Abstract Vaccines to prevent infant group B streptococcus (GBS) disease are advancing, with licensure likely based on safety and immunologic endpoints rather than clinical efficacy data. This approach requires robust, generalisable serological thresholds of risk reduction (SToRRs). We combined data from six case-control studies in Europe and Africa to define SToRRs for early-onset (EOD) and late-onset (LOD) GBS disease. Across diverse epidemiological and healthcare settings, anti-capsular polysaccharide IgG concentrations were consistently higher in infants who remained disease free than in those who developed disease. Higher antibody concentrations were required to reduce the risk of EOD than LOD, and higher concentrations were required for serotype Ia than for serotype III. This study provides a quantitative framework to support correlates-based evaluation and potential licensure of maternal GBS vaccines.

To assess the real-world performance of the Serial Clinical Observation (SCO) strategy in identifying and treating Early-Onset Sepsis (EOS) cases, and to compare it with the recommendations the Neonatal Sepsis Calculator (NSC) would have provided. This multicentre study analyzed prospectively culture-confirmed EOS cases caused by Group B Streptococcus (GBS) or Escherichia coli (2016–2022) in term and late-preterm infants managed with the SCO approach in Italy. We evaluated the proportion of infants assigned to routine care at birth and the time to antibiotics. NSC scores at 4, 12, and 24 h after birth were retrospectively calculated. Of 57 EOS cases, 23 (40.4

OBJECTIVES:Neonatal sepsis in one twin poses a dilemma in managing the healthy-appearing sibling. Shared exposures and genetic factors increase risk, and early signs of sepsis can be subtle with rapid deterioration. However, the magnitude of this risk for the healthy twin is unclear, and management strategies vary considerably. METHODS:We systematically searched PubMed and EMBASE on June 10th 2025 for multiples in which at least one infant (0-89 days) developed culture-confirmed Group B Streptococcus or Escherichia coli early-onset or late-onset sepsis or meningitis. RESULTS:Of 151 sets of multiples from 51 studies, all siblings developed disease in 70 sets (46%). Concordance was 35% in cases described in cohort or surveillance studies and 69% among cases in case reports/series. Median onset interval between siblings was 3 days (IQR 1-7 days). In a small subgroup, pre-emptive antibiotics for the well-appearing twin were associated with lower disease risk (11% vs 56%, p=0.03). CONCLUSIONS:Concordance rates of the well-appearing sibling was a third in cohort or surveillance studies and up to half in all identified cases. Even though this can be inflated by reporting bias, cautious management should include strict clinical monitoring, parental education and a low threshold for antibiotics.

Importance:Despite continuous improvements in neonatal resuscitation and stabilization in the last decades, thermal management immediately after birth remains an unresolved issue in preterm infants. Objective:To compare 2 strategies of thermal management (plastic wrapping with or without drying) for preventing heat loss at birth in very preterm infants. Design, Setting, and Participants:This multicenter, unblinded, randomized clinical trial was conducted among very preterm infants (birth weight <1500 g and/or gestational age ≤30 weeks 6 days) at 21 tertiary care hospitals in Italy from February 21, 2023, to July 18, 2024. Interventions:Eligible neonates were randomly allocated to either drying before plastic wrapping in the delivery room (intervention arm) or plastic wrapping without drying (control arm). Main Outcomes and Measures:The primary outcome was the proportion of participants with normothermia (36.5-37.5 °C) at admission to the neonatal intensive care unit (NICU). The secondary outcomes included hypothermia (<36.5 °C), moderate to severe hypothermia (<36.0 °C), and hyperthermia (>37.5 °C) at NICU admission, temperature at 1 hour after NICU admission, intraventricular hemorrhage, respiratory distress syndrome, late-onset sepsis, bronchopulmonary dysplasia, and mortality before hospital discharge. Results:Overall, 354 very preterm infants were randomized (180 [50.8%] female; mean [SD] gestational age, 28.6 [2.5] weeks); all received the allocated intervention and were included in the analysis. Normothermia at NICU admission was achieved in 81 of 177 dried infants (45.8%) and 82 of 177 undried infants (46.3%; risk ratio, 0.99; 95% CI, 0.79-1.24). The mean (SD) neonatal temperature at NICU admission was 36.4 °C (0.8 °C) in dried neonates and 36.5 °C (0.7 °C) in undried neonates (mean difference, -0.1 °C; 95% CI, -0.2 °C to 0.1 °C). In-hospital mortality included 26 of 177 dried neonates (14.7%) and 10 of 177 undried neonates (5.6%) (unadjusted risk ratio, 2.60; 95% CI, 1.29-5.23). The other secondary outcome measures were not different between the 2 arms. Conclusions and Relevance:In this multicenter randomized clinical trial, drying before plastic wrapping provided no benefit to very preterm infants in maintaining normothermia at NICU admission. Most deaths could be expected due to the compromised profile of the neonates, with no pathophysiological explanation related to the trial interventions. Approximately half of the infants were outside the normal thermal range at NICU admission; hence, thermal management remains a challenge requiring further investigations. Trial Registration:ClinicalTrials.gov Identifier: NCT05740072.

