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The influence of different levels of nitrogen (N1, N2), phosphorous (P1, P2) and N+P (N1P1, N1P2, N2P1, N2P2) mixed fertilizers was investigated on volatile substances, soluble sugars, organic acids, titratable acidity, dry matter and lycopene of "Corbarino" cherry-like tomatoes. The flavour volatiles reached the highest concentrations in red-ripe cherry-like tomatoes treated with N1. Glucose, fructose, dry matter and titratable acidity increased only in N+P fertilized samples. Among the organic acids, citric increased, malic decreased and oxalic was constant in all the fertilized samples. Lycopene reached the highest values in N2 and N2P2 samples. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding plays a primary role in the events that characterize the development of the relationship between a mother and her newborn. However, this essential process sometimes does not fully cover the nutritional requirements of the newborn due to altered biomechanical sucking skills. In this context, adequate osteopathic treatment associated with neuromotor facilitation techniques could play a promoting role., Methods: This study evaluated the effect of the osteopathic approach using myofascial release on 26 infants with ineffective sucking ability, identified by the POFRAS scale and LATCH score, compared with 26 untreated similar infants. After the procedure was initially performed in the hospital, the strategy based on basic neuromotor patterns was taught to the parents to be continued at home. The effects were measured at hospital discharge, during the first outpatient visit, which occurred after about seven days, and at one month of life., Results: The number of valid and continuous suctions, initially less than five per feed in both groups, at the first outpatient check-up was significantly higher (p < 0.00001) in the treated group. Exclusive breastfeeding, initially present in all enrolled children, was maintained mainly in treated children, both at discharge (p < 0.003), at outpatient follow-up (p < 0.00001), and at one month of life (p < 0.00001). Differences in growth and health conditions were not found between the groups., Conclusion: We believe that osteopathic treatment associated with neuromotor facilitation techniques can optimize newborns' sucking skills, improving the acquisition and duration of breastfeeding., (© 2024. The Author(s).)

This narrative non-systematic review addresses the sex-specific differences observed both in prenatal period and, subsequently, in early childhood. Indeed, gender influences the type of birth and related complications. The risk of preterm birth, perinatal diseases, and differences on efficacy for pharmacological and non-pharmacological therapies, as well as prevention programs, will be evaluated. Although male newborns get more disadvantages, the physiological changes during growth and factors like social, demographic, and behavioural reverse this prevalence for some diseases. Therefore, given the primary role of genetics in gender differences, further studies specifically targeted neonatal sex-differences will be needed to streamline medical care and improve prevention programs., (© 2023. The Author(s).)

Aims: No previous research provided a complete biventricular and multidirectional left ventricular (LV) functional assessment by two-dimensional (2D) speckle tracking echocardiography (STE) in infants of gestational diabetic mothers (IGDM) METHODS: A total of 30 consecutive IGDM and 30 infants of healthy mothers were examined between March 2021 and July 2021. Both groups of infants underwent evaluation by neonatologist and 2D transthoracic echocardiography (TTE) implemented with 2D-STE quantification of LV-global longitudinal strain (GLS), LV-global circumferential strain (GCS), LV-global radial strain (GRS) and right ventricular (RV)-GLS, within 3 days of life and at 40 days after birth. Predictors of persistent subclinical myocardial dysfunction, defined as a LVGLS less negative than -20% at 40-day follow-up, in IGDM population, were determined., Results: At 2.2 ± 1.3 days after birth, LV-GLS (- 17.2 ± 1.9 vs. - 23.9 ± 3.8%), LV-GCS (- 17.9 ± 2.7 vs. - 27.3 ± 3.4%), LV-GRS (25.6 ± 3.4 vs. 35.8 ± 3.6%) and RV-GLS (- 17.6 ± 3.6 vs. - 22.6 ± 3.8%) were significantly impaired in IGDM than controls (all p < 0.001). At 36.8 ± 5.2 days of life, LV-GLS was still impaired (less negative than -20%) in 26.6% of IGDM. Maternal third trimester body mass index (BMI) (OR 1.89, 95%CI 1.05-3.39) and third trimester glycosylated hemoglobin (HbA1C) (OR 1.59, 95%CI 1.08-2.19) were independently associated with persistent LV-GLS impairment in IGDM. Maternal BMI ≥ 30 Kg/m2 and HbA1C ≥ 38 mmol/mol showed the maximum of sensitivity and specificity for predicting persistent subclinical myocardial dysfunction in IGDM at 40 days of life., Conclusions: IGDM have diffuse pattern of myocardial dysfunction during perinatal period. This dysfunction may be persistent up to 40 days of life in infants of GDM women with obesity and uncontrolled diabetes., (© 2022. Springer-Verlag Italia S.r.l., part of Springer Nature.)

