe3O4, biotite, and ferrous oxalate dihydrate (FOD). A significant altitude effect was detected for snow. The proportion of Fe2O3 in snow decreases gradually, and vice versa for FOD. As for Fe3O4 and biotite, the altitude effect was also detected, but separate regions should be considered to be deduced by topography. The Fe species in moraines and soils were also analyzed to identify the source of moraines and the heterogeneity of soils, and were compared with snow.

X-ray absorption near edge structure (XANES) measurements at the Fe K-edge were performed on aeolian dust in the TALos Dome Ice CorE drilling project (TALDICE) ice core drilled in the peripheral East Antarctic plateau, as well as on Southern Hemisphere potential source area samples. While South American sources show, as expected, a progressive increase in Fe oxidation with decreasing latitude, Antarctic sources show Fe oxidation levels higher than expected in such a cold polar environment, probably because of their very high exposure ages. Results from the TALDICE dust samples are compatible with a South American influence at the site during MIS2 (marine isotopic stage 2, the last and coldest phase of the last glacial period), in particular from Patagonia and Tierra del Fuego. However, a contribution from Australia and/or local Antarctic sources cannot be ruled out. Finally, important changes also occurred during the deglaciation and in the Holocene, when the influence of Antarctic local sources seems to have become progressively more important in recent times. This research is the first successful attempt to extract temporal climatic information from X-ray absorption spectroscopic data of the insoluble mineral dust particles contained in an ice core and shows the high potential of this technique.

In this work, we will report applications of the total external X-ray fluorescence (TXRF) station, a prototype assembled at the XLab Frascati laboratory (XlabF) at the INFN National Laboratories of Frascati (INFN LNF). XlabF has been established as a facility to study, design and develop X-ray optics, in particular, polycapillary lenses, as well as to perform X-ray experiments for both elemental analysis and tomography. The combination of low-power conventional sources and policapillary optics allows assembling a prototype that can provide a quasi-parallel intense beam for detailed X-ray spectroscopic analysis of extremely low concentrated samples, down to ng/g. We present elemental analysis results of elements contained in tree rings and of dust stored in deep ice cores. In addition to performing challenging environmental research studies, other experiments aim to characterize novel optics and to evaluate original experimental schemes for X-ray diffraction (XRD), X-ray fluorescence (XRF and TXRF) and X-ray imaging.

The possibility of finding a stratigraphically intact ice sequence with a potential basal age exceeding one million years in Antarctica is giving renewed interest to deep ice coring operations. But the older and deeper the ice, the more impactful are the post-depositional processes that alter and modify the information entrapped within ice layers. Understanding in situ post-depositional processes occurring in the deeper part of ice cores is essential to comprehend how the climatic signals are preserved in deep ice, and consequently how to construct the paleoclimatic records. New techniques and new interpretative tools are required for these purposes. In this respect, the application of synchrotron light to microgram-sized atmospheric dust samples extracted from deep ice cores is extremely promising. We present here preliminary results on two sets of samples retrieved from the Talos Dome Antarctic ice core. A first set is composed by samples from the stratigraphically intact upper part of the core, the second by samples retrieved from the deeper part of the core that is still undated. Two techniques based on synchrotron light allowed us to characterize the dust samples, showing that mineral particles entrapped in the deepest ice layers display altered elemental composition and anomalies concerning iron geochemistry, besides being affected by inter-particle aggregation.

The analysis of particulate matter (PM) in dilute solutions is an important target for environmental, geochemical, and biochemical research. Here, we show how microdrop technology may allow the control, through the evaporation of small droplets, of the deposition of insoluble materials dispersed in a solution on a well-defined area with a specific spatial pattern. Using this technology, the superficial density of the deposited solute can be accurately controlled. In particular, it becomes possible to deposit an extremely reduced amount of insoluble material, in the order of few μg on a confined area, thus allowing a relatively high superficial density to be reached within a limited time. In this work, we quantitatively compare the microdrop technique for the preparation of particulate matter samples with the classical filtering technique. After having been optimized, the microdrop technique allows obtaining a more homogeneous deposition and may limit the sample amount up to a factor 25. This method is potentially suitable for many novel applications in different scientific fields such as demanding spectroscopic studies looking at the mineral fraction contained in ice cores or to pollution investigations looking at the detection of heavy metals present in ultra-trace in water.