Importance Despite continuous improvements in neonatal resuscitation and stabilization in the last decades, thermal management immediately after birth remains an unresolved issue in preterm infants. Objective To compare 2 strategies of thermal management (plastic wrapping with or without drying) for preventing heat loss at birth in very preterm infants. Design, Setting, and Participants This multicenter, unblinded, randomized clinical trial was conducted among very preterm infants (birth weight <1500 g and/or gestational age ≤30 weeks 6 days) at 21 tertiary care hospitals in Italy from February 21, 2023, to July 18, 2024. Interventions Eligible neonates were randomly allocated to either drying before plastic wrapping in the delivery room (intervention arm) or plastic wrapping without drying (control arm). Main Outcomes and Measures The primary outcome was the proportion of participants with normothermia (36.5-37.5 °C) at admission to the neonatal intensive care unit (NICU). The secondary outcomes included hypothermia (<36.5 °C), moderate to severe hypothermia (<36.0 °C), and hyperthermia (>37.5 °C) at NICU admission, temperature at 1 hour after NICU admission, intraventricular hemorrhage, respiratory distress syndrome, late-onset sepsis, bronchopulmonary dysplasia, and mortality before hospital discharge. Results Overall, 354 very preterm infants were randomized (180 [50.8%] female; mean [SD] gestational age, 28.6 [2.5] weeks); all received the allocated intervention and were included in the analysis. Normothermia at NICU admission was achieved in 81 of 177 dried infants (45.8%) and 82 of 177 undried infants (46.3%; risk ratio, 0.99; 95% CI, 0.79-1.24). The mean (SD) neonatal temperature at NICU admission was 36.4 °C (0.8 °C) in dried neonates and 36.5 °C (0.7 °C) in undried neonates (mean difference, −0.1 °C; 95% CI, −0.2 °C to 0.1 °C). In-hospital mortality included 26 of 177 dried neonates (14.7%) and 10 of 177 undried neonates (5.6%) (unadjusted risk ratio, 2.60; 95% CI, 1.29-5.23). The other secondary outcome measures were not different between the 2 arms. Conclusions and Relevance In this multicenter randomized clinical trial, drying before plastic wrapping provided no benefit to very preterm infants in maintaining normothermia at NICU admission. Most deaths could be expected due to the compromised profile of the neonates, with no pathophysiological explanation related to the trial interventions. Approximately half of the infants were outside the normal thermal range at NICU admission; hence, thermal management remains a challenge requiring further investigations. Trial Registration ClinicalTrials.gov Identifier: NCT05740072

Background: some consensus guidelines include C-reactive protein (CRP) in the diagnostic workup of early-onset neonatal sepsis (EOS), but its routine use remains debated due to variable diagnostic performance. The experiences and data from individual centers can help clarify its clinical utility and inform local practice. Methods: Retrospective analysis at a level III center assessing the impact of discontinuing routine C-reactive protein (CRP) testing for suspected early-onset sepsis (EOS). Laboratory use, antibiotic therapy, and outcomes in neonates of all gestational ages were compared before (2021-2022) and after (2024-2025) the policy change. Results: A total of 638 neonates were included (period 1, n = 348; period 2, n = 290). CRP testing decreased markedly (218/348 in period 1 vs. 40/290 in period 2; p < 0.001), alongside a significant reduction in the number of complete blood counts performed (285/348 vs. 214/290; p = 0.02). Concurrently, both the proportion of short antibiotic courses (≤48 h) initiated within the first 3 days of life (98/181 vs. 88/133) and the median duration of antibiotic therapy (48.0 h vs. 40.0 h; p < 0.001) decreased without worsening outcomes. The duration of antibiotic therapy was even shorter in infants born before 34 weeks' gestation (48.0 h vs. 37.5 h; p < 0.001). Conclusions: Restricting the use of CRP in the evaluation of EOS was associated with a reduction in unnecessary antibiotic exposure. This strategy may be considered a core component of neonatal antibiotic stewardship programs.

Fluid overload in children undergoing dialysis can lead to serious cardiac complications, i.e., left ventricular hypertrophy (LVH) and cardiac dysfunction. Studies investigating the cardiovascular effects of persistent subclinical hypervolemia—characterized by euvolemia at clinical assessment but hypervolemia at technical evaluation—are lacking. This pilot study explored the combined use of lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and ultrasound assessment of the inferior vena cava collapsibility index (IVC-CI) to identify subclinical hypervolemia and investigated its cardiac impact. In this longitudinal study, we recruited 23 children on chronic dialysis who underwent fluid status evaluation (physical examination, LUS, IVC-CI, BIS) every 2 months and echocardiography every 6 months. In clinically euvolemic patients, we observed a significant positive correlation between the interdialytic weight gain and the number of B-lines observed by LUS (R = 0.2923, p < 0.001); similar results were obtained for the OH/ECW measured by BIS (R = 0.4144, p < 0.001), while a negative correlation with IVC-CI (R = − 0.2597, p = 0.019) was observed. Moreover, we identified a significant linear correlation between left ventricular mass index values and the average pre-dialysis systolic blood pressure measured over the preceding 6 months (R2 = 0.16, p = 0.002). Hospitalizations due to hypertensive crises (67

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Our aim was to develop a quantitative model for immediately estimating the risk of death and/or brain injury in late-onset sepsis (LOS) in preterm infants, based on objective and measurable data available at the time sepsis is first suspected (i.e., time of blood culture collection). Retrospective study on neonates ≤36 weeks’ gestation with a positive blood and/or cerebrospinal fluid culture after 72 hours from birth. Among 3217 preterm live births, 94 cases were included (median gestational age 26.5 weeks’ IQR 25.0;28.0), of whom 26 (27.7

BACKGROUND:In preterm infants receiving noninvasive ventilation, data about inspiratory effort (ΔPes) and transpulmonary driving pressure (ΔPL) are scarce. Electrical activity of the diaphragm (EAdi) can estimate ΔPes and ΔPL when patient size precludes more accurate measurements. This estimation may reveal new insights into respiratory pathophysiology and potential risk of self-inflicted lung injury in neonates receiving noninvasive support. RESEARCH QUESTION:What are the characteristics of ΔPes and ΔPL in extremely preterm infants undergoing noninvasive ventilation? STUDY DESIGN AND METHODS:Prospective, observational pilot cohort study, in which EAdi was recorded in neonates receiving noninvasive ventilation during recovery from respiratory distress syndrome (RDS), in those with evolving bronchopulmonary dysplasia (BPD), and in term controls. EAdi was used to estimate ΔPes and ΔPL. In a subset of patients with RDS and BPD, diaphragmatic thickening fraction (TF) and peripheral oxygen saturation (Spo2)/Fio2 were recorded. RESULTS:Ten patients with RDS, 25 patients with evolving BPD, and 5 control term neonates were studied. Average EAdi, ΔPes, ΔPL, and TF were similar between control infants and those with RDS and BPD. Inter-patient variability of ΔPes (RDS, 24 [9]%; BPD, 28 [9]%; controls, 10 [6]%; P < .001) and ΔPL (RDS, 25 [7]%; BPD, 27 [9]%; controls, 17 (7)%; P = .05) was higher in patients than in controls. Breaths with ΔPes > 10 cm H2O occurred more often in BPD than in RDS patients (P = .035) and control infants (P = .006). Breaths with ΔPL > 20 cm H2O occurred similarly in patients with BPD or RDS and more frequently than in control infants (P < .001). EAdi-based estimations correlated with TF, and ΔPL had an inverse correlation with Spo2/Fio2 (ρ = -0.64; P = .018). INTERPRETATION:ΔPes and ΔPL showed relevant variability in preterm infants. High ΔPes was more common in patients with BPD than in those with RDS or control infants. High ΔPL was observed in patients with BPD and RDS, occurred more often than in control infants, and correlated with the degree of oxygenation impairment.