Background: The present study was designed to investigate the possible influence of chest shape, noninvasively assessed by modified Haller index (MHI), on ventricular-arterial coupling (VAC) parameters in a population of term infants with pectus excavatum (PE)., Methods: Sixteen consecutive PE infants (MHI >2.5) and 44 infants with normal chest shape (MHI ≤2.5) were prospectively analyzed. All infants underwent evaluation by a neonatologist, transthoracic echocardiography, and MHI assessment (ratio of chest transverse diameter over the distance between sternum and spine) within 3 days of life. Arterial elastance index (EaI) was determined as end-systolic pressure (ESP)/stroke volume index, whereas end-systolic elastance index (EesI) was measured as ESP/left ventricular end-systolic volume index. Finally, VAC was derived by the Ea/Ees ratio., Results: At 2.1 ± 1 days after birth, compared to controls (MHI = 2.01 ± 0.2), PE infants (MHI = 2.76 ± 0.2) were diagnosed with significantly smaller size of all cardiac chambers. Biventricular systolic function, left ventricular filling pressures, and pulmonary hemodynamics were similar in both the groups of infants. Both EaI (4.4 ± 1.0 mmHg/ml/m 2 vs. 3.4 ± 0.6 mmHg/ml/m 2 , P < 0.001) and EesI (15.1 ± 3.0 mmHg/ml/m 2 vs. 12.7 ± 2.5 mmHg/ml/m 2 , P = 0.003) were significantly increased in PE infants than controls. The resultant VAC (0.30 ± 0.10 vs. 0.30 ± 0.08, P > 0.99) was similar in both the groups of infants. Both EaI ( r = 0.93) and EesI ( r = 0.87) were linearly correlated with MHI in PE infants, but not in controls. On the other hand, no correlation was found between MHI and VAC in both the groups of infants., Conclusions: Chest deformity strongly influences both Ea and Ees in PE infants, due to extrinsic cardiac compression, in the absence of any intrinsic cardiovascular dysfunction., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Cardiovascular Echography.)

