CONTEXT:Bronchopulmonary dysplasia (BPD) is a multifactorial, chronic lung disease affecting preterm infants. Several interventions have been proposed to prevent BPD; a role for specific nutritional practices has also been suggested. OBJECTIVE:To evaluate, by means of a systematic review of the available literature, which nutritional interventions might prevent BPD in preterm infants. DATA SOURCES:PubMed, The Cochrane Library, and CINAHL were searched using a predefined PICO/PECO strategy for studies recruiting preterm infants (gestational age <37 weeks), examining nutritional interventions, and reporting on BPD. No study design limitation was applied. Articles were included if written in English and published before March 3, 2024. DATA EXTRACTION:The literature search yielded 1825 results. After screening, removal of duplicates, and retrieval of additional papers by hand-searching, 135 papers were included in the systematic review and categorized according to their main topic (parenteral nutrition, enteral nutrition, and nutritional supplements). Study quality assessment was performed using the criteria set out by the Cochrane Handbook for Systematic Reviews of Interventions. DATA ANALYSIS:Several nutritional interventions appear to reduce the risk of BPD in preterm infants. These include early optimization and balance of fluid, energy, and nutrient intakes through parenteral nutrition, early enteral feeding, and use of own mother's milk in a dose-dependent fashion. The quality of the examined literature was mixed. CONCLUSION:The available literature suggests that several nutritional interventions could play a role, together with intensive and respiratory care, to minimize the risk of chronic lung disease in preterm infants. However, the evidence for some interventions is inconclusive and deserves additional, well-designed research. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration no. CRD42022300524.

BACKGROUND:The BORN trial suggested that using cord blood-red blood cells (CB-RBCs) to transfuse severely preterm neonates significantly improves clinical outcomes compared to standard adult donor RBCs (A-RBC). STUDY DESIGN AND METHODS:The study illustrates CB-RBC concentrate production and inventory management across nine CB banks participating in the BORN trial. Quality requirements were those established by the European regulation for leukocyte-depleted RBC concentrates in additive solution. The compliance rate among centers was reported. RESULTS:During the BORN study, 451 CB-RBC units were processed and 107 were transfused to 69 patients in the intervention arm. However, for 67 transfusion requests, no compatible CB-RBC units were available and adult-RBCs were given. The CB-RBC inventory comprised a minor fraction of CB units collected during the study period, suggesting that many did not meet the protocol-defined volume threshold of 67 mL at collection. Quality control results showed that 84.0% of units achieved target hematocrit (Htc) levels (50-70%), with higher success rates in centers processing more CB units. All centers met quality standards, maintaining residual leukocytes below 1 × 106 and end-storage hemolysis below 0.8% in more than 90% of cases. CB-RBC availability was significantly limited by the time required for bacterial testing results and the need for γ-irradiation. DISCUSSION:These data suggest that the standardized CB-RBC production is reproducible. Moreover, extending CB-RBC storage to 21 days could maximize the inventory utility.

Background: Congenital cytomegalovirus (cCMV) is the most frequent infective cause of morbidity and long-term sequelae in infancy. Despite great attention to this clinical condition, potential prognostic factors for neurodevelopmental sequelae in cCMV patients are poorly understood, therefore hampering optimization of clinical care and management of cCMV patients. Methods: A retrospective single-center cohort study was conducted on 66 infants with congenital CMV infection in order to identify among clinical presentation at birth potential predictors of the absence of neurodevelopmental sequelae at 12 months of age. A logistic regression model was built in order to identify a correlation between potential predictors and neurodevelopmental status at one year of age in the cohort in the study. Results: The results of our study showed a significant correlation between normal neutrophil count and normal audiological assessment at birth in a logistic regression model (p < 0.05) in patients with cCMV with the absence of neurodevelopmental sequelae at M12. Our findings also underlined that normal platelet count and normal cerebral imaging are connected with normal neurodevelopment at one year of age, though not in a statistically significant way. Conclusions: Our findings underscore the need for appropriate assessment at birth in order to improve clinical management of cCMV patients.