INTRODUCTION:Group-B Streptococcus(GBS) infections may rarely recur after antibiotic treatment. We aimed to fill existing gaps on epidemiology, clinical features, and outcomes of GBS recurrences. METHODS:A systematic search of PubMed and Embase was conducted, covering the period until 1 July 2024. The demographics, clinical characteristics, treatment, and outcomes of infants withGBS recurrence were analyzed. Recurrence was defined as > 1 episode of invasiveGBS infection (positive blood and/or cerebrospinal fluid culture), occurring after the completion of treatment for the initial episode. RESULTS:Among the 213 recurrences, 146 reported individual data and were included in the analysis. GBS recurrences developed shortly after the completion of antibiotic treatment for the initial infection (median = 10 days 95%CI 6.0-18.8). Most infants were preterm (63.5%) and had received an adequately long course of antibiotics for the initial infection (median = 13 days, 95%CI 10-14). Serotype III waspredominant. Breast milk yielded GBS in most samples cultured (41/62, 66%); 5/15 (33%) infants who discontinued breastfeeding after recurrence had further GBS recurrence. Case fatalities were 3.7%. CONCLUSIONS:Preterm birth is closely associated with GBS recurrences. Adequately long courses of antibiotics or withdrawal of breast milk may not be useful measures to prevent recurrences.

Maternal vaginal and rectal colonization by Streptococcus agalactiae (group B streptococcus, GBS) is the main risk factor for the development of newborn early-onset GBS disease (GBS-EOD). Much effort is in place for its prevention, including the development of vaccines. Currently, both a hexavalent glycoconjugate GBS vaccine against the most prevalent serotypes and a protein subunit vaccine have completed phase two clinical trials. GBS surveillance in both maternal carriage and neonatal disease is therefore important in establishing the coverage of the potential vaccines and in setting up the basis for pre- and post-marketing surveillance. A single-site study was conducted in the years 2020–2021 on the characteristics of 325 GBS strains (serotype distribution; identification of the alpha-like protein family member; and resistance to macrolides, tetracycline, and high-level gentamicin) isolated from the vaginal/rectal site in women in late pregnancy as well as in seven cases of GBS-EOD and one case of GBS-related stillbirth occurring in the same location and time period. The study indicated that the coverage of the developing vaccines was excellent (97.2% for the hexavalent glycoconjugate vaccine and 98.7% for the alpha-like protein subunit vaccine). However, the detection of the serotypes VI, VII, and IX—not covered by current vaccine formulations—accounting for 3.0% of isolates, as well as of negative alpha-like GBS strains from maternal carriage (1.2%), should be closely monitored over time. The high rates of GBS resistance to erythromycin (33.5%) and to clindamycin (29.5% in maternal carriage and 57.1% in GBS-EOD) was mostly due to the ever-increasing spread of the multidrug-resistant ST-17 subclone of serotype III. This finding, along with the newly emerging high-level gentamicin resistance in carriers (4.0%), mainly in serotype IV strains, poses a threat for the continued effectiveness of antibiotic therapy in invasive disease.

Background: Antimicrobial therapies used for treating group B streptococcus (GBS) early-onset sepsis (EOS) provide insight into clinicians’ adherence to antimicrobial stewardship (AMS) guidelines. Methods: We reviewed antimicrobial therapies given to treat newborns with GBS-EOS. Data were obtained from an Italian surveillance network (including 35 birthing centers) and were prospectively collected from 1 January 2003 to 31 December 2024. Empiric and definitive therapies were classified as adequate and inadequate. Results: There were 967,054 live births and 200 cases of GBS-EOS, of which 43 (21.5%) were preterm and 157 (78.5%) were full-term; 35 (17.5%) out of 200 showed no signs of illness. Fourteen (7.0%) died (one full-term and thirteen preterm newborns under 34 weeks of gestation). Based on the available information, antibiotics were adequate in 106/137 (77.4%) empiric and 48/119 (40.3%) definitive therapies. The duration of antibiotic courses did not differ between severe (median 10 days, IQR 8.0–14.0) and non-severe cases (median: 10 days; IQR: 10.0–12.5; p = 0.68). Antibiotic treatments lasted ≥ 15 days in 34 (20.1%) out of 169 cases with available information. Conclusions: In this large Italian multicenter study, deviations from international recommendations in antimicrobial therapies for GBS-EOS were critical. Our findings underscore the importance of timely antimicrobial de-escalation and the need to avoid excessively prolonged courses of antimicrobials.