The present study was primarily designed to accurately determine biventricular and biatrial myocardial function, assessed by two-dimensional speckle tracking echocardiography (2D-STE), in a prospective cohort of pregnant women aged ≥ 35 years, at the second trimester of pregnancy. Secondly, we aimed at investigating the main independent predictors of adverse maternal outcome (AMO) in the same study population. 80 consecutive pregnant women aged ≥ 35 years, 80 gestational week-matched (18.4 ± 1.6 vs 18.5 ± 1.8 weeks, p = 0.71) pregnant women aged < 35 years and 80 non-pregnant women aged ≥ 35 years without any comorbidity were included in this prospective study. All pregnant women underwent obstetric evaluation, modified Haller index (MHI) assessment and a conventional two-dimensional transthoracic echocardiography implemented with complete 2D-STE analysis of both ventricles and atria at the second trimester of pregnancy. AMO was defined as the occurrence of any of the following: gestational hypertension (GH) including preeclampsia; gestational diabetes mellitus (GDM); preterm delivery (PD); emergency caesarean section (ECS); postpartum haemorrhage (PPH); premature rupture of membranes (PROM); maternal death. Compared to younger pregnant women, pregnant women aged ≥ 35 years were more likely to be found with: (1) body mass index (BMI) ≥ 30 kg/m 2 (37.5% of total); (2) significantly increased inflammatory markers; (3) significantly greater left ventricular mass index; (4) significantly impaired hemodynamics; (5) significantly reduced bi-atrial and bi-ventricular myocardial strain parameters, despite normal ejection fraction. A strong inverse correlation between second trimester BMI and left ventricular (LV)-global longitudinal strain (GLS) (r =  - 0.84) and between second trimester MHI and LV-GLS (r =  - 0.81) was demonstrated in pregnant women aged ≥ 35 years. GH, GDM, PD, ECS, PPH and PROM were detected in 15%, 12.5%, 10%, 8.7%, 8.7% and 7.5% of women, respectively. Age (OR 2.04, 95% CI 1.46-2.84), second trimester BMI (OR 2.40, 95% CI 1.64-3.51) and second trimester LV-GLS (OR 0.07, 95%C I 0.01-0.34) were independently associated with outcome. Age ≥ 37 years, BMI ≥ 30 kg/m 2 and LV-GLS less negative than - 18% were the best cut-off values for predicting AMO. A LV-GLS less negative than - 18% allows to identify, among older pregnant women, those with an increased risk of AMO. Both intrinsic myocardial dysfunction and extrinsic compressive mechanical phenomena might affect global myocardial deformation during gestation., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To investigate the possible influence of chest wall conformation on myocardial strain parameters in a consecutive population of infants with pectus excavatum (PE), noninvasively assessed by modified Haller index (MHI)., Methods: Sixteen consecutive PE infants (MHI >2.5) and 44 infants with normal chest shape (MHI ≤2.5) entered in this prospective case-control study. All infants underwent evaluation by neonatologist, transthoracic echocardiography implemented with two-dimensional speckle tracking echocardiography (2D-STE) analysis of both ventricles and MHI assessment (ratio of chest transverse diameter over the distance between sternum and spine), at two time points: within 3 days and at about 40 days of life., Results: At 2.1 ± 1 days of life, compared to controls (MHI = 2.01 ± 0.2), PE infants (MHI = 2.76 ± 0.2) were diagnosed with significantly smaller cardiac chambers dimensions. Biventricular contractile function and hemodynamics were similar in both groups of infants. Left ventricular (LV) global longitudinal strain (GLS) (-16.0 ± 2.8 vs. -21.7 ± 2.2%), LV-global circumferential strain (GCS) (-16.3 ± 2.7 vs. -24.0 ± 5.2%), LV-global radial strain (GRS) (24.2 ± 3.0 vs. 31.5 ± 6.3%), and right ventricular free wall longitudinal strain (RVFWLS) (-16.0 ± 3.2 vs. -22.3 ± 4.4%) were significantly reduced in PE infants versus controls (all p < 0.001). A strong inverse correlation between MHI and the following parameters: LV-GLS (r = -0.92), LV-GCS (r = -0.88), LV-GRS (r = -0.87), and RVFWLS (r = -0.88), was demonstrated in PE infants, but not in controls, in perinatal period (all p < 0.001). Analogous results were obtained at 36.8 ± 5.2 days after birth., Conclusions: Abnormal chest anatomy progressively impairs myocardial strain parameters in PE infants. This impairment might reflect intraventricular dyssynchrony due to compressive phenomena rather than intrinsic myocardial dysfunction., (© 2021 Wiley Periodicals LLC.)

We carried out a survey of current practices of neonatal respiratory support in neonatal intensive care units (NICUs) in Italy with the aim of comparing the current reality with evidence from the literature. We sent a questionnaire by email to the 103 level III neonatal units in Italy. There was a 61 % (73/120) response rate to the questionnaire. We found that synchronized intermittent positive pressure ventilation is mostly used in infants in the acute phase of respiratory distress syndrome (RDS), while the majority of the units prefer volume-targeted ventilation for those in the weaning phase. Nasal continuous positive airway pressure is the most commonly used non-invasive mode of respiratory support, both in the acute and post-extubation phase of RDS. Surfactant is mainly given as rescue treatment. Infants receive caffeine before extubation and analgesia under mechanical ventilation, while post-natal steroids are given after the first week of life in the majority of the units. In conclusion, respiratory support strategies in Italian NICUs are frequently evidence-based. However, since there are areas where this does not occur, we suggest that focused interventions take place on these areas to help improve clinical practice and increase their adherence to evidence-based medical criteria.

Background: In recent years there has been growing interest in the influence of sustainable cultivation systems on the biochemical quality of vegetables. In this study, two genotypes of tomato, Giulianova and Perbruzzo, were grown in both organic (Or) and conventional (Conv) systems for three years and harvested at commercial ripening in each year. The Conv system was established according to traditional techniques and the Or system according to current EU regulations. Samples were evaluated for volatile substances, sugars, organic acids, dry matter, pH and lycopene., Results: During the three years, volatile substances increased in Or samples of Giulianova, while this response was less evident in Perbruzzo. Other parameters of both genotypes were not influenced by Or cultivation. Lycopene content in both Conv-cultivated genotypes was constant during the whole experimental period. In Or samples, lycopene content was lower than in Conv samples during the first and second years. In the last year, lycopene content in Or samples of Giulianova was similar to that in Conv samples, while lycopene content in Or samples of Perbruzzo was higher than that in Conv samples., Conclusion: Changes in biochemical parameters of tomato fruits could be affected by both cultivation system and genotype, with a significant increase in both volatile substances and lycopene in the 2010 crop., (Copyright © 2012 Society of Chemical Industry.)

Although the management of respiratory distress syndrome (RDS) in preterm infants has been characterized by significant progress in recent years, it is difficult to translate the research results into clinical practice. Previous surveys have demonstrated that in some areas, the current management of RDS does not reflect evidence from randomized trials. Therefore, the Pulmonology Study Group of the Italian Society of Neonatology decided to perform a similar survey in Italy with the aim of identifying possible aspects of respiratory management of preterm infants with RDS that merit improvement, and of suggesting focused interventions for their resolution.

Objective: To assess the therapeutic effects of breathing a low-density helium and oxygen mixture (heliox, 80% helium and 20% oxygen) in premature infants with respiratory distress syndrome (RDS) treated with nasal continuous positive airway pressure (NCPAP)., Methods: Infants born between 28 and 32 weeks of gestational age with radiologic findings and clinical symptoms of RDS and requiring respiratory support with NCPAP within the first hour of life were included. These infants were randomly assigned to receive either standard medical air (control group) or a 4:1 helium and oxygen mixture (heliox group) during the first 12 hours of enrollment, followed by medical air until NCPAP was no longer needed., Results: From February 2008 to September 2010, 51 newborn infants were randomly assigned to two groups, 24 in the control group and 27 in the heliox group. NCPAP with heliox significantly decreased the risk of mechanical ventilation in comparison with NCPAP with medical air (14.8% vs 45.8%)., Conclusions: Heliox increases the effectiveness of NCPAP in the treatment of RDS in premature infants.

The correct management of preterm babies requires, after discharge, an adequate follow-up program. The plan could be adjusted in relation to economical rises, rooms and staff amount of Neonatal Intensive Care Unit (NICU), varying its length and number of visits for patient for year. A survey was performed in Lombardy Region, Italy, to evaluate the differences among the various follow-up programs and to find a possible common approach suitable by all NICUs. A 23 questions formulated questionnaire, with multiple choice answers, has been sent to the referents of outpatients management of any NICU of the Region. The answers obtained from 13 of the 17 Units interviewed have been evaluated. All NICUs have a follow-up program, including ophthalmological, neurological, cardiac and audiometric evaluations. The plan length vary by 1 to 7 years; annually a mean of 130, and daily a mean of 7.4 patients are visited. At discharge all NICUs provide a clinical report to the family, but it is mailed to the Primary Care Physician just in 54% of cases. The differences founded among the follow-up programs resulted not significant for the preterm management, therefore it is possible to uniform the different plans, improving communication and interaction between NICUs and Primary Care Physicians.

Chylothorax is the accumulation of chyle in the pleural space. In newborns the congenital form is often prenatal diagnosed, while the late variety originates to damage to the thoracic duct by cardiac surgery, diaphragmatic hernia, etc. Clinical presentation results from the accumulation of pleural fluid and the symptoms depends on the size of the effusion. The treatment needs both medical and surgical care. The pleural cavity should be drained via thoracocentesis, and total parenteral nutrition should be started. Afterward fat-free diet with the addition of medium-chain triglycerides could be initiate. Somatostatin and octreotide have been successfully employed, mainly in post-surgery chylothorax. Surgery should be considered when medical management fails. Some approaches are reported, and thoracic duct ligation, pleurodesis and pleuroperitoneal shunts are the most utilized. The prognosis of chylothorax depends on the etiology, and it is consequence of a variety of treatments that may influence the outcome.

In respiratory care some gases are generally used to support the ventilation. Though oxygen is the most frequently dispensed, other specialty gases has become common practice in the last years. This report reviews the literature concerning the four gases mainly utilized in Neonatal Intensive Care Unit (NICU). Inhaled Nitric oxyde is a selective pulmonary vasodilator largely employed in NICU, while the helium-oxygen mixture, also knows as heliox, is less common, although it is widely note both the capability of decrease the pressure and work of breathing necessary to ventilate the lung, and the improvement of gas exchange in particular clinical situations. Carbon dioxide is generally used in the management of a specific congenital heart defect, and xenon, already known for its aesthetic proprieties but rarely used, because of its neuroprotective effects, could play a role in neonatal hypoxia/ischemia syndrome.

