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Abstract: Despite using antenatal steroids, surfactants and protective ventilation, bronchopulmo-nary dysplasia (BPD) affects 10-89% of preterm infants. Since lung inflammation is central to the BPD pathogenesis, postnatal systemic corticosteroids could reduce the risk of BPD onset in preterm infants, but short and long-term adverse consequences have been underlined in literature after their use (i.e., hyperglycaemia, hypertension, hypertrophic cardiomyopathy, growth failure, gastrointesti-nal bleeding, cerebral palsy). Alternative therapeutic strategies such as postponing corticosteroid administration, lowering the cumulative dose, giving pulse rather than continuous doses, or individ-ualizing the dose according to the respiratory condition of the infant have been proposed to avoid their adverse effects. Dexamethasone remains the first-line drug for newborns with severe pulmo-nary disease beyond the second to the third week of life. Hydrocortisone administration in very pre-term infants does not appear to be associated with neurotoxic effects, even if its efficacy in prevent-ing and treating BPD has yet been clearly demonstrated. Alternative methods of corticosteroid ad-ministration seem promising. A positive effect on BPD prevention occurs when budesonide is nebu-lized and intratracheally instilled with a surfactant, but more data are required to establish safety and efficacy in preterm newborns. Additional studies are still needed before the chronic lung dis-ease issue, and its related challenges can be solved.

Background Delayed umbilical cord clamping is associated with greater haemoglobin concentration and iron storage between 3 and 6 months of life and with less need of blood transfusion and lower incidence of neonatal hypotension compared to early umbilical cord clamping. Methods The aim was to test the hypothesis that delayed cord clamping is better than early cord clamping in term infants born by elective caesarean section. Group A was subjected to immediate cord clamping while in the Group B, the umbilical cord was clamped 1 min after birth. Primary aim was revealed the difference in pre-ductal saturation between two groups while secondary aim was investigating the difference in HR, Ht, bilirubin and glycaemia. Pre-ductal SpO2 and HR were recorded at 5 and 10 min after birth, T was analysed 10 min after birth, glycaemia was revealed at 120 min while Ht and bilirubin were collected at 72 h. Results 132 newborns were enrolled in the study and allocated in ratio 1:1 to group A or B. Delayed cord clamping did not improve SpO2, HR and T values compared to immediate cord clamping (p > 0,05). However, Group B showed greater haematocrit and bilirubin values at 72 h compared to Group A (56,71 ± 6663 vs 51,56 ± 6929; p p p > 0,05). Conclusions Group B did not reveal any differences in SpO2, HR, T and glycaemia compared to Group A. Group B showed greater values of haematocrit and bilirubin but without need of phototherapy. Trial registration Umbilical Cord Clamping: What Are the Benefits; NCT03878602. Registered 18 March 2019 retrospectively registered.

Introduction. Pulse oximetry screening is a safe, feasible test, effective in identifying congenital heart diseases in otherwise well-appearing newborns. Uncertainties still persist on the most effective algorithm to be used and the timing of screening. The aim of this study was to evaluate the role of the pulse oximetry screening associated with the peripheral perfusion index performed in the first 24 hours of life for the early detection of congenital heart diseases and noncongenital heart diseases in the newborns. Materials and Methods. A prospective observational cohort study was conducted. The enrollment criteria were as follows: term newborns with an APGAR score >8 at 5 minutes. The exclusion criteria were as follows: clinical signs of prenatal/perinatal asphyxia or known congenital malformations. Four parameters of pulse oximetry screening were utilized: saturation less than 90% (screening 1), saturation of less than 95% in one or both limbs (screening 2), difference of more than 3% between the limbs (screening 3), and preductal peripheral perfusion index or postductal peripheral perfusion index below 0.70 (screening 4). The likelihood ratio, sensibility, specificity, and positive and negative predictive values for identification of congenital heart diseases or noncongenital heart diseases (suspicion of perinatal infection and any respiratory diseases) were evaluated. Results. The best predictive results for minor congenital heart disease were obtained combining screening 3 and screening 4 (χ2 (1) = 15,279; p < 0.05 ; OR = 57,900 (9,465–354,180)). Screening 2, screening 3, and screening 4 were predictive for noncongenital heart diseases (χ2 (1) = 11,550; p < 0.05 ; OR = 65,744 (10,413–415,097)). Combined screenings 2–4 were predictive for both congenital heart disease and noncongenital heart disease (χ2 (1) = 22,155; p < 0.05 ; OR = 117,685 (12,972–1067,648)). Conclusions. Combining peripheral saturation with the peripheral perfusion index in the first 24 hours of life shows a predictive role in the detection of minor congenital heart diseases and neonatal clinical conditions whose care needs attention.

Prematurity is a risk factor for the development of chronic adult diseases. Metabolomics can correlate the biochemical changes to a determined phenotype, obtaining real information about the state of health of a subject at that precise moment. Significative differences in the metabolomic profile of preterm newborns compared to those born at term have been already identified at birth. An observational case–control study was performed at the University Hospital of Siena. The aim was to evaluate and compare the metabolomic profiles of young adults born preterm to those born at term. Urinary samples were collected from 67 young adults (18–23 years old) born preterm (mean gestational age of 30 weeks, n = 49), and at term of pregnancy (mean gestational age of 38 weeks, n = 18). The urinary spectra of young adults born preterm was different from those born at term and resembled what was previously described at birth. The Random Forest algorithm gave the best classification (accuracy 82%) and indicated the following metabolites as responsible for the classification: citrate, CH2 creatinine, fumarate and hippurate. Urine spectra are promising tools for the early identification of neonates at risk of disease in adulthood and may provide insight into the pathogenesis and effects of fetal programming and infants’ outcomes.

Giuseppe De Bernardo,1 Marina Riccitelli,2 Desiree Sordino,1 Maurizio Giordano,3 Sabrina Piccolo,1 Giuseppe Buonocore,2 Serafina Perrone2 1Department of Emergency, NICU, AORN Santobono-Pausilipon, Naples, Italy; 2Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy; 3Faculty of Medicine, Federico II University, Naples, Italy Objective: To test the hypothesis that oral administration of 24% sucrose associated with ­nonnutritive sucking in healthy newborns receiving venipuncture beyond the first week of life controls pain and pain-related variation in heart rate (HR) and noninvasive oxygen saturation (SpO2).Methods: A total of 66 term newborns were enrolled between February and September 2017 in the Neonatology Department of AORN Santobono-Pausilipon, Naples. They were randomly assigned to receive oral 1 mL 24% sucrose (treated group [TG], n=33; gestational age 38.53±1.49 weeks; body weight 3,035±55 g; age 22.40±6.82 weeks) or oral 1 mL 10% glucose (control group [CG], n=33; gestational age 38.91±1.45 weeks; body weight 3,203±65 g; age 23.36±7.02 weeks) 1 minute before and during venipuncture. Evaluations were carried out between 8 and 9 am in all newborns. The Neonatal Infant Pain Scale (NIPS) was used to assess pain in newborns. Outcome measurements (HR, SpO2) were obtained before (T0), during (T1), and 1 minute after (T2) venipuncture using a Nellcor bedside SpO2 patient-monitoring system. NIPS scores were recorded throughout the procedure. Statistical analysis was performed using SPSS version 20.0. Changes in HR and SpO2 were assessed by mixed ANOVA for repeated measures. NIPS scores were evaluated by Mann–Whitney U test.Results: There were no statistically significant differences in HR or SpO2 between TG and CG at T0. HR was significantly lower in TG than CG at both T1 and T2 (P

