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The mechanisms of perinatal stroke are poorly understood but preclinical studies point to the crucial role of perinatal inflammation. Carotid artery occlusion represents a very rare and severe cause of perinatal stroke. We describe two cases diagnosed with extensive ischemic stroke due to carotid artery occlusion. In both cases, we demonstrated placental vasculopathy. High levels of C-reactive protein in mother and/or neonates suggested inflammatory mechanism as a potential trigger. Both cases underwent hypothermic treatment without complications because of initial diagnosis of perinatal asphyxia. The prognosis at the time of the last follow up was severe including cerebral palsy, epilepsy and cognitive impairment. Our cases contribute to the actual debate on pathogenic mechanisms and treatment options for this rare condition. [ABSTRACT FROM AUTHOR]

Non-thermal plasma is a promising tool for novel technologies to treat water contaminated by recalcitrant pollutants. We report here on products, reactive species and mechanisms of the efficient degradation of perfluorooctanoic acid (PFOA) achieved with a self-pulsing discharge developed previously in our lab. Air or argon were used as plasma feed gas, ultrapure or tap water as aqueous medium. Identified organic intermediate products arise from chain-shortening and defluorination reactions, the latter achieving not only C-F to C-H exchange (hydro-de-fluorination), as reported in the literature, but also C-F to C-OH exchange (hydroxy-de-fluorination). In contrast with chain-shortening, yielding lower homologues of PFOA via selective cleavage of the C-C bond at the carboxylate group, defluorination occurs at various sites of the alkyl chain giving mixtures of different isomeric products. Plasma generated reactive species were investigated under all experimental conditions tested, using specific chemical probes and optical emission spectroscopy. Cross-analysis of the results revealed a striking direct correlation of energy efficiency for PFOA degradation and for production of plasma electrons. In contrast, no correlation was observed for emission bands of either Ar + or OH radical. These results indicate a prevalent role of plasma electrons in initiating PFOA degradation using self-pulsing discharge plasma above the liquid., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Among infants needing urgent transfer after birth, very preterm infants are a high-risk sub-group requiring special attention. This study aimed to assess trends in early respiratory management in a large series of very preterm infants undergoing postnatal transfer., Methods: Trends in patient characteristics and early respiratory management were assessed in 798 very preterm infants who were transferred by the Eastern Veneto Neonatal Emergency Transport Service in 2000-2019. Trends were analyzed using joinpoint regression analysis and summarized as annual percentage changes (APCs)., Results: Proportion of neonates with birth weight less than 1 kg decreased from 33% to 16% (APC -3.82%). Use of nasal-continuous-positive-airway pressure increased (at call: APC 15.39%; during transfer: APC 15.60%), while use of self-inflating bag (at call: APC -12.09%), oxygen therapy (at call: APC -13.00%; during transfer: APC -23.77%) and mechanical ventilation (at call: APC -2.71%; during transfer: APC -2.99%) decreased. Use of oxygen concentrations at 21% increased (at call: APC 6.26%; during transfer: APC 7.14%), while oxygen concentrations above 40% decreased (at call: APC -5.73%; at transfer APC -8.89%). Surfactant administration at call increased (APC 3%-10%), while surfactant administration when arriving at referring hospital remained around 7-11% (APC 2.55%)., Conclusion: Relevant trends toward "gentle" approaches in early respiratory management of very preterm infants undergoing postnatal transfer occurred during the last twenty years. In addition, the proportion of transferred extremely low birth weight infants halved. Clinicians and stakeholders should consider such information when allocating assets to both hospitals and transfer services and planning regional perinatal programs., (© 2021 Wiley Periodicals LLC.)

The mechanisms of perinatal stroke are poorly understood but preclinical studies point to the crucial role of perinatal inflammation. Carotid artery occlusion represents a very rare and severe cause of perinatal stroke. We describe two cases diagnosed with extensive ischemic stroke due to carotid artery occlusion. In both cases, we demonstrated placental vasculopathy. High levels of C-reactive protein in mother and/or neonates suggested inflammatory mechanism as a potential trigger. Both cases underwent hypothermic treatment without complications because of initial diagnosis of perinatal asphyxia. The prognosis at the time of the last follow up was severe including cerebral palsy, epilepsy and cognitive impairment. Our cases contribute to the actual debate on pathogenic mechanisms and treatment options for this rare condition.

Objective: To evaluate clinical data and associated risk conditions of noncerebral systemic venous thromboembolism (VT), arterial thromboembolism (AT), and intracardiac thromboembolism (ICT) in neonates., Study Design: Data analysis of first systemic thromboembolism occurring in 75 live neonates (0-28 days), enrolled in the Italian Registry of Pediatric Thrombosis from neonatology centers between January 2007 and July 2013., Results: Among 75 events, 41 (55%) were VT, 22 (29%) AT, and 12 (16%) ICT; males represented 65%, and 71% were preterm. In 19 (25%), thromboembolism was diagnosed on the first day of life. In this "early onset" group, prenatal-associated risk conditions (maternal/placental disease) were reported in 70% and inherited thrombophilia in 33%. Postnatal risk factors were present in 73%; infections and central vascular catheters in 56% and 54% VT, respectively, and in 67% ICT vs 27% AT (<.05). Overall mortality rate was 15% and significant thromboembolism-related sequelae were reported in 16% of discharged patients., Conclusions: This report from the Registro Italiano Trombosi Infantili, although limited by representing an uncontrolled case series, can be used to develop future clinical trials on appropriate management and prevention of neonatal thrombosis, focusing on obstetrical surveillance and monitoring of critically ill neonates with vascular access. A thrombosis risk prediction rule specific for the neonatal population should be developed through prospective controlled studies., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The objective of the study is to describe safety and effects of protein C concentrate (PCConc) administration in neonates with sepsis-induced coagulopathy. Eighteen neonates (12 preterm and 6 full term) aged between 1 and 28 days who have severe sepsis (n = 6) or septic shock (n = 12), with coagulopathy and acquired protein C (PC) deficiency received PCConc (i.v. bolus of 100 IU/kg, followed by 50 IU/kg every 6 h for 72 h). Platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, C-reactive protein (CRP), antithrombin (AT), PC, CRP, and neonatal therapeutic intervention scoring system (NTISS) were assessed before and 24, 48, and 72 h after the study entry. According to Clinical Risk Index for Babies II score (CRIB II score), the expected mortality in preterms was 10%. After 24 h of treatment, PC activity levels increased from an average of 19% to 57%, and they were within normal limits before the last PCConc bolus. During the treatment period, a shortening of PT (P = 0.04) and activated partial thromboplastin time (P = 0.02), and an increase in antithrombin levels (P < 0.0001) were observed, along with a reduction in CRP (P = 0.005) and NTISS values (P = 0.003). No adverse events were observed. This pilot study shows that in neonatal severe sepsis, normalization of PC levels is safe and probably effective in modulating the inflammatory response and in controlling coagulopathy. However, for the potential beneficial effects of PCConc administration on morbidity and mortality, a placebo-controlled, double-blind study is required.

Objective: To evaluate the impact of the laryngeal mask airway (LMA) on neonatal resuscitation policy., Design: We analyzed retrospectively the records of neonates requiring positive pressure ventilation (PPV) at birth before (1996) and after (2000) the introduction of the LMA into our delivery suites. In addition, the outcome of neonates treated with the LMA was compared with that of neonates matched for gestational age and mode of delivery who were resuscitated using a face mask., Results: During the year 2000, 95 out of 380 (25%) resuscitated neonates were treated with the LMA. The LMA was effective in 94 out of 95 (99%) of these infants. Over the same period, the percentage of neonates receiving tracheal intubation (TI) at birth (34%) was significantly reduced compared with the figure for 1996 (67%). There were no reported complications associated with the use of the LMA. Seventy-four out of the 95 neonates treated with the LMA were considered suitable for matching for gestational age and mode of delivery with 74 neonates treated with a face mask. No differences were found between the two groups for birth weight, Apgar scores, need for tracheal intubation, need for admission to the Neonatal Intensive Care Unit (NICU), primary diagnosis at discharge and primary outcomes. The LMA provided effective ventilation in four neonates in whom the face mask failed., Conclusions: The LMA is changing neonatal resuscitation practice in our Institution. Our data suggest that it is a safe and useful alternative method for respiratory support in neonates requiring PPV at birth, which merits further study.

We are conducting a validation study of questionnaire to the parents according to the Griffiths Mental Developmental Scale, used in pediatric follow-up of obstetric studies among the Italian population. The questionnaire concerns the child's gross and fine motor and language development, swallowing, respiratory, hearing and vision problems, and hospital admissions within the first 18 months of life. The purpose of this study is to examine the degree of agreement between parental and professional assessment of normal and high-risk infants development at 18 months of life.

We have undertaken a survey to establish current practices and differences in the use of bronchoscopes in children in European centres. A questionnaire was sent to all 220 members of the Paediatric Assembly of the European Respiratory Society (ERS). The questions concerned the following points: indications for bronchoscopy; site of bronchoscopy; type of sedation; any oxygen supplementation during the procedure; number of procedures performed in the previous 12 months; number of procedures performed in the neonatal intensive care unit; number of bronchoalveolar lavages (BALs); side-effects during and after the procedures; and diagnostic yield. Fifty one European centres (40.8% of the European centres contacted) took part in the study. A total of 7,446 bronchoscopies had been performed in the last 12 months: 4,587 using the flexible bronchoscope and 2,859 using the rigid bronchoscope. At centres using only the fibreoptic bronchoscope, the most frequent indication was "recurrent/persistent pneumonia" (17%); at centres using only the rigid bronchoscope, it was "foreign body inhalation" (36.7%); at centres using both methods, the most frequent indication was "other indications" (23.9%). In 12 months, 2,231 BALs were performed: 1,419 in immunocompetent children and 812 in immunocompromised patients. In centres using only the fibreoptic bronchoscope, the highest yield was for "stridor" (81%); in centres using only the rigid bronchoscope, the highest yield was for "persistent atelectasis" (68%); and in centres using both instruments, it was for "foreign body inhalation" (93%). The results of the study suggest that bronchoscopy in children is now a well-established procedure at several European centres, while others are just beginning to use this technique.