We reviewed the literature on the effects of high flow nasal cannula (HFNC) and heated, humidified, high-flow, nasal cannula (HHHFNC) treatment in preterm infants. We found nine studies, but only two were randomized controlled trials. These studies show that: HFNC application is associated to the delivery of continuous distending pressure (CDP) in patients with closed mouth, whose value is proportional to the delivered flow only in smaller infants; the CDP delivered by HFNC is unpredictable and present large inter-patient and intra-patient variability; the use of recently available HHHFNC devices is effective in minimizing nasal mucosa injuries compared to traditional HFNC; the effectiveness of HHHFNC versus NCPAP for the treatment of apnoea of prematurity, respiratory distress syndrome, and the prevention of extubation failure, has been poor investigated and firm conclusions cannot be drawn on this matter. In conclusion, on the basis of published data, the routinary application of HFNC should be limited to patients requiring oxygen-therapy, HHHFNC devices should be preferred to HFNC, but their employment as an alternative to NCPAP should wait for the conclusion of randomized controlled trials.

Objectives: Our goal was to evaluate the effects of a helium/oxygen mixture (heliox) on pulmonary mechanics and gas exchange in preterm infants during both conventional and noninvasive ventilation., Patients and Methods: Ten preterm infants, ventilated from birth, were enrolled. Resistive work of breathing, pulmonary compliance, static compliance, respiratory rate, minute ventilation, ventilatory support, and gas exchange were measured before and during treatment. One hour after heliox therapy, subjects who showed a decrease of peak inspiratory pressure of >20% of the initial value were extubated and shifted to nasal bilevel positive airway pressure with heliox for the following 3 hours. Pulmonary mechanics and ventilatory parameters were measured during air/oxygen ventilation and again 10 minutes and 1 hour after starting heliox. Transcutaneous pressure of O(2) and CO(2), oxygen saturation, and respiratory rate were recorded continuously. Arterial blood gases were measured immediately before and 1 hour after initiating bilevel positive airway pressure. To maintain oxygen saturation at >92% during the bilevel positive airway pressure phase, the mean fraction of inspired oxygen was increased from 0.34 to 0.36., Results: Mean peak inspiratory pressure decreased from 21.4 to 17.4 cmH(2)O, work of breathing decreased from 0.46 to 0.22 joule/L, and transcutaneous pressure of CO(2) decreased from 52.3 to 49.1 mmHg. Mean transcutaneous pressure of O(2) improved from 42.8 to 46.7 mmHg, and minute ventilation improved from 332 to 478 mL/kg per minute. No significant differences were observed in mean airway pressure, respiratory rate, oxygen saturation, pulmonary compliance, and static compliance. Eight infants were extubated. One of them needed to be reintubated after 5 hours., Conclusions: Our data show that mechanical ventilation with heliox reduces resistive work of breathing and ventilatory support requirements and improves gas exchange in preterm infants.

Background: The aim was to determine the effectiveness of continuous aminophylline infusion on refractory bronchospasm in long-term mechanically ventilated neonates., Case Report: Presented are seven newborns with gestational ages from 24 to 38 weeks and mean age at treatment of 29.7 days. All were mechanically ventilated from birth because of respiratory distress syndrome. Bronchospasm was diagnosed by wheezing, worsening of gas exchange, lengthening of expiratory time, and the need to modify the peak inspiratory pressure (PIP) to maintain the tidal volume. All patients had received conventional bronchodilator treatment for more than 24 hours before aminophylline treatment, without significant response. After discontinuation of previous bronchodilator drugs, an intravenous 6 mg/kg aminophylline bolus was administered over 20 minutes, followed by continuous infusions of 0.7 mg/kg/h for 12 hours and 0.35 mg/kg/h during the next 12 hours. Altogether, the treatment was carried out for 24 hours. Pulse-oximetry saturation (SpO(2)), transcutaneous pO(2)/pCO(2) (TcPO(2)/PCO(2)), heart rate, blood pressure, mean airway pressure (MAP), and fraction of inspired oxygen (FiO(2)) were recorded before and after the treatment. The SpO(2) (p<0.005) and TcPO(2) (p<0.002) increased significantly, while significant reductions in TcPCO(2) (p<0.00008) and FiO(2) (p<0.03) were observed. No signs of toxicity or significant differences in heart rate or blood pressure were reported. Mean serum aminophylline concentration resulted in therapeutic levels at both 12 and 24 hours., Conclusions: It is suggested that continuous infusion of aminophylline is well tolerated and may prove useful in improving the gas exchange in long-term mechanically ventilated neonates with refractory bronchospasm.

Objective: To determine possible relations between Apgar score, umbilical artery haemogasanalysis and delivery mode., Methods: 948 babies were considered; preterm infants and charts with incomplete data were excluded. 762 newborns and their respective umbilical artery blood gas parameters at delivery were evaluated. The collected Data were related to mode of delivery: vaginal with and without analgesia, elective caesarean section (CS), CS after labour, emergency CS for non reassuring trace., Results: Mean pH (+/- DS) was 7.26 (+/- 0.08). The comparison vaginal delivery vs. CS was statistically significant (p < 0.0001). Analyzing the CS only, the babies born by emergency CS for non reassuring trace had pH statistically lower (ANOVA p < 0.004) and, in the latter group, there was a statistically difference between Italian newborns and those from other ethnicities (p < 0.02). No difference were found on Apgar score, excluding babies by vaginal delivery with analgesia that showed lower scores both at 1 (p < 0.02) and 5 (p < 0.002) minutes versus newborns without analgesia., Conclusions: Normal labour causes frequently a mild degree of acidosis, but it is not always related to neonatal asphyxia. The differences found between different delivery modes are, probably, the expression of causes related to the obstetric choice. That is also remarked by the statistically difference found in emergency CS for non reassuring trace in Italian population and in other ethnicities, showing a probably different cultural level, mainly about the "obstetric emergency" poorly understood by the pregnant. In vaginal deliveries the analgesia does not modify the neonatal metabolism, but can be a reason of delayed adaptation of extrauterine life.

Our aim was to compare the effects of nasal bilevel positive airway pressure (N-BiPAP) and nasal continuous positive airway pressure (N-CPAP) on gas exchange in preterm babies. Twenty preterm infants (mean gestational age, 26.3 weeks; mean weight at study, 1,033 g) were evaluated. Patients received two repeated cycles of N-CPAP alternated with N-BiPAP, for a total of four alternated phases, each phase lasting 1 hr. Transcutaneous PO2 (TcPO2), transcutaneous PCO2 (tcPCO2), pulsoximetry, and respiratory rate were recorded every 15 min. Arterial blood gases and acid-base balance were measured at the beginning of the first study period on baseline CPAP and at the end of the last study period on bilevel positive airway pressure. During the two N-BiPAP phases, a statistically significant (P < 0.001) increase of peripheral oxygen saturation and tcPO2, and a significant (P < 0.001) reduction of tcPCO2 and respiratory rate, were noted as compared to the two N-CPAP periods. In addition, a significant improvement of PO2 (P < 0.003) and a reduction of PCO2 were noted at the end of the test (P < 0.02). In conclusion, N-BiPAP, as compared to N-CPAP, improved gas exchange in preterm infants., ((c) 2005 Wiley-Liss, Inc.)

Two infants on high-frequency oscillatory ventilation for chronic lung disease and severe respiratory failure, received a bolus of warmed and oxygenated perfluorodecalin up to residual functional capacity, followed by a continuous infusion of 6 ml/kg/hour. Our aim was to improve gas exchange without increasing ventilatory-induced lung injury. Heart rate, oxygen saturation, blood pressure, and TcPO(2)/TcPCO(2) were continuously monitored during treatment. Arterial blood gas was evaluated every 3 hours. Both patients showed improvement of gas exchange with a 13.6 and 12.5% reduction of oxygenation index, respectively. High-frequency partial liquid ventilation is an experimental ventilation technique that could be considered as rescue treatment, to improve oxygenation in subjects with critical respiratory failure. This method could probably produce less damage, than other ventilation modes, to severely injured lungs.

Objective: Pneumothorax (PNX) is a relatively common complication of nasal-CPAP (N-CPAP). Aim of the study was to identify prognostic factors of its onset., Methods: Seventy-seven newborns, admitted from January to December 2002 to the Neonatal Intensive Care Unit of Brescia, who were treated with N-CPAP with Infant Flow System as first intention, were included. Gestational age and birth weight were (mean +/- SD) 33.7 +/- 3.02 weeks and 2.047 +/- 684 grams, respectively. Infants were put on N-CPAP at 2.7 +/- 4.1 hours of life. The duration of treatment was 27.7 +/- 27.7 hours., Results: Fifty-one neonates improved and N-CPAP was discontinued, 26 worsened and required intubation and mechanical ventilation. Eight of them developed PNX (10,3%). No significant differences were found among the three groups (improved, worsened without PNX and worsened with PNX) concerning mode of delivery, gestational age, birth weight and blood gases. The patients with PNX needed a FiO2 28% higher than the initial value after 12 hours of treatment, and 46% higher at 24 hours (p = 0,017). At diagnosis, FiO2 was 53,5% higher than the initial value (p = 0,005)., Conclusion: A 40% increase of FiO2, during the first 24 hours of N-CPAP may represent an useful marker to identify the infants at high risk of developing a pneumothorax.