BACKGROUND The use of simulation-based medical education is strongly recommended to insure neonatal resuscitation skills for health caregivers. High fidelity simulation was executed to allow the evaluation of technical and non-technical skills. Salivary cortisol level was considered reliable biomarkers of adrenocortical activity and useful tool to learning assessment and stress response. METHODS Our primary aim was to test changes in salivary cortisol levels before and after the simulation for neonatal resuscitation between high and low fidelity setting. Secondary aim was to evaluate salivary cortisol level in the participants, leader and not leader. Fifty-two health care providers were divided in ratio 1:1 into low-fidelity (LF group) and high-fidelity scenario (HF group) of neonatal resuscitation. In each group the participants assumed the role of team leader or not team leader. Salivary samples were collected from all participants 5 minutes before and after each simulation scenario by using oral swab. Analysis of difference was analysed by Kruskal Wallis test. RESULTS Salivary cortisol levels were significantly higher in HF group (n=26) than LF group (n=26) before the performance (5,407 mmol/l vs 3,090 mmol/l; p=0.018). In the HF group, salivary cortisol levels were significantly lower after simulation than before (p=0.007), moreover not team leader showed higher salivary cortisol levels before of the simulation than after (p=0.003). Team leaders showed higher salivary cortisol levels than not team leader after high-fidelity scenario (p=0.039). CONCLUSIONS High-fidelity simulation scenario had a great impact on stress level, furthermore leaders showed higher salivary cortisol levels than not team leaders.

Supplemental material, sj-docx-1-jicm-10.1177_08850666211055058 for Improving Care in Neonatal Intensive Units During the COVID-19 Pandemic: A Survey on Electronic Health Communication by De Bernardo Giuseppe, Napoletano Giuseppina, Sordino Desiree, Sodano Angela, Giordano Maurizio and Serafina Perrone in Journal of Intensive Care Medicine

The COVID-19 pneumonia was firstly reported in Wuhan, China, in December 2019. The disease had a rapid spread all over the word becoming an international public health emergency. Limited data were available on COVID-19 positive neonates. We reviewed relevant literature to understand the clinical course of disease and transmission routes in affected neonates. The aim of the study was evaluating the clinical course and prognosis of SARS-CoV-2 positive neonates. Based on current literature, the hypothesis of vertical transmission of SARS-CoV-2, though conceivable, remains unproven. A research conducted on PubMed database from December 2019 to April 27, 2020 revealed that were reported 25 neonates affected by SARS-CoV-2. Main symptoms were fever, cough, or shortness of breath but often these neonates did not show other symptoms during length stay in hospital. No deaths occurred.

Background Neonatal acidaemia at birth can increase neonatal morbidity and mortality and it is predictive of neonatal asphyxia. The umbilical blood gas analysis is a valid tool for the evaluation of neonatal acidaemia. However, umbilical cord blood gas analysis is commonly performed in high-risk situations or in the setting of Apgar scores Methods A retrospective cohort study was conducted from June to December 2018 at the Department of mother’s and child’s health, Poliambulanza Foundation Hospital Institute. Inclusion criteria were: full term newborns with body weight appropriate for gestational age, born by vaginal delivery or caesarean section, reassuring Apgar Score > 7 at 5 min, arterial cord blood gas analysis showing pH 6 mmol/l. The aim was to evaluate the predictive role of blood gas analysis for respiratory distress syndrome in newborns with reassuring Apgar Score. Results 352 full term newborns were enrolled. Umbilical cord blood artery pH showed an association with respiratory distress syndrome (χ2(1) = 10,084, OR (95% CI): 3,9 × 10− 4(2,9 × 10− 6 - 0,048); p Conclusions Umbilical cord blood artery pH

