Complementary feeding in preterm infants: a position paper by Italian neonatal, paediatric and paediatric gastroenterology joint societies

Nutrition in the first 1000 days of life is essential to ensure appropriate growth rates, prevent adverse short- and long-term outcomes, and allow physiologic neurocognitive development. Appropriate management of early nutritional needs is particularly crucial for preterm infants. Although the impact of early nutrition on health outcomes in preterm infants is well established, evidence-based recommendations on complementary feeding for preterm neonates and especially extremely low birth weight and extremely low gestational age neonates are still lacking. In the present position paper we performed a narrative review to summarize current evidence regarding complementary feeding in preterm neonates and draw recommendation shared by joint societies (SIP, SIN and SIGENP) for paediatricians, healthcare providers and families with the final aim to reduce the variability of attitude and timing among professionals

HAPPY MAMA Project (Part 2)-Maternal Distress and Self-Efficacy. A Pilot Randomized Controlled Field Trial

Introduction: The aim of the pilot randomized controlled field trial is to assess if a mid- wifery intervention is able to increase the maternal self-efficacy and reduce the stress level during the first six months after birth. Methods: The study was conducted in two different hospitals in Rome, Italy, involving women delivering at or beyond term, aged >18 years old and with normal APGAR scores of the infant. The participants were randomly divided into two groups: “Individual Intervention Group” (they received home midwifery assistance for one month after birth, I) and the “Control Group” (C). A self-administered questionnaire was administered four times: at the baseline about one week after the hospital delivery (T0), after the intervention about one month after the delivery (T1), and at three months (T2) and at six months after birth (T3). The questionnaire included different validated scales needed to assess maternal perceived self-efficacy (KPCS), parental stress scale stress (PSS) and maternal depressive risk symptoms (EPDS). Results: The study population counted 51 mothers: 28 women in the “C” group and 23 women in the “I” group. The PSS score was statistically higher in the “C” than “I” group at T1 (p = 0.024); whereas the KPCS score was statisti- cally higher in the “I” (p = 0.039) group; EPDS score did not show significant difference between the two groups in the follow-up period. An inverse significant correlation between KPCS and PSS was found during the study window time (p < 0.0001). Conclusions: These results potentially give the opportunity to explore this area of focus further, in order to better address maternal individual needs for the successful transition to motherhood. More research in this area is required

Lessons for Remote Post-earthquake Reconnaissance from the 14 August 2021 Haiti Earthquake

On 14th August 2021, a magnitude 7.2 earthquake struck the Tiburon Peninsula in the Caribbean nation of Haiti, approximately 150 km west of the capital Port-au-Prince. Aftershocks up to moment magnitude 5.7 followed and over 1,000 landslides were triggered. These events led to over 2,000 fatalities, 15,000 injuries and more than 137,000 structural failures. The economic impact is of the order of US$1.6 billion. The on-going Covid pandemic and a complex political and security situation in Haiti meant that deploying earthquake engineers from the UK to assess structural damage and identify lessons for future building construction was impractical. Instead, the Earthquake Engineering Field Investigation Team (EEFIT) carried out a hybrid mission, modelled on the previous EEFIT Aegean Mission of 2020. The objectives were: to use open-source information, particularly remote sensing data such as InSAR and Optical/Multispectral imagery, to characterise the earthquake and associated hazards; to understand the observed strong ground motions and compare these to existing seismic codes; to undertake remote structural damage assessments, and to evaluate the applicability of the techniques used for future post-disaster assessments. Remote structural damage assessments were conducted in collaboration with the Structural Extreme Events Reconnaissance (StEER) team, who mobilised a group of local non-experts to rapidly record building damage. The EEFIT team undertook damage assessment for over 2,000 buildings comprising schools, hospitals, churches and housing to investigate the impact of the earthquake on building typologies in Haiti. This paper summarises the mission setup and findings, and discusses the benefits, and difficulties, encountered during this hybrid reconnaissance mission.</jats:p