Technological activities to design, manufacture, and test new accelerating devices using different materials and methods is under way all over the world. The main goal of these studies is to increase the accelerating gradients and reduce the probability of radio-frequency (RF) breakdown. Indeed, it is still not clear why, by increasing the intensity of the applied field, intense surface damage is observed in copper structures, limiting the lifetime and, therefore, the practical applications. A possible solution is represented by a coating of a relatively thick layer of molybdenum in order to improve the breakdown rate. molybdenum can be reliably grown on different substrates with a negligible strain and, for thicknesses up to 600 nm, with a resistivity < 100–150·μΩ cm. Moreover, Mo coatings with controlled composition, internal stress, and roughness may allow improving thermo-mechanical properties reaching values not attainable by uncoated copper. Although the Mo conductivity remains lower compared to Cu, a Mo coating represents a very interesting option for high gradient accelerator components manufactured in copper.

Sexual violence is a widespread and common phenomenon in our society, which unfortunately often goes unreported or undetected: a hidden “iceberg” of great dimension. Often the victims arrive to our emergency department where the sanitary workers are not prepared to help them professionally. By this work the authors want to evaluate health workers true understanding of the “problem of violence”; their human and professional capacity to manage it; their capacity to create and promote sensitisation and training programmes for professionals working in the field; and the ability to design and implement protocols and procedures to be utilized when managing victims of violence by a questionnaire compiled and distributed to health professionals working in the critical areas (A&E and DEA) in the region Lazio.

Abstract Background In neonatology the role of chest physiotherapy is still uncertain because of the controversial outcomes. Methods The aim of this study was to test the applicability in preterm infants of 'reflex rolling', from the Vojta method, in preterm neonates with lung pathology, with particular attention to the effects on blood gases and oxygen saturation, on the spontaneous breathing, on the onset of stress or pain. The study included 34 preterm newborns with mean gestational age of 30.5 (1.6) weeks - mean (DS) - and birth weight of 1430 (423) g - mean (DS) -, who suffered from hyaline membrane disease, under treatment with nasal CPAP (continuous positive airways pressure), or from pneumonia, under treatment with oxygen-therapy. The neonates underwent phase 1 of 'reflex rolling' according to Vojta method three times daily. Respiratory rate, SatO2, transcutaneous PtcCO2 e PtcO2 were monitored; in order to evaluate the onset of stress or pain following the stimulations, the NIPS score and the PIPP score were recorded; cerebral ultrasound scans were performed on postnatal days 1-3-5-7, and then weekly. Results In this population the first phase of Vojta's 'reflex rolling' caused an increase of PtcO2 and SatO2 values. No negative effects on PtcCO2 and respiratory rate were observed, NIPS and PIPP stress scores remained unmodified during the treatment; in no patient the intraventricular haemorrhage worsened in time and none of the infants developed periventricular leucomalacia. Conclusions Our experience, using the Vojta method, allows to affirm that this method is safe for preterm neonates, but further investigations are necessary to confirm its positive effects and to evaluate long-term respiratory outcomes.

Background: Preterm infants are at high risk for retinopathy of prematurity (ROP), with potential life-long visual impairment. Low fetal hemoglobin (HbF) levels predict ROP. It is unknown if preventing the HbF decrease also reduces ROP., Methods: BORN is an ongoing multicenter double-blinded randomized controlled trial investigating whether transfusing HbF-enriched cord blood-red blood cells (CB-RBCs) instead of adult donor-RBC units (A-RBCs) reduces the incidence of severe ROP (NCT05100212). Neonates born between 24 and 27 + 6 weeks of gestation are enrolled and randomized 1:1 to receive adult donor-RBCs (A-RBCs, arm A) or allogeneic CB-RBCs (arm B) from birth to the postmenstrual age (PMA) of 31 + 6 weeks. Primary outcome is the rate of severe ROP at 40 weeks of PMA or discharge, with a sample size of 146 patients. A prespecified interim analysis was scheduled after the first 58 patients were enrolled, with the main purpose to evaluate the safety of CB-RBC transfusions., Results: Results in the intention-to-treat and per-protocol analysis are reported. Twenty-eight patients were in arm A and 30 in arm B. Overall, 104 A-RBC units and 49 CB-RBC units were transfused, with a high rate of protocol deviations. A total of 336 adverse events were recorded, with similar incidence and severity in the two arms. By per-protocol analysis, patients receiving A-RBCs or both RBC types experienced more adverse events than non-transfused patients or those transfused exclusively with CB-RBCs, and suffered from more severe forms of bradycardia, pulmonary hypertension, and hemodynamically significant patent ductus arteriosus. Serum potassium, lactate, and pH were similar after CB-RBCs or A-RBCs. Fourteen patients died and 44 were evaluated for ROP. Ten of them developed severe ROP, with no differences between arms. At per-protocol analysis each A-RBC transfusion carried a relative risk for severe ROP of 1.66 (95% CI 1.06-2.20) in comparison with CB-RBCs. The area under the curve of HbF suggested that HbF decrement before 30 weeks PMA is critical for severe ROP development. Subsequent CB-RBC transfusions do not lessen the ROP risk., Conclusions: The interim analysis shows that CB-RBC transfusion strategy in preterm neonates is safe and, if early adopted, might protect them from severe ROP., Trial Registration: Prospectively registered at ClinicalTrials.gov on October 29, 2021. Identifier number NCT05100212., (© 2024. The Author(s).)