Objective. Intrauterine growth restriction (IUGR) is a major cause of late stillbirth, though not all compromised babies remain small or are considered growth restricted as pregnancy progresses. Fetal Magnetic Resonance Imaging (f-MRI) represents a second-line tool to study pregnancies with IUGR fetuses. The aim of our study was to evaluate the usefulness of f-MRI on predicting fetal growth and the offspring’s perinatal respiratory outcome. Design. All f-MRI performed between 2014 and 2016 in Siena were analysed. Pregnancies with IUGR (Study group (SG)) were recruited together with a control population (Control group (CG)), coupled for gestational age (GA) at the time of f-MRI (mean GA 31 wks). Neonatal information was collected. The f-MRI protocol consisted of T2w images. Six regions of interest (ROI) were placed as follows: 2 on the lung, 2 on the liver, and 2 on the amniotic fluid. The signal intensities (SI) of each ROI were measured. The SI lung to liver ratio (SI lung/liver) and SI lung to amniotic fluid ratio (SI lung/amniotic fluid) were obtained for each fetus. Each ratio was compared between SG and CG. Therefore, SG was divided into two subgroups: adequate and small for gestational age (AGA and SGA) newborns. All measurements were related to offspring’s perinatal respiratory outcome. Results. SI lung/liver was linearly related with GA at the time of f-MRI and with EFW. SI lung/amniotic fluid was significantly higher in SG than in CG (p=0,014). In contrast, among SG, lower values of SI lung/amniotic fluid were found in the SGA compared to AGA (p=0,036). The days of oxygen supply were higher in the SGA subgroup than in the AGA subgroup (p=0,028). Conclusions. SI lung/liver increases with fetal lung maturation and appears to be useful to estimate intrauterine fetal growth. SI lung/amniotic fluid seems to be a reliable predictive index to distinguish the IUGR fetuses that can recover their growth from those that were born SGA. f-MRI represents a promising frontier to predict IUGR fetus outcome, thus contributing to ameliorate the perinatal management.

Wilms tumor (WT) occurs in 1:10.000 live births and affects mainly the unilateral kidney. The National Wilms Tumor Study Group registered 6832 patients with WT from 1969 to January 1993, out of whom only 11 patients (0.16%) were newborns. Since 1969, 14 cases of prenatal diagnosis of WT have been reported in literature, two of which were bilateral WT. Currently, the patients’ survival rate is greater than 90%, owing to a combination of surgery, chemotherapy, and radiotherapy for high-risk patients. We report a case of bilateral WT, undiagnosed during the prenatal period due to the incomplete evaluation of the abdomen with ultrasonography. The newborn was vaginally delivered at 40 weeks’ gestational age with a good perinatal adaptation. Suddenly, during the night the newborn showed respiratory distress, bradycardia and then respiratory arrest. For this reason, he was ventilated, intubated and subjected to conventional mechanical ventilation. Despite the normal cardiac ultrasonography, the health care providers suspected a cyanotic congenital heart disease with duct dependency. After a gradual resumption of the oximetry and blood pressure, the infant was transported by the neonatal emergency transport system to the Cardiac Pediatric Surgery Department of a level III hospital. There, the clinical condition became extremely serious and the infant died of asystole. During autopsy, two large tumoral masses were found in both kidneys, also the characterization of the tumors was done through histological exam, which confirmed the diagnosis of WT. A prenatal diagnosis of WT is very important because the families can take advantage of prenatal counseling to understand the risks of continuing the pregnancy and to evaluate the need for abortion, while health care providers can prepare to face a difficult delivery. The review of the literature suggests that prenatal diagnosis of bilateral WT is possible. During prenatal age, the complete assessment of the abdomen with ultrasonography and Eco-Color-Doppler can reveal kidney anomalies and raise suspicion of diseases with urinary malformations.

During normal gestations, oxidant molecules have many physiological functions, which are summarized in controlling cellular fate and signaling, thus playing a crucial role in pregnancy development. Oxidative stress (OS) arises when the production of reactive oxygen species (ROS) overwhelms the intrinsic antioxidant defenses. OS is implicated in the pathophysiology of many complications of human pregnancy, such as gestational diabetes mellitus (GDM), in which both free-radical production and antioxidant defenses are disrupted. The mechanisms of such kind of relation between OS and gestational diabetes have been analyzed during the years. Hyperglycemia leads to an increased production of ROS through different metabolic pathways. Thus, when ROS production increases, transcription factors (TFs) such as nuclear factor-κB will become activated and lead to insulin resistance due to the impairment of insulin signaling. Moreover, TFs may also induce proinflammatory cytokine expression, such as interleukin-6, tumor necrosis factor-α, and monocyte chemoattractant protein-1, which are able to cause insulin resistance directly or indirectly. Placental tissue, fetuses and preterm infants are greatly susceptible to OS damage because of the organ and functional immaturity. ROS were first suggested to be related to diabetes-induced teratogenicity by Eriksson and Borg. Indeed, during the period of organogenesis, ROS attack on DNA represents the first step involved in mutagenesis, carcinogenesis, and fetal programming. Therefore, pregnancies complicated with GDM have miscarriage, PROM, and other anomaly rates higher than nondiabetic gestation. Furthermore, children of GDM mothers are at high risk to develop obesity and type 2 diabetes later in life. The management of OS, along with tight glycemic control, could be beneficial, both preconceptionally and during pregnancy, in women with GDM. However, whether an antioxidant supplementation or a diet rich in antioxidants can prevent the consequences of OS in the offspring or not is yet to be elucidated.

During fetal life, a right balance between oxidants and antioxidants is required for survival and growth of the fetus. At birth, an overproduction of free radicals (FRs) together with poor antioxidant defenses may be detrimental for developing organs and tissues. Protecting the newborn infant against perinatal oxidative stress (OS) is a health care priority, and therefore the search for new, safe, and efficacious antioxidants has been a major quest during the last decade. Due to its antioxidant and anti-inflammatory properties, lutein, a compound belonging to the xanthophyll family of carotenoids, is one of the most promising molecules with clinical application during neonatal age. Lutein is not synthesized by humans, hence the intake primarily depends on diet. In the neonatal period, fresh human milk is the main source of lutein, though lutein-enriched infant formulas are now available. Oral supplementation represents an alternative source of lutein, and it has been demonstrated to decrease plasma biomarkers of OS and increase antioxidant capacity in the first days of life.

Background Pregnancy is characterized by multiple metabolic processes to allow proper foetal development and ensure adequate stores. Little is known about the interactions between maternal and foetal metabolism during the last phase of pregnancy. Metabolomic offers potential to discover changes in maternal metabolism in pregnancy and their relation to the newborn metabolic status. Objective In this study we tested the hypothesis that metabolomic status in newborns at birth depends upon the metabolomic profile of their mothers in the last phase of pregnancy. Study design Urine samples were collected from 36 pregnant women three weeks before delivery and from 21 healthy term newborns within 48 h after birth. Urines were analysed using proton nuclear magnetic resonance (1H NMR) spectroscopy and NMR urine spectra were evaluated through Principal Components Analysis. Results The first component of the PCA analysis showed two distinct metabolic groups: pregnant women and newborns. A significant correlation was found between urine metabolic profiles of newborns and those of their mothers. Conclusion Urine metabolomic profiles of newborns at birth mirrors that of their mothers in the last phase of pregnancy. The metabolomic approach appears to be crucial to understand the maternal effects on foetal programming and infant outcomes.

