Clinical predictors for surfactant retreatment in preterm infants with respiratory distress syndrome: the results of a pooled analysis.

Background: The issue of retreatment with surfactant of infants with respiratory distress syndrome (RDS) has been poorly investigated. Our aim was to identify possible clinical predictors of the need for multiple doses of surfactant in a large cohort of very preterm infants.

Methods: Data were analyzed from three previous studies on infants born between 25 and 31 weeks of gestation with RDS who were treated with surfactant.

Resuscitation With Placental Circulation Intact Compared With Cord Milking: A Randomized Clinical Trial.

Importance: Among preterm newborns undergoing resuscitation, delayed cord clamping for 60 seconds is associated with reduced mortality compared with early clamping. However, the effects of longer durations of cord clamping with respiratory support are unknown.

Objective: To determine whether resuscitating preterm newborns while keeping the placental circulation intact and clamping the cord after a long delay would improve outcomes compared with umbilical cord milking.

Splanchnic and cerebral oxygenation during cyclic phototherapy in preterm infants with hyperbilirubinemia.

Cyclic phototherapy (cPT) can achieve a reduction in total serum bilirubin comparable to that achieved with standard continuous PT in preterm infants. Our aim was to assess the effect of cPT on splanchnic (rSOS) and cerebral (rSOC) oxygenation measured by near-infrared spectroscopy (NIRS). We prospectively studied 16 infants with a gestational age of 25-34 weeks with hyperbilirubinemia requiring PT.

Direct breastfeeding: Predictive factors and possible effects on neurodevelopment in very preterm infants.

Background: the importance of sucking milk directly at the mother's breast is often underestimated and many aspects of direct breastfeeding of very preterm infants are not investigated.

Aim: The primary endpoint of the study was to identify maternal and infant clinical predictors of direct breastfeeding in a cohort of infants born at <32 weeks of gestation or weighing <1500 g. The secondary endpoint was to evaluate the possible effects of direct breastfeeding on infant neurodevelopment.

A structured programme to promote breastfeeding improved the rates in very preterm infants at discharge.

Aim: We developed the Promotion of Breastfeeding (PROBREAST) programme and evaluated what effect it had on the breastfeeding rate in infants born at less than 32 weeks of gestation or weighing ≤1500 grams.

Methods: We compared the breastfeeding rate in two cohorts of patients who were born before (n = 72; January 2017 to June 2018) and after (n = 80; July 2018 to December 2019) the application of the programme. Moreover, we compared the correlation between type of feeding at discharge and post-discharge breastfeeding rate, between exclusive breastfeeding, postnatal growth and neurodevelopment.

A Simulation Competition on Neonatal Resuscitation as a New Educational Tool for Pediatric Residents.

Background: Training programs on resuscitation have been developed using simulation-based learning to build skills, strengthen cognitive strategies, and improve team performance. This is especially important for residency programs where reduced working hours and high numbers of residents can reduce the educational opportunities during the residency, with lower exposure to practical procedures and prolonged length of training. Within this context, gamification has gained popularity in teaching and learning activities.

Carboxyhemoglobin as biomarker of late-onset sepsis in preterm infants.

Carboxyhemoglobin (COHb) is considered a biomarker of oxidative stress and previous studies reported an increase in COHb levels in preterm infants who develop late-onset sepsis (LOS). Our aim was to assess the correlation between COHb levels and the risk for LOS development. We retrospectively studied 100 preterm infants, 50 in the LOS and 50 in the no LOS group.

Neonatal Outcomes of Term Infants Born with Meconium-Stained Amniotic Fluid.

Meconium-stained amniotic fluid (MSAF) is considered an alarming sign of possible fetal compromise and it has recently been reported that neonatal outcome correlates with the degree of meconium thickness. We retrospectively studied 400 term infants allocated in clear amniotic fluid and grade 1, 2, and 3 MSAF groups on the basis of color and thickness of AF. Multivariable logistic regression analysis was performed to evaluate the potential independent effect of delivery with MSAF of different severity on the risk of a composite adverse neonatal outcome.

Cardiac Hypertrophy Associated with Insulin Therapy in Extremely Preterm Infants.

Background: In the neonatal period, cardiac hypertrophy (CH) has been commonly associated with hyperinsulinemic pathologies, and the first case of CH in an extremely preterm infant treated with insulin infusion has recently been reported. To confirm this association, we report a case series of patients who developed CH after insulin therapy.

Methods: Infants with gestational age < 30 weeks and birth weight < 1500 g, born from November 2017 to June 2022, were studied if they developed hyperglycemia requiring treatment with insulin and had echocardiographic diagnosis of CH.

Carboxyhemoglobin as biomarker of prematurity complications.

Background: Carboxyhemoglobin (COHb) is considered a biomarker of oxidative stress and previous studies suggest a correlation between its blood level and prematurity complications. Our aim in this study was to assess the correlation between COHb levels and the risk for bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP).

Methods: We retrospectively studied 178 preterm infants with gestational age of 27.

Chronic Training Induces Metabolic and Proteomic Response in Male and Female Basketball Players: Salivary Modifications during In-Season Training Programs.

The aim of this study was to characterize the salivary proteome and metabolome of highly trained female and male young basketball players, highlighting common and different traits. A total of 20 male and female basketball players (10 female and 10 male) and 20 sedentary control subjects (10 female and 10 male) were included in the study. The athletes exercised at least five times per week for 2 h per day.

