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Introduction: The SafeBoosC-III trial investigated the effect of cerebral oximetry-guided treatment in the first 72 h after birth on mortality and severe brain injury diagnosed by cranial ultrasound in extremely preterm infants (EPIs). This ancillary study evaluated the effect of cerebral oximetry on global brain injury as assessed by magnetic resonance imaging (MRI) at term equivalent age (TEA). Methods: MRI scans were obtained between 36 and 44.9 weeks PMA. The Kidokoro score was independently evaluated by two blinded assessors. The intervention effect was assessed using the nonparametric Wilcoxon rank sum test for median difference and 95% Hodges-Lehmann (HL) confidence intervals (CIs). The intraclass correlation coefficient (ICC) was used to assess the agreement between the assessors. Results: A total of 210 patients from 8 centers were included, of whom 121 underwent MRI at TEA (75.6% of alive patients): 57 in the cerebral oximetry group and 64 in the usual care group. There was an excellent correlation between the assessors for the Kidokoro score (ICC agreement: 0.93, 95% CI: 0.91–0.95). The results showed no significant differences between the cerebral oximetry group (median 2, interquartile range [IQR]: 1–4) and the usual care group (median 3, IQR: 1–4; median difference −1 to 0, 95% HLCI: −1 to 0; p value 0.1196). Conclusions: In EPI, the use of cerebral oximetry-guided treatment did not lead to significant alterations in brain injury, as determined by MRI at TEA. The strong correlation between the assessors highlights the potential of the Kidokoro score in multicenter trials. Plain Language Summary: Our study looked at whether monitoring the cerebral oxygenation by a specific tool can help protect the brains of very premature babies. We wanted to see if this tool could reduce the chances of any degree of brain injury in these tiny babies. The SafeBoosC-III was a big multicenter trial that found that using cerebral oximetry did not make a big difference in preventing severe brain injuries or saving lives in these babies. To study in more depth a representative group of babies in this big trial, we used advanced brain scans like MRI to check babies' brain health. Even though we noticed a small improvement in overall brain health when using cerebral oximetry, it was not enough to show a clear benefit. It is important to note that only one baby out of every five had severe brain injuries in the study. Our research shows that while cerebral oximetry is helpful for monitoring brain oxygen levels, it did not lead to noticeable changes in how often brain injuries happened in premature babies. This tells us that we still have more to learn about protecting these fragile babies' brains, and we need to keep looking for better ways to help them. In conclusion, our study highlights the challenges in using cerebral oximetry to prevent brain injuries in very premature babies, urging doctors and researchers to keep exploring new ideas to improve their brain health. [ABSTRACT FROM AUTHOR]

This document discusses the challenges and importance of addressing antimicrobial resistance in neonatal infections. Neonatal deaths due to infections are a significant contributor to child mortality, and diagnosing and treating severe bacterial infections in neonates can be difficult. The emergence of multidrug-resistant pathogens poses a threat to both high-income and low/middle-income countries, especially in neonatal intensive care units. Understanding local resistance patterns is crucial for selecting appropriate treatment strategies, and the misuse of antibiotics can perpetuate resistance. Conducting clinical trials involving neonates is challenging due to ethical considerations and the diverse nature of pediatric populations. Limited data is available on the impact of resistance profiles and treatment choices on patient mortality. The document also provides an overview of published papers in a special issue on this topic, including studies on antimicrobial stewardship programs, colonization screening, the impact of antibiotic therapy on the gut microbiota, and the management of gram-negative multidrug-resistant bacteria. The document concludes by highlighting the need for a universally applicable definition of neonatal sepsis and the challenges faced in conducting research on neonatal infections. The text emphasizes the importance of evidence-based approaches to address neonatal sepsis and improve healthcare decisions for newborns. [Extracted from the article]

A retrospective multicentre study conducted in Italy analyzed hospitalization trends for bronchiolitis in infants between October 2019 and March 2023. The study found that bronchiolitis cases, particularly those caused by the respiratory syncytial virus (RSV), experienced a significant reduction during the 2020-2021 winter due to preventive measures implemented during the COVID-19 pandemic. However, subsequent winters saw a notable and sustained increase in bronchiolitis hospitalizations, with the 2022-2023 winter period experiencing a 47% higher rate compared to the pre-pandemic winter of 2019-2020. The changing seasonality of bronchiolitis, including altered patterns of RSV circulation, poses challenges for disease control strategies and immunoprophylaxis measures. Further research is needed to monitor the epidemiology of bronchiolitis and inform public health interventions. [Extracted from the article]

Background: Exposure to hypothermia is somehow unavoidable when a baby comes to life. This is the reason why any possible effort should be made by every caregiver involved during birth, from labour to transfer into the maternity ward, to reduce it. Hypothermia has widely shown to be related to several neonatal problems, and the risks are more relevant when the babies are born prematurely. Method: An observational study was conducted in April 2016 to assess the current practises to avoid hypothermia at birth in 20 Italian neonatal units. Each unit introduced local improvements in clinical practice and the same observational study was repeated 1 year later. Results: A total of 4722 babies were analysed. An overall increase in adherence to local and international recommendations emerged from our study. Significant differences between 2016 and 2017 were found in regard to neonatal temperature at nursery entry (36.3 °C vs 36.5 °C, respectively, p < 0.0001), delayed cord clamping practice > 60″ (48.1% vs 68.1%, respectively, p < 0.0001) and skin-to-skin practice > 60′ (56.3% vs 60.9, respectively, p = 0.03). Statistical correlations with the risk of hypothermia were found for delivery room (OR 0.88 (CI 95%0.83–0.94), p < 0.0001) and maternal temperature (OR 0.57 (CI 95% 0.48–0.67), p < 0.0001). Conclusion: Periodical assessment of the delivery room practice has shown to be effective in improving adherence to the international recommendations. Relationship between neonatal hypothermia and several other variables including the delivery room and mother temperature underlines how neonatal thermoregulation starts immediately after birth. Hence, a multi-disciplinary approach is needed to provide the optimal environment for a safe birth. [ABSTRACT FROM AUTHOR]