Introduction: Necrotizing enterocolitis is the most common cause of the postnatal critical conditions and remains one of the dominant causes of newborns’ death in Neonatal Intensive Care. The morbidity and mortality associated with necrotizing enterocolitis remains largely unchanged and the incidence of necrotizing enterocolitis continues to increase. There is no general agreement regarding the surgical treatment of the necrotizing enterocolitis. Methods: In this paper, we want to evaluate the results obtained in our centre from different types of necrotizing enterocolitis’s surgical treatment and to analyse the role of traditional X-ray versus ultrasound doppler imaging in the evolutionary phases of necrotizing enterocolitis. The study was conducted in the Department of Emergency-Urgency NICU, A.O.R.N. Santobono-Pausilipon in Naples from January 2010 to December 2016. Patients were monitored by hematochemical examinations and radiological orthostatic exams every 12 hours, so that they had a surgical opportunity before intestinal perforation occurred. Ultrasonography was performed to monitor preterm infants who were hospitalized in NICU and that showed NEC symptomatology in phase I Bell staging. Results: They were recruited 75 premature infants with NEC symptomatology in phase I-III of Bell staging, who underwent surgical or medical treatment. In infants with a birth weight >1500 g (N=30), laparotomy and necrotic bowel resection has generally been our preferred approach. In 46 patients we practiced a primary anastomosis after resection of an isolated necrotic intestinal segment. In patients with multiple areas of necrosis and dubious intestinal vitality, were performed a 'second-look' scheduled after 24 to 48 hours to re-evaluate the intestine. In the initial phase of necrotizing enterocolitis, when the radiographic examination shows only a specific dilation of the loops, ultrasonography shows more and more specific signs, as wall thickening, alteration of parietal echogenicity, increase in wall perfusion, single or sporadic airborne microbubbles in the thickness of wall sections. Conclusion: Optimal surgical therapy for NEC begins with adequate antibiotic therapy, reintegration of liquids but above all with timely diagnosis, aimed to discover early prodromic phases of wall damage by US, a fundamental tool. Abdomen radiography shows specificity frameworks only when barrier damage is detected while US provides real-time imaging of abdominal structures, highlighting some elements that are completely excluded by radiograph.

Background. Rooming-in practice improves breastfeeding and reduces newborn stress reactivity. When this modality is not available, partial rooming-in after birth can be considered. Salivary cortisol levels (SCLs) are considered reliable biomarkers to indicate stress. Objective. To test the hypothesis that rooming-in duration impacts neonatal stress response in hospitalized newborns. Design/methods. Forty term newborns, enrolled in the Neonatology and Obstetrics Nursing, C.G. Ruesch, Naples, Italy, were divided, according to the mother’s choice, into the study (SG; n=20) and control (CG; n=20) groups if they received full (24 hs) or partial (14 hs) rooming-in care, respectively. Saliva samples were collected from all babies between 7:00 a.m. and 8:00 a.m. of the 3rd day of life by using oral swab. Salivary cortisol levels were measured using an enzyme immunoassay kit (Salimetrics LLC, PA, USA). Results. A statistically significant difference in the SCLs between SG and CG was found (median: 258 ng/dl versus 488.5 ng/dl; p=0.048). Conclusions. Data support the practice of full rooming-in care compared with partial rooming-in. The rooming-in duration clearly reduces SCLs and likely neonatal stress. These lower SCLs may have long-term positive effects reducing the risk of metabolic syndrome, high blood pressure, and cognitive and behavioural changes.

Esophageal atresia (EA) with tracheoesophageal fistula occurs in about 1:2,500 births. We report a case of persistent bronchography in a newborn with EA and distal tracheoesophageal fistula. A large amount of barium sulfate was injected for mistake by a tube directly in the right bronchus to evaluate the patency of the esophagus. The infant showed signs of respiratory distress; he was intubated and transported at children's Hospital Santobono Pausilipon. Here, it was performed a chest X-ray that confirmed the opacification of the right bronchial tree, and it was suspected an EA type 3b. The literature recommends that: evaluation of the patency of the esophagus, with an iodinate contrast medium, should be done in a pediatric specialized center for high risk of lung aspiration.

Background Family-Centred Care (FCC) is recognized as an important component of all paediatric care, including neonatal care, although practical clinical guidelines to support this care model are still needed in Italy. The characteristics and services for families in Italian NICUs show a lack of organization and participation. Methods The first aim was to compare satisfaction and stress levels in two groups of parents: an FCC group and a non-FCC group (NFCC). The second aim was to evaluate body weight gain in the newborns enrolled. This non-randomized, prospective cohort pilot study was conducted in a single level III NICU at a hospital in Naples, Italy. A cohort of newborns in the NICU, with their parents were enrolled between March 2014 and April 2015 and they were divided into two groups: the FCC group (enrolled between October 2014 and April 2015) remained in the NICU for 8 h a day with FCC model; the NFCC group (enrolled between March 2014 and September 2014) was granted access to the NICU for only 1 hour per day. At discharge, both parent groups completed the Parental Stressor Scale (PSS)-NICU and a questionnaire to assess their satisfaction. In addition, we compared scores from the mothers and fathers within and between groups and the body weights of the newborns in the two groups at 60 days. Results Parents participating in the FCC group were more satisfied and less stressed than those in the NFCC group. Infants in the FCC group also showed increased body weight after 60 days of hospital stay. Conclusions Despite our small population, we confirm that routine adoption of a procedure designed to apply a FCC model can contribute to improving satisfaction and distress among preterm infants’ parents. Future multi-centre, randomized, controlled trials are needed to confirm these findings.

BACKGROUND This study evaluates endoscopic and quality of life (QoL) outcomes in two groups, composed by both allergic (A) and non-allergic (N-A) adolescents undergoing septoplasty with concurrent turbinate surgery by radiofrequency treated after surgery with nasal spray containing liposomes and vitamins A and E. METHODS This double-blind randomized study was carried out on 40 patients (22 males, 18 females, mean age 15.5±1.0 years) undergoing septoplasty and volumetric tissue reduction of inferior turbinates by radiofrequency for post-traumatic deformities and severe nasal obstruction. We enrolled 20 subjects with positive skin prick tests and 20 with negative skin prick tests (SPT) to aeroallergens. All subjects underwent the Visual Analogue Scale (VAS) questionnaire and the nasal endoscopy score by Lund and Kennedy (LK) at baseline before surgery (T0) and 15 days (T15) and 21 days (T21) after treatment. After surgery, the nose was not packed and the day after surgery all subjects were randomized into two groups, experimental arm group I (GI) and control arm group II (GII) and given the treatment, nasal spray containing liposomes composed of phospholipids, fatty acids, and vitamin A and E for group I and saline solution (sodium chloride 0.9%) for group II. RESULTS After therapy, the VAS and LK scores were better (P

Objective To assess the accuracy of time perception during a simulated complex neonatal resuscitation. Study design Participants in 5 neonatal resuscitation program courses were directly involved in a complex simulation scenario. They were asked to assume the role of team leader, assistant 1, or assistant 2. At the end of the scenario, each participant completed a questionnaire on perceived time intervals for key resuscitation interventions. During the scenario, actual times were documented by an external observer and video recorded for later review. In addition, participants were asked to evaluate their self-perceived level of stress and preparation. Results Health care providers (68 physicians and 40 nurses) were involved in 36 scenarios. Perceived time intervals for the initiation of key resuscitation interventions were shorter than the actual time intervals, regardless of the participant's role in the scenario. Self-assessed levels of stress and preparation did not influence time perception. Conclusions Health care providers underestimate the passage of time, irrespective of their role in a simulated complex neonatal resuscitation. Participant's self-assessed levels of stress and preparation were not related to the accuracy of their time perception. These findings highlight the importance of assigning a dedicated individual to document interventions and the passage of time during a neonatal resuscitation.

Canavan syndrome is a rare genetic disorder characterised by progressive severe leukodystrophy involving the degeneration of white matter. Currently, there is no effective therapy, but after recent studies using early gene therapy, the outcome has appeared to improve. It is of fundamental importance to recognise signs of neonatal Canavan syndrome early on. We describe a case of neonatal Canavan syndrome in which diagnosis was made only at the fourth month of age.