Repeated red blood cell (RBC) transfusions in preterm neonates cause the progressive displacement of fetal hemoglobin (HbF) by adult hemoglobin. The ensuing increase of oxygen delivery may result at the cellular level in a dangerous condition of hyperoxia, explaining the association between low-HbF levels and retinopathy of prematurity or bronchopulmonary dysplasia. Transfusing preterm neonates with RBC concentrates obtained from allogeneic umbilical blood is a strategy to increase hemoglobin concentration without depleting the physiologic HbF reservoir. This review summarizes the mechanisms underlying a plausible beneficial impact of this strategy and reports clinical experience gathered so far in this field., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Importance: Repeated transfusions in preterm neonates with anemia of prematurity replace fetal hemoglobin (HbF) with adult Hb (HbA), which has a low oxygen affinity. The reduction of HbF is associated with a higher incidence of retinopathy of prematurity (ROP)., Objective: To assess whether HbF and HbA are differently associated with cerebral tissue oxygenation in preterm neonates., Design, Setting, and Participants: This cohort study was a single-center, pilot study on cerebral oxygenation kinetics in preterm neonates with a gestational age between 24.0 weeks and 27.9 weeks who were admitted to the neonatal intensive care unit of Policlinico Universitario A. Gemelli IRCCS from December 27, 2021, to May 15, 2023. This study was ancillary to the ongoing, double-blind, multicenter Umbilical or Adult Donor Red Blood Cells in Extremely Low Gestational Age Neonates and Retinopathy of Prematurity (BORN) randomized clinical trial. The BORN trial outcome was ROP severity in neonates randomized to receive standard packed red blood cell (PRBC) transfusions obtained from RBCs of adult donors (A-RBCs) or from cord blood (CB-RBCs). According to standard procedures at the institute's neonatal intensive care unit, patients concurrently received continuous cerebral near-infrared spectroscopy (NIRS) monitoring. This cohort study was not prespecified in the trial protocol., Exposure: Transfusion with A-RBCs or CB-RBCs., Main Outcomes and Measures: The main outcome was the kinetics of cerebral regional oxygen saturation (crSO2) and cerebral fraction of tissue oxygen extraction (cFTOE) associated with A-RBC or CB-RBC transfusions. Cerebral NIRS monitoring was performed by neonatologists and nurses, who were blinded to the PRBC type. The NIRS monitoring was conducted starting with the blood product order, during transfusion, and for the subsequent 24 hours after transfusion completion. The mean treatment effects of A-RBCs or CB-RBCs were quantified using a linear mixed model for repeated measures., Results: Of 23 randomized neonates, 17 (11 male [64.7%]; median gestational age at birth, 25.6 weeks [IQR, 25.3-26.1 weeks]) with a median birth weight of 840 g (IQR, 580-900 g) were included in the study; NIRS was evaluated for 42 transfusion episodes, of which 22 were A-RBCs and 20 were CB-RBCs. Globally considering all posttransfusion time points, the overall crSO2 covariate-adjusted mean after CB-RBC transfusions was 5.27% lower (95% CI, 1.20%-9.34%; P = .01) than that after A-RBC transfusions, while the cFTOE after CB-RBC transfusions was 6.18% higher (95% CI, 1.66%-10.69%; P = .009) than that after A-RBCs., Conclusions and Relevance: The findings of this cohort study suggest that A-RBC transfusions may be associated with more oxygen delivery to cerebral tissues of preterm neonates than transfusions from CB-RBCs. This finding may explain the previously observed association between low HbF and high ROP risk. It also suggests that use of CB to meet the RBC transfusion needs of neonates with a gestational age of less than 28 weeks may protect cerebral tissues from overexposure to oxygen.