Efficacy of a new technique - INtubate-RECruit-SURfactant-Extubate - "IN-REC-SUR-E" - in preterm neonates with respiratory distress syndrome: Study protocol for a randomized controlled trial

Background: Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69&nbsp;%. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria. Methods/design: In this study, 206 spontaneously breathing infants born at 24+0-27+6 weeks' gestation and failing nCPAP during the first 24&nbsp;h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3&nbsp;days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30&nbsp;min after surfactant administration or when they meet the nCPAP failure criteria after extubation. Discussion: From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following hypothesis: a lung recruitment maneuver performed with a step-by-step Continuous Distending Pressure increase during High-Frequency Oscillatory Ventilation (and not with a sustained inflation) could have a positive effects in terms of improved surfactant distribution and consequent its major efficacy in preterm newborns with respiratory distress syndrome. This represents our challenge. Trial registration: ClinicalTrials.gov identifier: NCT02482766. Registered on 1 June 2015

Progetto per la costa orientale a Napoli.

La riconversione dell'ex-Corradini costituisce una opportunità di rigenerazione di una vasta area lungo la costa orientale di Napoli

Decifrare le pietre, in, Figure urbane nell'antico, di R. Capozzi e F. Visconti a cura di N. Campanile. E. Di Chiara

L'attività di ricerca affronta lo studio delle insulae romane ellenistiche di Agrigento e indaga la struttura spaziale e simbolica delle loro case e i meccanismi di aggregazione, attraverso il loro confronto con esempi più noti di Olinto, Priene, Paestum, Pompei, Ercolano e Neapolis, che hanno assolutamente forme e dimensioni simili, sebbene separate da distanze geografiche e temporali. La serie di esempi emergenti è integrata da alcune case di recente costruzione o solo redatte, che mostrano di seguire lo stesso principio fondante interno e di osservare gli stessi criteri di aggregazione. Tutto ciò ha portato gli studenti a sperimentare insulae simili, progettate sulla base di misure e caratteri di Akragas

Effect of Mozart music on heel prick pain in preterm infants: a pilot randomized controlled trial

Objective: The aim of this pilot study was to determine the effect of music by Mozart on heel prick procedural pain in premature infants. Background: Painful procedures are routinely performed in the setting of neonatal intensive care unit (NICU). Pain may exert short- and long-term deleterious effects on premature babies. Many non-pharmacological interventions have been proven efficacious for blunting neonatal pain. Study design: Randomized, controlled trial. Methods: The study was carried out in the NICU of the “G. Rummo” Hospital in Benevento, Italy. The sample consisted of 42 preterm infants, with no hearing loss or significant cerebral lesions on cranial ultrasound. They were randomized to receive heel lance during a music condition or a no-music control condition. We set strict criteria for selecting and delivering the music. Baseline and postprocedural heart rate and transcutaneous oxygen saturation were manually recorded. The Premature Infant Pain Profile (PIPP) score was used to measure the behavioral response to prick. An unpaired t-test was performed for the intergroup comparisons. Results: There were significant differences between groups on heart rate increase, oxygen saturation reduction and PIPP score following the procedure. Conclusions: Listening to Mozart music during heel prick is a simple and inexpensive tool for pain alleviating in preterm stable neonates

Favignana

Presentazione dei criteri di lavoro per il progetto sull'isola di Favigan

Fetal echocardiographic features of absent pulmonary valve syndrome

Absent pulmonary valve syndrome represents a rare defect, characterized by rudimental pulmonary valve leaflets. The presence of a nonfunctional valve can result in right ventricle dilation (Figure 1) and reduced ventricular compliance. There is often a ventricular septal defect with aortic override, as seen in tetralogy of Fallot (Figure 2, Video 1) while ductus arteriosus is frequently absent (Figure 3). Pulmonary valve stenosis may coexist (Figure 4). The main sonographic feature is massive dilation of pulmonary branches (Figure 5, Video 2). The prognosis is poor, and in addition to cardiac complications, most infants develop respiratory distress secondary to compression of bronchi by dilated pulmonary arteries