OBJECTIVES:To standardize the diagnosis of patent ductus arteriosus (PDA) and report its association with adverse neonatal outcomes in very low birth weight infants (VLBW, birth weight < 1500 g). STUDY DESIGN:A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. The association between ultrasound grading of PDA and adverse neonatal outcomes was evaluated after correction for gestational age. A diagnosis of hemodynamically significant PDA (hsPDA) was established when the PDA diameter was ≥ 1.6 mm at the pulmonary end with growing or pulsatile flow pattern, and at least 2 of 3 indexes of pulmonary overcirculation and/or systemic hypoperfusion were present. RESULTS:218 VLBW infants were included. Among infants treated for PDA closure in the first postnatal week, up to 40% did not have hsPDA on ultrasound, but experienced clinical worsening. The risk of death was 15 times higher among neonates with non-hemodynamically significant PDA (non-hsPDA) compared to neonates with no PDA. In contrast, the risk of death was similar between neonates with hsPDA and neonates with no PDA. The occurrence of BPD was 6-fold higher among neonates with hsPDA, with no apparent beneficial role of early treatment for PDA closure. The risk of IVH (grade ≥ 3) and ROP (grade ≥ 3) increased by 8.7-fold and 18-fold, respectively, when both systemic hypoperfusion and pulmonary overcirculation were present in hsPDA. CONCLUSIONS:The increased risk of mortality in neonates with non-hsPDA underscores the potential inadequacy of criteria for defining hsPDA within the first 3 postnatal days (as they may be adversely affected by other clinically severe factors, i.e. persistent pulmonary hypertension and mechanical ventilation). Parameters such as length, diameter, and morphology may serve as more suitable ultrasound indicators during this period, to be combined with clinical data for individualized management. Additionally, BPD, IVH (grade ≥ 3) and ROP (grade ≥ 3) are associated with hsPDA. The existence of an optimal timeframe for closing PDA to minimize these adverse neonatal outcomes remains uncertain.

Early treatment with caffeine in the delivery room (DR) has been proposed to decrease the need for mechanical ventilation (MV) by limiting episodes of apnoea and improving respiratory mechanics in preterm infants. Our aim was to verify the hypothesis that intravenous or enteral administration of caffeine can be performed in the preterm infant in the DR. Infants with 25±0–29±6 weeks of gestational age were enrolled and randomised to receive 20 mg/kg of caffeine citrate intravenously, via the umbilical vein, or enterally, through an orogastric tube, within 10 min of birth. Caffeine blood level was measured at 60 ± 15 min after administration and 60 ± 15 min before the next dose (5 mg/kg). The primary endpoint was evaluation of the success rate of intravenous and enteral administration of caffeine in the DR. Nineteen patients were treated with intravenous caffeine and 19 with enteral caffeine. In all patients the procedure was successfully performed. Peak blood level of caffeine 60 ± 15 min after administration in the DR was found to be below the therapeutic range (5 µg/mL) in 25

The quality of cranial ultrasound has improved over time, with advancing technology leading to higher resolution, faster image processing, digital display, and back-up. However, some brain lesions may remain difficult to characterize: since higher frequencies result in greater spatial resolution, the use of additional transducers may overcome some of these limitations. The very high-frequency transducers (18-5 MHz) are currently employed for small parts and lung ultrasound. Here we report the first case series comparing the very high-frequency probes (18-5 MHz) with standard micro-convex probes (8-5 MHz) for cranial ultrasound in preterm infants. In this case series, we compared cranial ultrasound images obtained with a micro-convex transducer (8-5 MHz) and those obtained with a very high-frequency (18-5 MHz) linear array transducer in 13 preterm infants ≤ 32 weeks gestation (9 with cerebral abnormalities and 4 with normal findings). Ultrasound examinations using the very high-frequency linear transducer and the standard medium-frequency micro-convex transducer were performed simultaneously. We also compared ultrasound findings with brain MRI images obtained at term corrected age. Ultrasound images obtained with the very high-frequency (18-5 MHz) transducer showed high quality and accuracy. Notably, despite their higher frequency and expected limited penetration capacity, brain size is small enough in preterm infants, so that brain structures are close to the transducer, allowing for complete evaluation. Conclusion: We propose the routine use of very high-frequency linear probes as a complementary scanning modality for cranial ultrasound in preterm infants ≤ 32 weeks gestation.