Background: Extremely low gestational age neonates (ELGANs, i.e., neonates born before 28 weeks of gestation) are at high risk of developing retinopathy of prematurity (ROP), with potential long-life visual impairment. Due to concomitant anemia, ELGANs need repeated red blood cell (RBC) transfusions. These produce a progressive replacement of fetal hemoglobin (HbF) by adult hemoglobin (HbA). Furthermore, a close association exists between low levels of HbF and severe ROP, suggesting that a perturbation of the HbF-mediated oxygen release may derange retinal angiogenesis and promote ROP., Methods/design: BORN (umBilical blOod to tRansfuse preterm Neonates) is a multicenter double-blinded randomized controlled trial in ELGANs, to assess the effect of allogeneic cord blood RBC transfusions (CB-RBCs) on severe ROP development. Recruitment, consent, and randomization take place at 10 neonatology intensive care units (NICUs) of 8 Italian tertiary hospitals. ELGANs with gestational age at birth comprised between 24+0 and 27+6 weeks are randomly allocated into two groups: (1) standard RBC transfusions (adult-RBCs) (control arm) and (2) CB-RBCs (intervention arm). In case of transfusion need, enrolled patients receive transfusions according to the allocation arm, unless an ABO/RhD CB-RBC is unavailable. Nine Italian public CB banks cooperate to make available a suitable amount of CB-RBC units for all participating NICUs. The primary outcome is the incidence of severe ROP (stage 3 or higher) at discharge or 40 weeks of postmenstrual age, which occurs first., Discussion: BORN is a groundbreaking trial, pioneering a new transfusion approach dedicated to ELGANs at high risk for severe ROP. In previous non-randomized trials, this transfusion approach was proven feasible and able to prevent the HbF decrease in patients requiring multiple transfusions. Should the BORN trial confirm the efficacy of CB-RBCs in reducing ROP severity, this transfusion strategy would become the preferential blood product to be used in severely preterm neonates., Trial Registration: ClinicalTrials.gov NCT05100212. Registered on October 29, 2021., (© 2022. The Author(s).)

Repeated red blood cell (RBC) transfusions are thought to increase the risk for retinopathy of prematurity (ROP), likely due to a critical fetal hemoglobin (HbF) reduction. In this study, we investigated if the postmenstrual age (PMA) of neonates at transfusion influences the risk for ROP. We estimated the cumulative transfusion-free survival (TFS) in a series of 100 preterm neonates receiving one or more RBC units. TFS was calculated by censoring patients at first transfusion and expressing the time between birth and transfusion as either PMA or postnatal day. Then, we investigated if TFS predicted the occurrence of severe ROP, defined as ROP stage 3 or higher. We found that neonates with severe ROP displayed a significantly shorter TFS expressed according to their PMA ( p = 0.001), with similar TFS according to postnatal days. At receiver operating characteristic (ROC) curve analysis, receiving an RBC unit before week 28 of PMA predicted severe ROP with a sensitivity of 64% and a specificity of 78%. In addition, receiving a second RBC unit before the PMA of 29 weeks predicted severe ROP with a sensitivity of 75% and a specificity of 69%. At multivariate analysis, PMA at the second transfusion was even more informative than at first transfusion and outperformed all other variables in predicting severe ROP, with an odds ratio of 4.554 (95% CI 1.332-15.573, p = 0.016). Since HbF decrease is greater after multiple RBC transfusions, it is conceivable that neonates receiving more than one unit before the PMA of 29 weeks may be exposed to a greater disturbance of retinal vascularization. Any strategy aimed at preventing the critical HbF decrease at this low age might potentially reduce the risk for severe ROP., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Teofili, Papacci, Bartolo, Molisso, Orlando, Pane, Giannantonio, Serrao, Bianchi, Valentini, Pellegrino, Baldascino, Carducci, Lepore and Vento.)

Background: Retinopathy of prematurity (ROP) is a multifactorial retinal disorder characterized by an abnormal vascular development of the retina of the preterm infants. Carotenoids are natural pigments that are synthesized by all plants and some microorganisms where they play a role in photoprotection and coloration. Lutein and zeaxanthin (L/Z) are two carotenoids identified as the major components of the macular pigment. Recently it has been suggested that lutein and its isomer zeaxanthin may act as antioxidant agents and that they may prevent ROP., Objective: The primary objective of this study is to assess the safety and effectiveness of oral lutein in the prevention of retinopathy of prematurity in preterm neonates., Study Design: We conducted a systematic search for randomized or quasi-randomized controlled trials without any language or publication year restriction. The studies have to recruit preterm neonates ≤32 completed weeks of gestation and to compare the administration of oral L/Z at any dosage or duration, versus placebo in order to prevent ROP., Result: Data from three RCT with a total of 406 participants failed to show any reduction in ROP incidence nor the risk of BPD, sepsis, NEC and mortality. It may reduce the number of transfusions but this result has to be assessed in a separate ad hoc trial.

Repeated red blood cell (RBC) transfusions in preterm neonates are associated with poor outcome and increased risk for prematurity-associated diseases. RBC transfusions cause the progressive replacement of fetal haemoglobin (HbF) by adult haemoglobin (HbA). We monitored HbF levels in 25 preterm neonates until 36 weeks of post-menstrual age (PMA); patients received RBC units from allogeneic cord blood (cord-RBCs) or from adult donors (adult-RBCs), depending on whether cord-RBCs were available. Primary outcome was HbF level at PMA of 32 weeks. Twenty-three neonates survived until this age: 14 received no transfusions, two only cord-RBCs, three only adult-RBCs and four both RBC types. HbF levels in neonates transfused with cord-RBCs were significantly higher than in neonates receiving adult-RBCs (P < 0·0001) or both RBC types (P < 0·0001). Superimposable results were obtained at PMA of 36 weeks. Every adult-RBCs transfusion increased the risk for an HbF in the lowest quartile by about 10-fold, whereas this effect was not evident if combined adult- and cord-RBCs were evaluated. Overall, these data show that transfusing cord-RBCs can limit the HbF depletion caused by conventional RBC transfusions. Transfusing cord blood warrants investigation in randomised trials as a strategy to mitigate the severity of retinopathy of prematurity (NCT03764813)., (© 2020 British Society for Haematology and John Wiley & Sons Ltd.)

Objective: To investigate recombinant human insulin-like growth factor 1 complexed with its binding protein (rhIGF-1/rhIGFBP-3) for the prevention of retinopathy of prematurity (ROP) and other complications of prematurity among extremely preterm infants., Study Design: This phase 2 trial was conducted from September 2014 to March 2016. Infants born at a gestational age of 23 0/7  weeks to 27 6/7  weeks were randomly allocated to rhIGF-1/rhIGFBP-3 (250 µg/kg/ 24 hours, continuous intravenous infusion from <24 hours of birth to postmenstrual age 29 6/7  weeks) or standard neonatal care, with follow-up to a postmenstrual age of 40 4/7  weeks. Target exposure was ≥70% IGF-1 measurements within 28-109 µg/L and ≥70% intended therapy duration. The primary endpoint was maximum severity of ROP. Secondary endpoints included time to discharge from neonatal care, bronchopulmonary dysplasia, intraventricular hemorrhage, and growth measures., Results: Overall, 61 infants were allocated to rhIGF-1/rhIGFBP-3, 60 to standard care (full analysis set); 24 of 61 treated infants achieved target exposure (evaluable set). rhIGF-1/rhIGFBP-3 did not decrease ROP severity or ROP occurrence. There was, however, a 53% decrease in severe bronchopulmonary dysplasia in the full analysis set (21.3% treated vs 44.9% standard care), and an 89% decrease in the evaluable set (4.8% vs 44.9%; P = .04 and P = .02, respectively) for severity distribution between groups. There was also a nonsignificant trend toward decrease in grades 3-4 intraventricular hemorrhage in the full analysis set (13.1% vs 23.3%) and in the evaluable set (8.3% vs 23.3%). Fatal serious adverse events were reported in 19.7% of treated infants (12/61) and 11.7% of control infants (7/60). No effect was observed on time to discharge from neonatal care/growth measures., Conclusions: rhIGF-1/rhIGFBP-3 did not affect development of ROP, but decreased the occurrence of severe bronchopulmonary dysplasia, with a nonsignificant decrease in grades 3-4 intraventricular hemorrhage., Trial Registration: ClinicalTrials.gov: NCT01096784., (Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aims: Preterm breast milk contains high levels of bioactive components, including insulin-like growth factor 1 (IGF-1), that are reduced by Holder pasteurization. Animal studies have shown that milk-borne IGF-1 is likely absorbed intact in a bioactive form by the intestines. The aim of this study was to assess if early non-pasteurized expressed breast milk nutrition may affect IGF-1 plasma levels in premature infants. We also investigated the possible association between early expressed milk nutrition and short-term outcomes., Methods: Fifty-two preterm infants with gestational age < 31 weeks were divided into two groups according to expressed breast milk intake (< or ≥ 50 mL/Kg/day) until 32 weeks of postmenstrual age when blood sampling for IGF-1 analysis was performed., Results: In our population, early expressed breast milk does not affect IGF-1 plasma levels (p 0.48). An association was observed between early expressed milk nutrition and a lower incidence of bronchopulmonary dysplasia, sepsis, feeding intolerance, need for parenteral nutrition and length of hospitalization., Conclusions: Contrary to the results in some animal studies, our results did not seem to show that early expressed breast milk can help to maintain postnatal IGF-1 near foetal levels in preterm infants. The observed protective effect of expressed breast milk on short-term outcomes can be the starting point for further study of the effects of non-pasteurized human milk in preterm infants., Competing Interests: The authors have declared that no competing interests exist.

Background: Preterm infants often receive blood transfusions early in life. In this setting, umbilical cord blood (UCB) might be safer than adult blood (A) with respect to infectious and immunologic threats., Objectives: To evaluate, as a first objective, the feasibility of fulfilling transfusion needs of preterm infants with allogeneic UCB red blood cell (RBC) concentrates and, as a secondary objective, to assess the safety of allogeneic cord blood transfusions., Methods: At the Neonatal Intensive Care Unit and the UNICATT Cord Blood Bank of 'A. Gemelli' Hospital in Rome, a prospective study was carried out over a 1-year period, enrolling newborns with gestational age ≤30 weeks and/or birth weight ≤1,500 g requiring RBC transfusions within the first 28 days of life. At first transfusion, patients were assigned to receive UCB-RBCs or A-RBCs depending on the availability of ABO-Rh(D)-matched UCB-RBC units. The same regimen (UCB-RBC or A-RBC units) was thereafter maintained, unless ABO-Rh(D)-matched UCB-RBC units were not available., Results: Overall, 23 UCB-RBC units were transfused to 9 patients; the requests for UCB-RBC units were met in 45% of patients at the first transfusion and in 78% at the subsequent transfusions. At a median follow-up of 57 days (range 6-219), no acute or delayed transfusion-related adverse events occurred. Hematocrit gain after transfusion and time intervals between transfusions were similar in the UCB-RBC and A-RBC group, as well., Conclusions: Transfusing allogeneic UCB-RBC units in preterm infants appears a feasible and safe approach, although the transfusion needs of our study population were not completely covered. More data are necessary to validate this novel transfusion practice., (© 2014 S. Karger AG, Basel.)

Purpose: To compare the structural outcome at 9 months of eyes treated with intravitreal injection of bevacizumab with fellow eyes treated with conventional laser photoablation in zone I type 1 retinopathy of prematurity (ROP)., Design: Single randomized controlled trial., Participants: All inborn babies with type 1 zone I ROP at a single institution were included in the study. One eye was randomized to receive an intravitreal injection of 0.5 mg bevacizumab; the fellow eye received conventional laser photoablation., Methods: Digital fundus photographs and fluorescein angiography (FA) using the RetCam (Clarity Medical Systems Inc., Pleasanton, CA) were performed before treatment and 9 months after treatment., Main Outcome Measures: Presence of retinal and choroidal abnormalities on FA at 9 months., Results: Thirteen infants were enrolled; 1 died 3 months after birth. One laser-treated eye progressed to stage 5 retinal detachment. The remaining 23 eyes had favorable structural results at the 9-month follow-up and provided FA results. At 9 months of age, all eyes treated with a bevacizumab injection were noted to have abnormalities at the periphery (large avascular area, abnormal branching, shunt) or the posterior pole (hyperfluorescent lesion, absence of foveal avascular zone). These posterior and peripheral lesions were not observed in the majority of the lasered eyes., Conclusions: This study documents significant vascular and macular abnormalities of eyes in the bevacizumab group. Long-lasting implications of these abnormalities for visual function of the child need to be studied., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: To test the hypothesis that lutein, compared to the placebo, would enhance the total antioxidant status (TAS) in the preterm infants., Methods: Infants with gestational age (GA) ≤34 weeks were randomly assigned to receive a daily dose of lutein and zeaxanthin (0.5 mg + 0.02 mg/kg/d) or placebo from the 7th day of life until 40th week of postmenstrual age or until discharge., Results: Seventy-seven preterm infants were randomized (38 in the Lutein group and 39 in the Placebo group) with mean GA of 30.4 (±2.3) weeks and the mean birth weight of 1415 (±457) grams. The TAS did not result statistically different between the two groups during all the study period, but a significant linear correlation was evidenced between plasma lutein concentration and TAS (r = 0.14, p = 0.012) and between plasma zeaxanthin concentration and TAS (r = 0.13, p = 0.02)., Conclusions: Supplementation of preterm infants with orally lutein was ineffective in enhancing biological antioxidant capacity. Further studies need to better understand the bioavailability of lutein in the neonatal period in order to identify any best form of supplementation., Trial Registration Number: UMIN000007041.

Objective: To investigate the role of fluorescein angiography (FA) in the management of retinopathy of prematurity (ROP) in preterm newborns., Methods: An observational case series of 13 extremely low birth weight infants. From September 2009 to March 2010, 13 newborn infants with a gestational age <29 weeks end/or birth weight <1000 g underwent serial fluorescein angiography with RetCam (Clarity, Pleasanton, CA) every 2 weeks. The fluorescein angiograms were examined to optimize the timing of diagnosis of ROP and to investigate development of retinal and choroidal vascularization., Results: There were no side effects related to FA. Variable features of retinal and choroidal circulation in preterm infants with a high risk of developing ROP were noted. FA allows vessels branching at the junction between vascular and avascular retina (V-Av junction) to be viewed easily and shows the ROP findings that sometimes cannot be seen by indirect ophthalmoscopy. Dye leakage is the most significant sign of progression to severe ROP or the need for surgery in newborn babies with ROP., Conclusions: RetCam-assisted intravenous FA is safe and allows a more objective assessment of the ROP stage and zone.

Twin pregnancies are considered at a higher risk for fetal mortality than singleton pregnancies. The antenatal death of one of the twins is associated with an increasing rate of cerebral impairment and lesions in other organs in the surviving fetus, especially if the pregnancy is monochorionic. We describe a case of isolate renal failure becoming evident gradually after birth in a surviving twin after the antenatal death of the co-twin. Considering the deleterious effects of vascular disruption in a surviving twin, our findings suggest careful investigation of renal function, even if no intrauterine signs of diminished renal function were previously detected.

Lutein has been shown to have antioxidant functions in newborns and with zeaxantin selectively taken up into the macula of the eye. We hypothesize that lutein administration may contribute to reducing the incidence of Retinopathy of Prematurity (ROP). This was a single center, double-blind randomized controlled study. Preterm infants with gestational age (GA) ≤ 32 weeks able to tolerate minimal enteral feeding before the seventh day of life (DOL) were enrolled; lutein and zeaxantin plasma concentrations and ROP occurrence and severity were evaluated. Sixty-three newborns were enrolled, 31 in the lutein group and 32 in the placebo group (one died before ROP assessment). The mean GA was 29.9 (± 1.9) weeks and the mean birth weight was 1331 (± 415) grams. There were no differences in the incidence of ROP at any stage between groups. Oxidative injury is probably an additional mechanism of damage of the developing retinal vessels, and it probably plays only a minor role in the pathogenesis of ROP. Supplementation with antioxidant substances might have beneficial effects noticeable only on larger samples of high risk neonates or at very high dosage. Further investigations would be needed to evaluate whether lutein supplementation can influence functional rather than anatomical outcomes in preterm infants.

Purpose: This study assessed the effectiveness of the use of ketorolac tromethamine to reduce retinopathy of prematurity (ROP) incidence and its progression to more severe forms., Methods: Forty-seven preterm newborn infants with a birth weight (BW) of 1,000 grams or less and/or a gestational age (GA) of 29 weeks or less were enrolled in the study when avascular retina zone I or ROP any stage were diagnosed at screening. Studied infants were randomized to receive ketorolac tromethamine ophthalmic solution in one eye and a drop of placebo in the other eye, until ROP requiring treatment or full retinal vascularization was diagnosed., Results: Only 2 newborn infants did not develop ROP. Among 45 newborn infants who developed ROP, 6 showed different ROP staging between the two eyes, 4 of which had a better outcome in the eye receiving ketorolac tromethamine. The differences between ROP stagings were not significant even when analyzed by GA and BW subgroups. No significant treatment-related side effects occurred., Conclusion: This report suggests that ketorolac tromethamine ophthalmic solution cannot reduce the risk of developing severe ROP in preterm infants., (Copyright 2011, SLACK Incorporated.)

Background: In neonatology the role of chest physiotherapy is still uncertain because of the controversial outcomes., Methods: The aim of this study was to test the applicability in preterm infants of 'reflex rolling', from the Vojta method, in preterm neonates with lung pathology, with particular attention to the effects on blood gases and oxygen saturation, on the spontaneous breathing, on the onset of stress or pain. The study included 34 preterm newborns with mean gestational age of 30.5 (1.6) weeks - mean (DS) - and birth weight of 1430 (423) g - mean (DS) -, who suffered from hyaline membrane disease, under treatment with nasal CPAP (continuous positive airways pressure), or from pneumonia, under treatment with oxygen-therapy. The neonates underwent phase 1 of 'reflex rolling' according to Vojta method three times daily. Respiratory rate, SatO2, transcutaneous PtcCO2 e PtcO2 were monitored; in order to evaluate the onset of stress or pain following the stimulations, the NIPS score and the PIPP score were recorded; cerebral ultrasound scans were performed on postnatal days 1-3-5-7, and then weekly., Results: In this population the first phase of Vojta's 'reflex rolling' caused an increase of PtcO2 and SatO2 values. No negative effects on PtcCO2 and respiratory rate were observed, NIPS and PIPP stress scores remained unmodified during the treatment; in no patient the intraventricular haemorrhage worsened in time and none of the infants developed periventricular leucomalacia., Conclusions: Our experience, using the Vojta method, allows to affirm that this method is safe for preterm neonates, but further investigations are necessary to confirm its positive effects and to evaluate long-term respiratory outcomes.