Our objective was to compare the effects of pressure support ventilation and synchronized intermittent mandatory ventilation on respiratory function in preterm babies. Twenty preterm infants (mean gestational age, 29 weeks; mean weight at study, 1,354 g) were evaluated. Patients received two repeated cycles of synchronized intermittent mandatory ventilation, alternated with pressure support ventilation, for a total of four alternated phases, each phase lasting 4 hr. Spontaneous respiratory rate, tidal volume, minute volume, and mean airway pressure were recorded hourly. The tidal volume released by the ventilator was limited to 6 ml/kg. During the two pressure support ventilation phases, a statistically significant reduction of respiratory rate and a significant increase of tidal and minute volume were noted, as compared to the two synchronized intermittent mandatory ventilation periods. Mean airway pressure significantly increased only after the first shift from synchronized intermittent mandatory ventilation to pressure support ventilation. The changes of minute volume and respiratory rate observed during pressure support ventilation did not persist after the return to synchronized intermittent mandatory ventilation. In conclusion, pressure support ventilation, as compared to synchronized intermittent mandatory ventilation, seemed to improve respiratory function in preterm infants., (Copyright 2003 Wiley-Liss, Inc.)

The authors evaluate the use of data supplied by common systems used to calculate respiratory mechanics in newborns in order to analyse the impact on the management of patients requiring assisted ventilation. Over the past few years, the sale of respiratory monitors that are easier to use and less complicated to manage, as well as being less expensive, has meant that nearly every Neonatal ICU can now determine, in real time, both the causes of respiratory insufficiency and the conditions of the newborn lung during mechanical ventilation to ensure improved adaptation of ventilatory support. Leaving aside a discussion of respiratory physiopathology and the principles regulating pulmonary ventilation, the authors focus on the practical effect that data normally supplied by this type of apparatus (airway pressure, inspiration and expiration airflow, expiration minute volume calculated for each respiratory act, tidal volume, system leaks and dynamic compliance) have on the ventilatory "setting" chosen by the clinician or on the diagnosis of some commonly found situations during neonatal mechanical ventilation. The experience described concerns the impression of clinicians, skilled in the management of patients receiving conventional artificial ventilation but not so attracted by respiratory physiopathology, regarding the value of such instruments. The unanimous positive opinion confirms the thesis whereby respiratory monitoring can certainly help the neonatologist make a real time evaluation of both the causes leading to respiratory failure and the effect on the lung of any therapeutic decisions.

Background: The preparation of a PN (parenteral nutrition) solution in neonatal and paediatric Departments is an operation of both critical importance and great difficulty (need of time to do it; complex calculations in order, for example, to subtract takes of nutrients from other sources; etc.)., Materials and Methods: With the aim to speed such a proceeding, the authors (from a 1000 deliveries/year NICU) developed a computerised system for the preparation of PN mixtures, based on a common and easily available "spreadsheet"., Results: The results of its application on a population of preterm babies in which parenteral and enteral (minimal enteral nutrition etc.) feedings were contemporarily provided, are illustrated. Advantages by using this software are the lower cost if compared with other dedicated softwares on sale and its great simplicity and versatility. The program is easy to use eve if different feeding plans are required; the data obtained at the end of the study demonstrated the effectiveness of the software in correctly calculate food components dosages., Conclusions: Using producer's data on feedings composition and up-to-date parenteral nutrition schedules, a reliable composition of the obtained PN mixtures was eventually achieved, as demonstrated by growth and blood samples.

The Authors present a case of infestation by Toxocara canis occurring in a eighteen months' child. A first time he was hospitalised for wheezing, reported hypereosinophilia and a thoracic X-ray with a soften congestion in the right lung's base. Two months later he was admitted to hospital for the persistence of high level of eosinocyte. The clinical tests and the patient's history explain the first symptoms like the passage of the Toxocara's larvae in the lungs, but don't justify the anomalous behaviour of eosinocytes. In fact the hypereosinophilia was present two months before the admission in our Department, but two tests, executed during the first stay in hospital, didn't show abnormality. A few months after, another blood's sample showed an high level of eosinocytes and, in the same time, a new control of thoracic X-ray, didn't show any change in the image.