Introduction: Neonatal seizures (NS) are the most common neurological emergency in the neonatal period. The International League Against Epilepsy (ILAE) proposed a new classification of NS based on semiology and highlighted the correlation between semiology and aetiology. However, neurodevelopmental outcomes have not been comprehensively evaluated based on this new classification. Aims: To evaluate neurodevelopmental outcomes and potential risk factors for severe outcomes in NS. Methods: Patients with video electroencephalogram confirmed NS were evaluated. Seizure aetiology, cerebral magnetic resonance imaging (MRI) data, background electroencephalograms data, general movements, and neurodevelopmental outcomes were analysed. Severe outcomes were one of the following: death, cerebral palsy, Griffiths developmental quotient <70, epilepsy, deafness, or blindness. Results: A total of 74 neonates were evaluated: 62 (83.8 %) with acute provoked NS (primarily hypoxic-ischaemic encephalopathy), and 12 (16.2 %) with neonatal -onset epilepsies (self -limited neonatal epilepsy, developmental and epileptic encephalopathy, cerebral malformations). Of these, 32 (43.2 %) had electrographic seizures, while 42 (56.7 %) had electroclinical seizures - 38 (90.5 %) were motor (42.1 % clonic) and 4 (9.5 %) were non -motor phenomena. Severe outcomes occurred in 33 of the 74 (44.6 %) participants. In multivariate analysis, neonatalonset epilepsies (odds ratio [OR]: 1.3; 95 % confidence interval [CI]: 1.1-1.6), status epilepticus (OR: 5.4; 95 % CI: 1.5-19.9), and abnormal general movements (OR: 3.4; 95 % CI: 1.9-7.6) were associated with severe outcomes. Conclusions: At present, hypoxic-ischaemic encephalopathy remains the most frequent aetiology of NS. The prognosis of neonatal -onset epilepsies was worse than that of acute provoked NS, and status epilepticus was the most predictive factor for adverse outcomes.

Background. A key renovation of doctoral programs is currently ongoing in Italy. Public health and its competencies may play a pivotal role in high-level training to scientific research, including interdisciplinary and methodological abilities. Methods. As a case study, we used the ongoing renovation of the Clinical and Experimental Medicine doctoral program at the University of Modena and Reggio Emilia. We focused on how the program is designed to meet national requirements as well as students'needs, thus improving educational standards for scientific research in the biomedical field, and on the specific contribution of public health and epidemiology in such an effort. Results. The renovation process of doctoral programs in Italy, with specific reference to the biomedical field, focuses on epidemiologic-statistical methodology, ethics, language and communication skills, and open science from an interdisciplinary and international perspective. In the specific context of the doctoral program assessed in the study and from a broader perspective, public health appears to play a key role, taking advantage of most recent methodological advancements, and contributing to the renovation of the learning process and its systematic quality monitoring. Conclusions. From a comparative assessment of this case study and Italian legislation, the key role of public health has emerged in the renovation process of doctoral programs in the biomedical field.

Background: Bacterial meningitis (BM) in infants is a serious condition that can lead to significant complications. Lumbar puncture (LP) is essential to provide diagnoses, however false negatives may result if LP is performed after the starting of antibiotic therapy. Methods: We conducted a retrospective analysis of infants of any gestational age with BM within their first 90 days of life and admitted to the Neonatal Intensive Care Unit of Modena Policlinico between 1 January 2011, and 31 December 2023. Results: A total of 44 episodes of meningitis were confirmed in 40 infants, diagnosed by positive cerebrospinal fluid cultures (n = 37), polymerase chain reaction testing (n = 4), or both methods (n = 3). Three out of forty infants (8%) experienced a relapse of meningitis. Most episodes (31/44, 70%) occurred in preterm infants. The incidence of early-onset meningitis was lower than that of late-onset (0.18 vs. 0.94 cases per 1000 births, respectively), with Gram-positive accounting for most cases (27/44, 61%). LP was performed prior to antibiotic administration in most episodes (30/44, 68%). Two preterm infants (5%) died from meningitis-related complications. Forty-two episodes occurred among thirty-eight surviving infants; brain lesions were detected through brain ultrasound or MRI in nine out of forty-two episodes (21%). Conclusions: Preterm infants have higher rates of BM, brain lesions or case fatalities. Early diagnosis and prompt antibiotic treatment are critical to improve outcomes.