Objective: The objective of this study was to evaluate clinical and epidemiological characteristics of the maternal and neonatal immigrant population and to compare it with the Italian population in the Agostino Gemelli Hospital (Rome)., Methods: This study was a prospective population-based study. We compared 595 newborns from immigrant mothers with 2413 newborns from Italian mothers. Neonatal characteristics included in this study were sex, gestational age, birth weight, Apgar score, transfer to pathology units, minor pathologies, and type of breastfeeding at discharge. Maternal characteristics included nationality, age, parity, type of delivery, twin birth, and pathology during the pregnancy., Results: Immigrant newborns comprised 20% of the total births included in the study. No statistically significant differences were found between immigrant and Italian newborns in gestational age, birth weight, or Apgar score. Immigrant newborns were transferred to the Paediatric Infectious Disease Unit more frequently than Italian newborns, had a significantly higher incidence of hyperbilirubinemia and a higher rate of exclusive and prevalent breastfeeding at discharge. Immigrant mothers came predominantly from Eastern Europe, were younger and had caesarean sections less frequently than Italian mothers., Conclusion: No significant differences in biological and clinical characteristics or in medical practice were found between groups, except for a higher frequency of neonatal hyperbilirubinemia and an inclination among immigrant mothers toward breastfeeding.

Aim: To assess efficacy of remifentanil in preterm newborns during mechanical ventilation., Methods: Remifentanil was administered by continuous intravenous infusion to provide analgesia and sedation in 48 preterm infants who developed respiratory distress and required mechanical ventilation. We examined the doses needed to provide adequate analgesia, extubation time after the discontinuation of opioid infusion, the presence of side effects and safety of the use., Results: Remifentanil provided adequate analgesia, with a significant reduction of NIPS and COMFORT score since 1 h after starting the infusion of remifentanil. The drug was initially administered at a dose of 0.075 microg/kg/min, but in 73% of newborns the latter had to be increased; at a dose of 0.094 +/- 0.03 (mean +/- standard deviation) microg/kg/min, 97% of the newborns received adequate analgesia and sedation. The time elapsed between the discontinuation of remifentanil infusion and extubation was 36 +/- 12 min. Treatment was started between the 1st and the 17th day of life. The mean duration of therapy was 5.9 +/- 5.7 days. No side effects on the respiratory or cardiovascular system were observed., Conclusion: Remifentanil is a manageable and effective opioid in the newborn undergoing mechanical ventilation, though randomized controlled trials and information about long-term outcomes are necessary.

Background: Doppler US to measure abdominal blood flow velocities (ABFV) is increasingly used to investigate intestinal haemodynamics in several clinical conditions in neonates. Studies that provide reference values of ABFV during the entire neonatal period are currently lacking., Objective: To make available normal reference values of ABFV and Doppler indices in the coeliac trunk and superior mesenteric artery during the first month of life in term and healthy preterm infants., Materials and Methods: ABFV were obtained with colour Doppler US in 69 neonates (12 term, 57 preterm) divided into four gestational age groups (25-28 weeks, 29-32 weeks, 33-36 weeks, and 37-41 weeks)., Results: ABFV increased with increasing gestational and postnatal age. We also provide normal reference values of ABFV and Doppler indices to compare with measurements of abdominal blood flow changes during the neonatal period for diagnostic, therapeutic and prognostic purposes., Conclusion: These longitudinal reference values provide a useful tool for assessing possible alteration in ABFV secondary to neonatal pathologies.

Purpose: To analyze the incidence of retinopathy of prematurity (ROP) in a single neonatal intensive care unit over 10 years to clarify its ROP profile and how it was modified by advances in neonatal care., Methods: Epidemiological data related to incidence and severity of ROP were collected over 10 years. Premature infants with a birth weight of less than 1,500 g underwent a screening fundus examination and ROP was defined according to the International Classification of Retinopathy of Prematurity. The survival rates and incidence of ROP were calculated and compared for two consecutive time periods (1995-1999 vs 2000-2004), dividing the study population into subgroups according to their birth weights and gestational age., Results: Data of 607 preterm infants were collected. Survival rate significantly improved in the later time period (from 76.6% to 88.6%). The incidence of total, severe, and surgical ROP did not differ overall in the two time periods despite changes in survival rate, although some changes occurred in the most immature infants over time., Conclusion: Increased survival of immature infants seemed to correlate with an increased risk for severe ROP and need for retinal ablation therapy, even if the incidence did not reach statistical significance.

The aim of this study is to generate normal reference values of cerebral blood flow velocities (CBFV) and Doppler indices (DI) in the anterior (ACA) and the middle (MCA) cerebral arteries during the first month of life in "healthy" preterm infants. CBFV were obtained with color Doppler technique in seventy selected preterm infants divided in four groups of gestational age (GA) (25 to 28; 29 to 30; 31 to 32; 33 to 35 wk). Our data demonstrate that CBFV increase with rising GA, birth weight (BW) and postnatal age. Additionally, we can provide the median values, tenth and ninetieth percentiles of CBFV and DI, in the ACA and MCA in each GA group as reference normal values of CBFV and DI in preterm newborn.