Maternal hypertensive treatment with angiotensin receptor blockers (ARBs) during the second and third trimester of pregnancy is associated with several fetal and neonatal complications, and potential adverse outcomes. We report a neonate presenting with transient renal acute failure during the first days of life after maternal treatment with ARBs. Women who became pregnant while taking one of these drugs must modify antihypertensive therapy with a different class drug as soon as pregnancy is recognised.

Laryngeal Mask Airway (LMA) has been indicated as an effective device for airway management when face-mask ventilation and intubation have both failed in infants weighing >2000 g or delivered ≥34 weeks of gestation. All previous studies used a classic LMA. The current report describes the first case of a very low birthweight infant (1470 g

Il leprecaunismo, patologia autosomica recessiva, mortale nel I anno di vita, dovuta a mutazioni nel gene del recettore insulinico, é considerato estremamente raro (1: 4.000.000 nati vivi) cio’ nonostante negli ultimi 2 anni, abbiamo potuto diagnosticare due casi caratterizzati da grave insulinoresistenza. MF nasce il 22/7/2009 IUGR alla 37° settimana di gestazione da T.C. per distacco di placenta, da genitori consanguinei provenienti dal Marocco.Alla nascita Peso Kg 1.900,Lung.cm 42,CC.cm 33.Aspetto distrofico per assenza del pannicolo adiposo. Facies dismorfica, occhi grandi e prominenti, ipertelorismo, ipertricosi, acantosis nigricans,. Posto in terapia infusionale endovenosa presentava inizialmente un incremento di peso. Alla sospensione della terapia infusionale il peso iniziava, pero’, a decrementare e per la presenza di anemia il piccolo iniziava terapia con eritropoietina. Al monitoraggio glicemico durante e dopo la terapia infusionale i valori glicemici oscillavano tra i 50 ed i 240 mg/dl con valori prevalenti intorno ai 160 mg/dl. Non ha mai praticato insulina. L’insulinemia è sempre stata elevatissima: ( 24/08/09 ) 210.1 μU /mL; ( 04/09/09) > 320.1 μU/mL; ( 27/10/09 )3.935.2 μUI/mL(v.n.< 17) μU/mL. Nonostante le iperglicemie il bambino non ha mai manifestato acidosi metabolica fino al 3° mese quando, in poche ore, ha presentato una gravissima forma di chetoacidosi che ne ha determinato, robabilmente, l’exitus. Pochi mesi dopo abbiamo avuto un secondo caso nato da gravidanza gemellare da padre naturale e impianto di ovuli da donatrice eterologa. In questo caso abbiamo intrapreso fin dall’inizio terapia parenterale totale. Anche in questo caso, però, l’exitus si è verificato intorno al terzo mese per sepsi.L’interesse di questi casi, oltre alla rarità della patologia, è dovuta alla difficile scelta terapeutica (terapia infusionale, parenterale ecc) che deve, da un lato, gestire le iper e le ipoglicemie, dall’altro evitare l’ìpercatabolismo legato al deficit di funzione insulinica. E’ possibile ipotizzare che la chetoacidosi del primo caso sia stata la conseguenza della maturazione degli ormoni controinsulari (glucagone) che si ha, di solito tra i terzo ed il quarto mese di vita.

A few hours after birth, a newborn was admitted to Santobono-Pausilipon III level Hospital. Suspected eye injury was reported. During childbirth, the baby showed a face presentation and to help with the delivery, a vacuum extractor (VE) method was used. Body weight of the baby at the time of birth was 3200 g, length 50 cm and head circumference 35 cm. Apgar scores were 7I and 8V. The newborn was subjected to examinations by an …

A female infant was born at 27+5 weeks of gestation through emergency caesarean section, performed because of an acute increase of a compressive thoracic malformation diagnosed at the 20th gestational week. At birth, two enormous violaceous masses extending to thorax and superior limbs were observed (figure 1). The infant was immediately intubated and transfused because of severe anaemia. A compressive bandage on masses was performed to decrease the risk of bleeding. Angio-CT confirmed the presence of voluminous masses surrounding the …