BACKGROUND:The main aim of this study was to compare the costs of using standardized parenteral nutrition (PN) bags versus individualized PN bags for very low birth weight and extremely low birth weight preterm infants in the neonatal intensive care unit. METHODS:A micro-costing analysis was conducted from November 1, 2022 through October 31, 2023 on both individualized and standard PN bags. RESULTS:During the analysis period, 660 individual bags and 3700 standard bags were used. The average cost per individualized PN bag versus standardized bag was $160.92 versus $62.92 respectively. Standard bags were found to be 60.9% more cost-effective. CONCLUSION:The study concluded that standard PN bags are more cost-effective for very low birth weight and extremely low birth weight preterm patients. These findings support the potential shift towards using standardized PN in hospitals to manage resources effectively. Pharmacists can utilize these results to promote guideline-based use of standardized PN.

INTRODUCTION:Bloodstream infections remain a major cause of morbidity and mortality for infants admitted to neonatal intensive care units (NICUs), with central venous catheter use representing one of the principal risk factors. Among the strategies developed to prevent and manage catheter-related bloodstream infections (CRBSIs) and central line-associated bloodstream infections (CLABSIs), catheter-lock therapy (CLT) has emerged as a particularly promising approach. CLT is defined as the instillation of antimicrobial or antibiotic solutions into the catheter lumen, which are then left in place for a defined period, and has been adopted in adult and paediatric populations with satisfactory results. However, evidence supporting CLT efficacy and safety in newborns is still limited and fragmented. A rigorous synthesis of the available data is therefore critically needed. METHODS AND ANALYSIS:This systematic review will follow the methodological recommendations of the Cochrane Collaboration, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome will be the frequency of CRBSI and CLABSI in newborns receiving CLT in NICUs, compared with those receiving placebo or no lock therapy. Secondary outcomes will include mortality, duration of NICU stay, catheter survival rate and catheter dwell time, antibiotic exposure and safety profiles. A Population, Intervention, Comparison, and Outcome framework will be used to guide the inclusion criteria. A comprehensive search strategy has been developed across the most relevant electronic databases, together with grey literature. Search queries have been tailored for each specific database. Backward and forward citation strategies will be used. No restrictions regarding language or publication period will be applied. The systematic search will be conducted on 1 May 2026. All study designs presenting original data will be considered for inclusion-randomised controlled trials, cohort studies, case-control studies, case reports and surveys. Studies without original data will be excluded; however, the reference list of relevant reviews will be screened manually. Two reviewers will independently screen titles and abstracts, extract data and assess the risk of bias of each included study using standardised tools. In the event of disagreement, a third reviewer will be consulted. The quantitative synthesis will involve aggregation of comparable data, with results presented in tabular and graphical form. The effects of CLT will be evaluated separately according to its use as prophylaxis or as treatment. A subgroup analysis will be conducted according to the type of locking solution employed. Where at least two studies are judged sufficiently homogeneous, a meta-analysis will be performed. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach will be applied to assess the certainty of the evidence for clinically relevant outcomes. ETHICS AND DISSEMINATION:As this protocol pertains to a systematic review based on secondary data from published studies, formal ethical approval is not required. We anticipate completing the systematic review within 6 months. On conclusion, the findings will be submitted for publication in peer-reviewed journals indexed in PubMed. This systematic review protocol has been registered in PROSPERO (International Prospective Register of Systematic Reviews) under registration number: CRD420251176308.

Background:Feeding intolerance (FI) is common in very preterm infants and often leads to unnecessary interruptions in enteral nutrition (EN), delaying full enteral feeding (FEF). The absence of standardized criteria contributes to inconsistent management. We evaluated the impact of a structured protocol-Rapid Assessment of Feeding Intolerance (RAFI)-on FEF achievement in preterm infants. Methods:This single-center, retrospective-prospective superiority cohort study included infants <30 weeks' gestation. Two cohorts were defined: a historical control group (pre-RAFI) and a RAFI group (first implementation phase). The primary outcome was time to FEF (150 mL/kg/day of EN). One-sided statistical tests were used to assess the superiority of RAFI. Stratified analysis was performed for infants with intrauterine growth restriction (IUGR). Results:Sixty infants were included (30 per group). RAFI infants achieved FEF significantly earlier than controls [median 23.0 (IQR 18.0-30.0) vs. 30.0 (24.0-34.5) days; p = 0.041]. Among IUGR infants (n = 14), RAFI group achieved FEF earlier [27.00 (24.00-32.00) vs. 35.00 (34.00-61.00) days; p = 0.036] at earlier post-menstrual age [33.0 (32.5-34.0) vs. 34.0 (34.0-37.5) weeks; p = 0.028] and with a lower weight [1,280 (1,130-1,382) vs. 1,535 (1,325-2,002) g; p = 0.048]. A trend towards a shorter duration of central venous catheter (p = 0.059) and hospital stay (p = 0.064) was observed. Conclusions:RAFI implementation was associated with earlier achievement of FEF, particularly in IUGR infants. These findings suggest that a structured and standardized approach to feeding intolerance assessment may facilitate nutritional advancement in very preterm neonates.

Background:Red blood cell (RBC) transfusions in preterm neonates are associated with retinopathy of prematurity (ROP). Methods:BORN is a multicenter randomized trial investigating whether RBC transfusions from cord blood (CB-RBCs) instead of adult donors (A-RBCs) reduce ROP severity (NCT05100212). The study was conducted between December 2021 and November 2024 in 8 hospitals sited in 8 different Italian regions. Extremely low gestational age neonates (ELGANs) were randomized 1:1 to receive A-RBCs (control) or CB-RBCs (intervention) from birth to postmenstrual age (PMA) of 29 + 6 weeks. The main outcome was severe-ROP rate at 40 weeks PMA or discharge. Findings:By intention-to-treat-analysis, 56 patients per arm were evaluated: 16 in the control arm and 14 in the intervention arm developed severe ROP (28·6% versus 25·0%, risk difference [RD] -0·03 [95% CI -0·21% to 0·14%]; P = 0·831). Twenty-four (42·8%) patients in the intervention arm received also A-RBCs. Per-protocol-analysis included those patients receiving exclusively the assigned treatment, consisting of 38 ELGANs in the control arm and 17 in the intervention arm, with comparable characteristics. Thirteen ELGANs in the control arm developed severe ROP, and 10 required ROP treatment whilst no patients in the intervention arm developed severe ROP or treatment-requiring ROP (34·2% versus 0%, RD -0·34 [95% CI -0·51% to -0·07%] for severe ROP, P = 0·005, and 26·3% versus 0%, RD -0·28 [95% CI -0·46% to -0·02%] for treatment-requiring ROP, P = 0·022). Twenty-four patients in the control arm and 5 in the intervention arm developed moderate/severe BPD (63·2% versus 29·4%, RD -0·33 [95% CI -0·56% to -0·02%], P = 0·039). Interpretation:CB-RBCs may protect ELGANs from severe forms of ROP and BPD. Funding:Funded by Fresenius HemoCare Italia SRL (Prot. N 0038762/21-04/11/2021; grant number 5800134-FPG).

Introduction: Nasal synchronized intermittent positive pressure ventilation (nSIPPV) is an effective non-invasive ventilation technique, especially for preterm infants. Patient-ventilator synchrony is essential for providing effective respiratory support; however, no automated system is currently available for monitoring this parameter. A new tool for automatic assessment of patient-ventilator synchrony, the SyncNIV system, was developed and applied in this pilot study to evaluate differences between nSIPPV and non-synchronized nasal intermittent positive pressure ventilation (nIPPV) in preterm infants with respiratory distress. Methods: This study involved designing a custom algorithm for signal analysis. Data were collected through a polygraph that could simultaneously gather respiratory data from the patients and ventilator. Patient-ventilator synchrony was evaluated by applying the SyncNIV system in a randomized crossover study designed to compare nSIPPV and nIPPV. The primary outcome was the mean instant Synchrony Index (i-SI), defined as the portion of the inspiration effort sustained by ventilator inflation, expressed as a percentage. Results: Fourteen infants with a median (IQR) gestational age of 28.6 (25.6-30.3), were enrolled. We analyzed 43,304 ventilator inflations and 50,221 patient breaths. The i-SI was 54.69% (44.49-60.09) in nSIPPV and 39.54% (33.40-48.75) in nIPPV, p<0.05. Conclusion: The SyncNIV system confirmed better i-SI during nSIPPV than during nIPPV, demonstrating its effectiveness in assessing the differences between these two modes of non-invasive ventilation in preterm infants. The SyncNIV system could be a useful tool for optimizing the ventilation parameters and improving the effectiveness and comfort of respiratory support systems.

Fortification of human milk (HM) is often necessary to meet the nutritional requirements of preterm infants. The present experiment aimed to establish whether the supplementation of HM with either an experimental donkey milk-derived fortifier containing whole donkey milk proteins, or with a commercial bovine milk-derived fortifier containing hydrolyzed bovine whey proteins, affects peptide release differently during digestion. The experiment was conducted using an in vitro dynamic system designed to simulate the preterm infant's digestion followed by digesta analysis by means of LC-MS-MS. The different fortifiers did not appear to influence the cumulative intensity of HM peptides. Fortification had a differential impact on the release of either donkey or bovine bioactive peptides. Donkey milk peptides showed antioxidant/ACE inhibitory activities, while bovine peptides showed opioid, dipeptil- and propyl endo- peptidase inhibitory and antimicrobial activity. A slight delay in peptide release from human lactoferrin and α-lactalbumin was observed when HM was supplemented with donkey milk-derived fortifier.

Abstract Background Preterm infants are at high risk for retinopathy of prematurity (ROP), with potential life-long visual impairment. Low fetal hemoglobin (HbF) levels predict ROP. It is unknown if preventing the HbF decrease also reduces ROP. Methods BORN is an ongoing multicenter double-blinded randomized controlled trial investigating whether transfusing HbF-enriched cord blood-red blood cells (CB-RBCs) instead of adult donor-RBC units (A-RBCs) reduces the incidence of severe ROP (NCT05100212). Neonates born between 24 and 27 + 6 weeks of gestation are enrolled and randomized 1:1 to receive adult donor-RBCs (A-RBCs, arm A) or allogeneic CB-RBCs (arm B) from birth to the postmenstrual age (PMA) of 31 + 6 weeks. Primary outcome is the rate of severe ROP at 40 weeks of PMA or discharge, with a sample size of 146 patients. A prespecified interim analysis was scheduled after the first 58 patients were enrolled, with the main purpose to evaluate the safety of CB-RBC transfusions. Results Results in the intention-to-treat and per-protocol analysis are reported. Twenty-eight patients were in arm A and 30 in arm B. Overall, 104 A-RBC units and 49 CB-RBC units were transfused, with a high rate of protocol deviations. A total of 336 adverse events were recorded, with similar incidence and severity in the two arms. By per-protocol analysis, patients receiving A-RBCs or both RBC types experienced more adverse events than non-transfused patients or those transfused exclusively with CB-RBCs, and suffered from more severe forms of bradycardia, pulmonary hypertension, and hemodynamically significant patent ductus arteriosus. Serum potassium, lactate, and pH were similar after CB-RBCs or A-RBCs. Fourteen patients died and 44 were evaluated for ROP. Ten of them developed severe ROP, with no differences between arms. At per-protocol analysis each A-RBC transfusion carried a relative risk for severe ROP of 1.66 (95% CI 1.06–2.20) in comparison with CB-RBCs. The area under the curve of HbF suggested that HbF decrement before 30 weeks PMA is critical for severe ROP development. Subsequent CB-RBC transfusions do not lessen the ROP risk. Conclusions The interim analysis shows that CB-RBC transfusion strategy in preterm neonates is safe and, if early adopted, might protect them from severe ROP. Trial registration Prospectively registered at ClinicalTrials.gov on October 29, 2021. Identifier number NCT05100212.

The primary purpose of this practical overview is to provide a practical update on appropriate nutritional strategies to improve growth in preterm infants. Current recommendations for improving preterm growth concern both macronutrients and micronutrients, with tailored nutrition since the first days of life, particularly when fetal growth restriction has been reported. Human milk is undoubtedly the best nutrition for all newborns, but, in some populations, if not adequately fortified, it does not adequately support their growth. In all preterms, growth should be correctly monitored weekly to intercept a negative trend of growth and implement nutritional strategies to avoid growth restriction. Similarly, growth should be accurately supported and monitored after discharge to improve long-term health consequences.

Abstract Background Particulate contamination due to infusion therapy (administration of parenteral nutrition and medications) carries a potential health risk for infants in neonatal intensive care units (NICUs). This particulate consists of metals, drug crystals, glass fragments, or cotton fibers and can be generated by drug packaging, incomplete reconstitution, and chemical incompatibilities. In-line filters have been shown to remove micro-organisms, endotoxin, air, and particles in critically ill adults and older infants, but its benefits in newborn remain to be demonstrated. Moreover, 50% of inflammatory episodes in the setting of NICUs are blood culture-negative. These episodes could be partly related to the presence of particles in the infusion lines. Methods A multicenter randomized single-blind controlled trial was designed. All infants admitted to NICUs for which prolonged infusion therapy is expected will be enrolled in the study and randomized to the Filter or Control arm. All patients will be monitored until discharge, and data will be analyzed according to a “full analysis set.” The primary outcome is the frequency of patients with at least one sepsis-like event, defined by any association of suspected sepsis symptoms with a level of c-reactive protein (CRP) > 5 mg/L in a negative-culture contest. The frequency of sepsis, phlebitis, luminal obstruction, and the duration of mechanical ventilation and of catheter days will be evaluated as secondary outcomes. The sample size was calculated at 368 patients per arm. Discussion This is the first multicenter randomized control trial that compares in-line filtration of parenteral nutrition and other intravenous drugs to infusion without filters. Sepsis-like events are commonly diagnosed in clinical practice and are more frequent than sepsis in a positive culture contest. The risk of these episodes in the target population is estimated at 30–35%, but this data is not confirmed in the literature. If the use of in-line filters results in a significant decrease in sepsis-like events and/or in any other complications, the use of in-line filters in all intravenous administration systems may be recommended in NICUs. Trial registration ClinicalTrials.gov, NCT05537389, registered on 12 September 2022 ( https://classic.clinicaltrials.gov/ct2/show/results/NCT05537389?view=results ).

Surfactant is a well-established therapy for preterm neonates affected by respiratory distress syndrome (RDS). The goals of different methods of surfactant administration are to reduce the duration of mechanical ventilation and the severity of bronchopulmonary dysplasia (BPD); however, the optimal administration method remains unknown. This study compares the effectiveness of the INtubate-RECruit-SURfactant-Extubate (IN-REC-SUR-E) technique with the less-invasive surfactant administration (LISA) technique, in increasing BPD-free survival of preterm infants. This is an international unblinded multicenter randomized controlled study in which preterm infants will be randomized into two groups to receive IN-REC-SUR-E or LISA surfactant administration. In this study, 382 infants born at 24+0–27+6 weeks’ gestation, not intubated in the delivery room and failing nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV) during the first 24 h of life, will be randomized 1:1 to receive IN-REC-SUR-E or LISA surfactant administration. The primary outcome is a composite outcome of death or BPD at 36 weeks’ postmenstrual age. The secondary outcomes are BPD at 36 weeks’ postmenstrual age; death; pulse oximetry/fraction of inspired oxygen; severe intraventricular hemorrhage; pneumothorax; duration of respiratory support and oxygen therapy; pulmonary hemorrhage; patent ductus arteriosus undergoing treatment; percentage of infants receiving more doses of surfactant; periventricular leukomalacia, severe retinopathy of prematurity, necrotizing enterocolitis, sepsis; total in-hospital stay; systemic postnatal steroids; neurodevelopmental outcomes; and respiratory function testing at 24 months of age. Randomization will be centrally provided using both stratification and permuted blocks with random block sizes and block order. Stratification factors will include center and gestational age (24+0 to 25+6 weeks or 26+0 to 27+6 weeks). Analyses will be conducted in both intention-to-treat and per-protocol populations, utilizing a log-binomial regression model that corrects for stratification factors to estimate the adjusted relative risk (RR). This trial is designed to provide robust data on the best method of surfactant administration in spontaneously breathing preterm infants born at 24+0–27+6 weeks’ gestation affected by RDS and failing nCPAP or NIPPV during the first 24 h of life, comparing IN-REC-SUR-E to LISA technique, in increasing BPD-free survival at 36 weeks’ postmenstrual age of life. ClinicalTrials.gov NCT05711966. Registered on February 3, 2023.

IntroductionBreastfeeding naturally enables the coordination of sucking, swallowing, and respiration patterns for safe feeding. When breastfeeding is not possible a feeding device that releases milk in response to intra-oral vacuum could potentially offer improved coordination of sucking, swallowing, and breathing patterns compared to conventional devices. The aim of the study is to evaluate the effect of a valved infant-bottle with an ergonomic teat compared to a standard infant-bottle.MethodsThis unblinded randomized controlled trial focused on late preterm infants fed by bottle for at least three meals over the day, admitted to the Neonatal Unit of Sant’Anna Hospital (Turin, Italy). Infants were randomized to be fed with a valved infant-bottle with an ergonomic teat (B-EXP arm) or with a standard infant-bottle (B-STD arm). Monitoring included a simultaneous synchronized recording of sucking, swallowing and respiration. The main outcome was the swallowing/breathing ratio.ResultsForty infants (20 B-EXP arm; 20 B-STD arm) with a median gestational age of 35.0 weeks (IQR 35.0–36.0 weeks) completed the study. Four infants were censored for the presence of artifacts in the polygraphic traces. The median swallowing/breathing ratio was 1.11 (1.03–1.23) in the B-EXP arm and 1.75 (1.21–2.06) in the B-STD (p = .003). A lower frequency of swallowing events during the inspiratory phase of breathing was observed in B-EXP arm compared with B-STD arm (p = 0.013).DiscussionThe valved infant-bottle with an ergonomic teat improves the coordination of sucking-swallowing-respiration and limits the risk of inhalation reducing the frequency of swallowing during the inspiratory phase.

In most NICUs, the choice of the venous access device currently relies upon the operator's experience and preferences. However, considering the high failure rate of vascular devices in the neonatal population, such clinical choice has a critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems in line with the current scientific evidence. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in the neonatal population. After a systematic review of the available evidence, the panel of the consensus (which included Italian neonatologists specifically experts in this area) has provided structured recommendations answering four sets of questions regarding (1) umbilical venous catheters, (2) peripheral cannulas, (3) epicutaneo-cava catheters, and (4) ultrasound-guided centrally and femorally inserted central catheters. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice.Conclusion: The goal of the present consensus is to offer a systematic set of recommendations on the choice of the most appropriate vascular access device in Neonatal Intensive Care Unit.

Background: Human cytomegalovirus (HCMV) is the leading cause of congenital infections resulting in severe morbidity and mortality among newborns worldwide. Although both the host's and the virus' genetic back-grounds contribute to the outcome of infections, significant gaps remain in our understanding of the exact mechanisms that determine disease severity.Objectives: In this study, we sought to identify a correlation between the virological features of different HCMV strains with the clinical and pathological features of congenitally infected newborns, therefore proposing new possible prognostic factors.Study design: This short communication presents five newborns with congenital cytomegalovirus infection, whose clinical phenotype during fetal, neonatal, and follow-up periods is correlated with in-vitro growth properties, immunomodulatory abilities and genome variability of HCMV strains isolated from organic samples (urine) of the patients.Results: The five patients described in this short communication displayed a heterogeneous clinical phenotype and different virus replication properties, immunomodulatory abilities, and genetic polymorphisms. Interest-ingly, we observed that an attenuate viral replication in-vitro influences the immunomodulatory abilities of HCMV, leading to more severe congenital infections and long-term sequelae. Conversely, infection with viruses characterized by aggressive replicative behavior in-vitro resulted in asymptomatic patients' phenotypes.Conclusions: Overall, this case series suggests the hypothesis that genetic variability and differences in the replicative behavior of HCMV strains result in clinical phenotypes of different severity, most likely due to different immunomodulatory properties of the virus.

Preterm birth (PTB) identifies infants prematurely born <37 weeks/gestation and is one of the main causes of infant mortality. PTB has been linked to air pollution exposure, but its timing is still unclear and neglects the acute nature of delivery and its association with short-term effects. We analyzed 3 years of birth data (2015–2017) in Turin (Italy) and the relationships with proinflammatory chemicals (PM2.5, O3, and NO2) and biological (aeroallergens) pollutants on PTB vs. at-term birth, in the narrow window of a week before delivery. A tailored non-stationary Poisson model correcting for seasonality and possible confounding variables was applied. Relative risk associated with each pollutant was assessed at any time lag between 0 and 7 days prior to delivery. PTB risk was significantly associated with increased levels of both chemical (PM2.5, RR = 1.023 (1.003–1.043), O3, 1.025 (1.001–1.048)) and biological (aeroallergens, RR ~ 1.01 (1.0002–1.016)) pollutants in the week prior to delivery. None of these, except for NO2 (RR = 1.01 (1.002–1.021)), appeared to play any role on at-term delivery. Pollutant-induced acute inflammation eliciting delivery in at-risk pregnancies may represent the pathophysiological link between air pollution and PTB, as testified by the different effects played on PTB revealed. Further studies are needed to better elucidate a possible exposure threshold to prevent PTB.

This randomized clinical trial compares 2 types of noninvasive respiratory support on the basis of daily enteral feeding, signs of feeding intolerance, treatment effectiveness, peripheral oxygen saturation levels, fraction of inspired oxygen levels, and growth and respiratory outcomes.

Preterm birth, defined as birth before 37 weeks of gestation, is a major public health concern. It affects about 10% of all newborns globally and is the main cause of infant death and morbidity. Prematurity increases the likelihood of respiratory distress syndrome, cerebral palsy, and developmental abnormalities. Furthermore, premature newborns are at risk of acquiring chronic noncommunicable diseases later in life due to interference with organ system development during the in-utero and perinatal period. Because of the greater risk of long-term repercussions, preterm birth should be considered a chronic disorder, and gestational age and other birth histories should be included in all medical records for patients of all ages, especially when assessing the risk of multiple chronic diseases. Conventional methods for assessing preterm infant development, as well as reliable and precise growth monitoring, can lead to the early detection of growth decline and the adjustment of feeding regimens as needed. Because of its unique composition and useful components, human milk is a powerful tool for mitigating the negative outcomes associated with prematurity. It contains a variety of growth factors that promote the development of organs and systems, counteracting the negative effects of the abrupt interruption of intrauterine development and promoting better outcomes in all altered functions. Despite its multiple benefits, human milk cannot totally restore the lasting damage caused by premature birth. Premature infants cannot be completely overcome by nutrition alone, and yet adequate nutritional intake and human milk feeding are critical to their health and development.