Preliminary results indicate that regular training induces high protection against oxidative stress in basketball players compared to soccer.

In elite athlete several metabolic changes occur during regular training. These modifications are associated with changes in blood metabolic profile and can lead to adaptive mechanisms aimed at establish a new dynamic equilibrium, which guarantees better performance. The goal of this study was to characterize the plasma metabolic profile and redox homeostasis, in athletes practicing two different team sports such as soccer and basketball in order to identify potential metabolic pathways underlying the differences in training programs.

Effects of a 24-Week Exercise Program on Functional Fitness, Oxidative Stress, and Salivary Cortisol Levels in Elderly Subjects.

Aging is a biological and irreversible process characterized by physiological alterations resulting in a progressive decline in biological functions, decreased resistance or adaptability to stress, and increased disease susceptibility. A decline in functional fitness, imbalance between pro- and antioxidant capacity, and/or hormonal dysregulation adversely impact physical capacity, emotional status, and overall quality of life, especially within the elderly population. On the other hand, regular physical activity is considered an effective strategy to prevent and reduce those changes associated with primary aging and concurrent chronic disease, while slowing age-related physical degeneration.

Changes of Oxidative Stress-Related Gene Expression in an in vitro Model of Neonatal Hypoxic-Ischemic Encephalopathy.

Background: We recently demonstrated that oxygen-glucose deprivation (OGD) and unconjugated bilirubin (UCB) can damage mature and immature organotypic hippocampal slices and induce an oxidative stress similar to what occurs in jaundiced term and preterm infants with hypoxic-ischemic encephalopathy (HIE).

Objectives: To assess the effects of OGD and UCB on the expression of heme-oxygenase 1 (HO-1) and oxidative stress-related enzymes in an in vitro model of HIE.

Methods: Mature and immature organotypic hippocampal slices were exposed to 30-min OGD and to 24 h UCB or UCB plus human serum albumin (HSA).

Splanchnic oxygenation during phototherapy in preterm infants with hyperbilirubinemia.

Background: It has been reported that preterm infants can develop feeding intolerance during phototherapy (PT) and that PT can affect mesenteric perfusion in these patients.

Aims: Our aim was to assess if PT can decrease regional splanchnic oxygenation (rSOS) measured by near infrared spectroscopy (NIRS).

Study Design: We prospectively studied infants with gestational age of 25-34 weeks with hyperbilirubinemia requiring PT.

Measurement of lung oxygenation by near-infrared spectroscopy in preterm infants with respiratory distress syndrome: A proof-of-concept study.

Introduction: Noninvasive markers more accurate than FiO would be useful to assess the severity of RDS and guide its treatment. Our aim was to assess for the first time the possibility of continuously monitoring lung oxygenation (rSO L) by near-infrared spectroscopy (NIRS) and to evaluate whether rSO L correlates with other oxygenation indices and RDS severity.

Methods: We carried out this proof-of-concept study on 20 preterm infants with RDS requiring noninvasive respiratory support.

Pharmaceutical strategies for preventing toxicity and promoting antioxidant and anti-inflammatory actions of bilirubin.

Bilirubin (BR) is the final product of haem catabolism. Disruptions along BR metabolic/transport pathways resulting from inherited disorders can increase plasma BR concentration (hyperbilirubinaemia). Unconjugated hyperbilirubinemia may induce BR accumulation in brain, potentially causing irreversible neurological damage, a condition known as BR encephalopathy or kernicterus, to which newborns are especially vulnerable.

Neurotoxicity of Unconjugated Bilirubin in Neonatal Hypoxic-Ischemic Brain Injury .

The pathophysiology of bilirubin neurotoxicity in course of hypoxic-ischemic encephalopathy (HIE) in term and preterm infants is still poorly understood. We hypothesized that oxidative stress may be a common mechanism that link hyperbilirubinemia and HIE. The objective of the present study was to evaluate whether unconjugated bilirubin (UCB) may enhance the HI brain injury by increasing oxidative stress and to test pioglitazone and allopurinol as new antioxidant therapeutic drugs .

How to Provide Motherside Neonatal Resuscitation with Intact Placental Circulation?

Immediate clamping and cutting of the umbilical cord have been associated with death and/or neurodisability [...

Feeding intolerance during phototherapy in preterm infants.

Objective: Many very preterm infants are treated with phototherapy (PT) for hyperbilirubinemia and it has been reported that PT can negatively affect gut perfusion. Thus, our aim was to evaluate the occurrence of feeding intolerance in the course of PT in these patients.

Methods: We retrospectively studied infants born at 25-31weeks from November 2017 to April 2020 who required PT during the first two weeks of life.

Cerebral and splanchnic oxygenation during automated control of inspired oxygen (FiO ) in preterm infants.

Objectives: Our aim in this study was to assess the effect of the Predictive Intelligent Control of Oxygenation (PRICO ) system on cerebral (rSO C) and splanchnic (rSO S) oxygenation in a cohort of preterm infants with frequent desaturations.

Methods: Twenty infants with gestational age <32 weeks (n = 20) were assigned in random sequence to 12 h of automated or manual adjustment of FiO . Over this period, they were studied continuously by near-infrared spectroscopy (NIRS).

Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study.

Background: The thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed.

Objective: To compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth.

Study Design And Setting: Multicentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals.