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In Europe, micro-firms contribute significantly to both the economy and the environmental impact on ecosystems. Helping them become greener and stimulating innovation toward new sustainable and circular solutions could substantially contribute to the European goal of achieving carbon neutrality and environmental sustainability, as promoted by the European Green Deal and Next Generation EU programs. Nevertheless, eco-innovation (EI) by micro-firms is studied little in the literature. In this paper, we analyze the main determinants of conventional and EI adoption by microfirms. We used an ad-hoc survey developed for enterprises in Emilia-Romagna (Italy), an important region in terms of innovation where micro-firms play a significant role in the economy. The paper analyzes whether human capital, training, R&D activities, collaboration activities to improve learning, and the environmental culture within the firm act as main determinants of innovation adoption, in addition to other standard drivers and barriers to innovation adoption studied in the extant literature. Moreover, we compare innovation adoption strategies between micro-firms and SMEs. While our results highlight differences in the determinants of EI and conventional innovation adoption, there are important heterogeneities when it comes to innovation adoption strategies.

Background: Hypenatremic dehydration is a complication of preterm infants with reportedly high morbility. In preterm infants, this happens due to a combination of low fluid intake, transepidermal water loss (TEWL), and immaturity of kidney function. Semipermeable membranes are self-adhesive membranes that can be applied as an artificial skin to reduce TEWL.Aims: To test the hypothesis that early application of a semipermeable membrane (Tegaderm(TM)) in preterm infants <= 30 weeks could result in a significant reduction of hypenatremia (serum Na > 145 mEq/l) during the first 15 days of life.Study design: Randomized controlled trial (UMIN000010515).Subjects: 164 consecutive newborns with gestational ages <= 30 weeks, absence of congenital skin defects, and duration of admission a 15 days. Patients were randomized to receive semipermeable membrane (n = 82) or no membrane (n =82) for the first 15 days of life.Outcome measures: The primary endpoint of the study was the incidence reduction of hypernatremia (Na > 145 mEq/l). Secondary endpoints included: postnatal weight loss (WL) and time to birth weight (BW) recovery.Results: Incidence of hypernatremia in the control and semipermeable membrane group was 59.7% and 41.6%, respectively (p = 0.030). Postnatal WL was larger in the control group (13.9 +/- 5.6% vs 11.1 +/- 3.4%, p = 0.005) and occurred later than the semipermeable membrane group (5.4 +/- 2.3 vs 4.5 +/- 1.4 days, p = 0.005). Time to BW recovery was also longer for control group (13.5 +/- 4.3 vs 11.9 +/- 3.2 days, p = 0.016).Conclusions: Early application of skin semipermeable membrane to <= 30 week preterm is associated with decreased incidence of hypernatremia, decreased %WL, and earlier BW recovery. No complications were observed with membrane application.

Our aim was to assess the efficacy and safety of intravenous (i.v.) paracetamol vs. i.v. ibuprofen for the treatment of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. This is a multicenter randomized controlled study. Infants with a gestational age of 25+0–31+6 weeks were randomized to receive i.v. paracetamol (15 mg/kg/6 h for 3 days) or i.v. ibuprofen (10-5-5 mg/kg/day). The primary outcome was the closure rate of hsPDA after the first treatment course with paracetamol or ibuprofen. Secondary outcomes included the constriction rate of hsPDA, the re-opening rate, and the need for surgical closure. Fifty-two and 49 infants received paracetamol or ibuprofen, respectively. Paracetamol was less effective in closing hsPDA than ibuprofen (52 vs. 78%; P = 0.026), but the constriction rate of the ductus was similar (81 vs. 90%; P = 0.202), as confirmed by logistic regression analysis. The re-opening rate, the need for surgical closure, and the occurrence of adverse effects were also similar. Conclusions: Intravenous paracetamol was less effective in closing hsPDA than ibuprofen, but due to a similar constriction effect, its use was associated with the same hsPDA outcome. These results can support the use of i.v. paracetamol as a first-choice drug for the treatment of hsPDA. Trial registration:Clinicaltrials.gov: NCT02422966, Date of registration: 04/09/2015; EudraCT no: 2013-003883-30.What is Known:• The successful closure of patent ductus arteriosus with oral paracetamol has been recently reported in several preterm infants, but only one randomized controlled study investigated the efficacy of intravenous paracetamol.What is New:• Intravenous paracetamol is less effective in closing hsPDA than ibuprofen, but have a similar constriction effect.• These results can support the use of i.v. paracetamol as a first-choice drug for the treatment of hsPDA.

The FEEM report 2019 (Zoboli et al. 2019) proposed to embed the Circular Economy (CE) into a broader NEXUS framework, in which the relationships between the CE transition, the decarbonization transition, and the bioeconomy transition have to be considered in sustainability transition strategies. In this report, the focus is on the CEDecarbonisation nexus, in particular the energy-CE links, taking into consideration also those links to the bioeconomy that can be relevant for the energy-CE link. We will highlight how, in spite of the very broad policy vision emerging from the European Green Deal (EGD) and the continuously increasing industrial interest for the CE, there are still missing, or not completely deployed, links between CE and energy/decarbonization. In particular, there are missing links within the EU policy framework, in which legislation on CE and energy/climate are still delinked. The wide range of specific strategies triggered by the EGD, including the new EU Circular Economy Action Plan 2020 (EC 2020c), are going towards a deeper integration between CE and energy/decarbonization, and this can provide new opportunities. At the same time, the CE-related new business models are more and more holistic and flexibly encompass the CE-energy/decarbonizations links. In this framework, the energy industry is undertaking broad strategies for the CE that emphasize these links and move in the direction of integrated business models. The report first presents the CE-energy/decarbonizations links. Then it takes stock of the evolving policy framework for these links. The other sections address the CE-energy/decarbonizations links in the energy industry, also presenting the range of initiatives of some major players, and the CE measurement at the company level.

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Objective: To assess changes in neonatal lung ultrasonography score (nLUS) after surfactant administration in preterm infants with respiratory distress syndrome (RDS). Working Hypothesis: The reduction of nLUS score before (nLUSpre), 2 hours (nLUS2h), and 12 hours (nLUS12h) after surfactant administration to identify patients who will not need a second treatment. Study Design and Setting: Prospective observational study in the tertiary neonatal intensive care unit. Patients Selection: Forty-six preterm neonates with RDS of 32 weeks median gestational age (IQR 30-33) and mean birth weight of 1650 ± 715 g. Methodology: Lung ultrasonography was performed before, 2 hours, and 12 hours after surfactant administration in preterm infants with RDS needing surfactant treatment. Resulting nLUS was analyzed. Results: The Wilcoxon signed-rank test demonstrated an nLUS lowering after 2 hours (P <.001) and 12 hours (P <.001) from surfactant administration. Sixteen newborns required surfactant retreatment with median gestational age of 32 weeks (IQR 29-33) and mean birth weight of 1519 ± 506 g.The receiver operating characteristic analysis for the nLUS2h yielded an area under the curve of 0.80 (95% confidence interval, 0.76-0.85; P <.001). A nLUS2h ≥7 showed a sensitivity of 94% and a specificity of 60% for needing a second treatment with surfactant. Conclusions: In preterm infants with RDS requiring surfactant treatment, nLUS evaluated 2 hours after surfactant administration can be used to identify patients who will not need a second treatment.

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We report a case of transient pseudohypoparathyroidism in a full-term newborn that presented at 20 hours of life with hypocalcemic seizures, hyperphosphatemia and raised parathormone levels. The diagnosis of pseudohypoparathyroidism was made according to biochemical investigations. The infant was treated with calcium supplementation and vitamin D analog therapy, and he remained stable and symptom-free with normal serum biochemistries during follow-up. We suggest that transient pseudohypoparathyroidism of the newborn (ntPHP) might be included among inactivating parathyroid hormone (PTH)/PTH-related protein signaling disorders as defined by the classification schema recently proposed by the European Pseudohypoparathyroidism Network. To the best of our knowledge, this is the first report in which the new classification has been applied to a case of ntPHP.

Background: Continuous glucose monitoring using subcutaneous sensors is useful in the management of glucose control in neonatal intensive care. We evaluated feasibility and reliability of a continuous glucose monitoring system in a population of very low birth weight neonates needing parenteral nutrition. Moreover, we presented percentiles of glycemia of the studied population. Methods: Very low birth weight neonates were enrolled within 24 h from birth. An ENLITE sensor connected to a continuous glucose monitoring system was inserted and maintained for at least 72 h. Data obtained with the continuous glucose monitoring system and with a glucometer were compared. Calibration was performed every 12 h. Results: Twenty-three patients (9 males) were included. Median gestational age was 28 weeks (range 23-30) and median birth weight was 860 g (range 500-1092). A total of 299 paired glucose values were obtained. Modified Clarke Error Grid criteria for clinical significance were met. 74 and 33 episodes of hypoglycemia and hyperglycemia were detected, respectively. 31,329 values of glycemia were analyzed and the percentiles calculated. Conclusions: This continuous glucose monitoring system is safe and accurate. It allows increasing the detection of hypo- and hyper-glycaemia episodes and it could be routinely used in the management of glucose infusion in very low birth weight neonates under total parenteral nutrition.

Objectives: We aim to verify the diagnostic accuracy of a lung ultrasonography (LUS) score to early predict the need for surfactant therapy in newborns with respiratory distress syndrome (RDS), and to compare it with a chest X-ray score. Methods: In this prospective diagnostic accuracy study we included all newborns admitted for respiratory distress and initially treated with nasal CPAP. LUS was performed within 2 h from nasal CPAP positioning and in any case before surfactant administration. A chest X-ray was also performed. A LUS score and an X-ray score were used and compared. Ability of the scores to predict surfactant administration was evaluated through ROC analysis. Results: In our population of 56 newborns with mean gestational age of 31 weeks (SD 3) and mean birth weight of 1442 g (SD 520), LUS score showed higher AUC than X-ray score in early recognition of infants with respiratory distress syndrome requiring surfactant treatment (0.94; 95%CI, 0.89-0.98; P < 0.001 vs 0.80; 95%CI, 0.74-0.86; P < 0.001). It showed also higher sensitivity (86% vs 82%), higher specificity (88% vs 76%), better positive (83% vs 69%), and negative (91% vs 87%) predictive values. Conclusions: LUS is a non-invasive, bedside and reproducible method that could improve the management of neonatal respiratory distress. It is accurate and reliable to early identify patients who will need treatment with surfactant allowing both an early treatment and a reduction of radiation exposure.

Secrecy and anonymity related to heterologous assisted reproduction may hide basic newborn data to neonatologists. Secrecy and anonymity are discussed in view of their possible consequences on relational dynamics and on developmental psychology. Nevertheless, they can also involve the offspring's genetic status regarding inheritable diseases. International guidelines have been recently published on this topic. Because no guidelines are 'ideal' unfortunate and possibly dramatic consequences can occur. We aimed to embark on a debate about this matter starting with a real clinical experience. In our case a rarely fatal but widespread disease, together with the lack of knowledge about parental status led, in a fast succession of clinical events, to the unavoidable insurgence of kernicterus. © 2008 Informa UK Ltd.