A case of Henoch-Schönlein purpura (HSP) characterized by several unusual complications and exceedingly prolonged course is reported. A 6-year-old boy, hospitalized with a typical clinical picture of HSP, developed after a few days a severe gastrointestinal vasculitis leading to digestive hemorrhages and food intolerance. The treatment included continuous gastrointestinal infusion, parenteral nutrition, and corticosteroids during the exacerbations of symptoms. Intestinal ultrasonography showed diffuse submucous edema and widespread mural hematomas; hydrops of the gallbladder and edematous swelling of the pancreas were also detected. A gastro-duodenoscopy revealed diffuse and severe mucosal vasculitis with ulcers and petechial lesions. One week after admission the occurrence of weight gain, hyponatremia, and hypoprotidemia in the absence of proteinuria suggested a protein-losing enteropathy. The elevation of serum and urine amylases was consistent with pancreatic involvement. The course was characterized by recurrent exacerbations of gastrointestinal manifestations; symptoms subsided slowly to such a degree that oral feeding could be gradually restarted only seven weeks after admission. The use of high-frequency intestinal ultrasonography proved useful and sensitive in monitoring the evolution of intestinal involvement. During hospitalization the child complained of acute painful scrotal swelling. Ultrasonography showed scrotal hemorrhage and testicular swelling but no signs of testicular torsion, thus helping to avoid surgical exploration. In the recovery phase the child complained of colicky abdominal pain with vomiting. A plain abdominal roentgenogram showed bilateral staghorn pelvic urolithiasis. This finding was confirmed by an intravenous pyelography which also revealed a bilateral pyeloureteritis with edema of the ureteral wall and partial stenosis of the lumen.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum androgens and 17-hydroxyprogesterone concentrations and HLA genotypes were determined in 124 families of patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH). In 8 pedigrees, we discovered 16 pubertal or postpubertal family members of either sex who had biochemical evidence of 21-hydroxylase deficiency but were without clinical symptoms of excess virilism, amenorrhea, or infertility. We designated these family members as individuals with cryptic 21-hydroxylase deficiency. Within each generation, the family members with cryptic 21-hydroxylase deficiency were HLA identical. It is proposed that these family members are genetic compounds, having 21-hydroxylase deficiency as a result of two recessive gene defects: 1) a severe 21-hydroxylase gene defect present in the index case with classical CAH (21-OHCAH) and 2) a mild 21-hydroxylase gene defect (21-OHCRYPTIC). Thus, the CAH genotype in the family members with cryptic 21-hydroxylase deficiency is 21-OHCAH/21-OHCRYPTIC. Lod score analysis for linkage between the cryptogenic 21-OH trait and HLA gave a combined Lod score for males and females of theta = 0.00 of 3.409. Close genetic linkage between HLA and 21-OHCRYPTIC was thus established. This study provides support for the previously reported heterogeneity of 21-hydroxylase deficiency which may result from allelic variability at the locus for steroid 21-hydroxylase.

Cryptic 21-hydroxylase deficiency has been previously described in asymptomatic family members of patients with classical congenital adrenal hyperplasia (CAH). These family members were detected by high baseline 17-hydroxyprogesterone levels found in the course of family studies. The hormonal responses to ACTH of the family members with cryptic 21-hydroxylase deficiency were determined and compared to the responses of patients with CAH, patients with acquired adrenal hyperplasia, family members predicted to be heterozygous for CAH, family members predicted to be unaffected, and the general population. The ACTH-stimulated levels of 17-hydroxyprogesterone and delta 4-androstenedione in the cryptic family members were elevated above the level of the general population or family members heterozygous for classical CAH, but below that of patients with CAH. The hormonal profile of patients with cryptic 21-hydroxylase deficiency is similar to that of patients with acquired adrenal hyperplasia. The response of family members heterozygous for the cryptic gene (21-OH CRYPTIC/21-OH NORMAL) was indistinguishable from that of family members heterozygous for the classical CAH gene (21-OH CAH/21-OH NORMAL). These studies support our previous proposal that patients with cryptic 21-hydroxylase deficiency are genetic compounds, having one gene for a severe enzyme deficiency and one gene for a mild 21-hydroxylase deficiency. Thus, the 21-hydroxylase genotype in cryptic 21-hydroxylase deficiency is 21-OH CAH/21-OH CRYPTIC.