Objectives: To evaluate the proportion of neonatal intensive care units with facilities supporting parental presence in their infants' rooms throughout the 24-hour day (i.e., infant-parent rooms) in highincome countries and to analyze the association of this with outcomes of extremely preterm infants. Study design: In this survey and linked cohort study, we analyzed unit design and facilities for parents in 10 neonatal networks of 11 countries. We compared the composite outcome of mortality or major morbidity, length of stay, and individual morbidities between neonates admitted to units with and without infantparent rooms by linking survey responses to patient data from the year 2015 for neonates of <29 weeks' gestation. Results: Of 331 units, 13.3% (44/331) provided infant-parent rooms. Patient-level data were available for 4662 infants admitted to 159 units in 7 networks; 28% of the infants were cared for in units with infant-parent rooms. Neonates from units with infant-parent rooms had lower odds of mortality or major morbidity (adjusted OR 0.76; 95% CI 0.64, 0.89), including lower odds of sepsis and bronchopulmonary dysplasia, than those from units without infant-parent rooms. The adjusted mean length of stay was 3.4 days shorter (95% CI -4.7, -3.1) in the units with infant-parent rooms. Conclusions: The majority of units in high-income countries lack facilities to support parents' presence in their infants' rooms 24 hours per day. The availability vs absence of infant-parent rooms was associated with lower odds of composite outcome of mortality or major morbidity and shorter length of stay.

Objective We assessed lung function and respiratory health in an area‐based prospective cohort of preschool children born very preterm. Design Lung function was measured by interrupter respiratory resistance (Rint) and forced oscillation technique (FOT) (respiratory resistance (Rrs8), reactance (Xrs8), and area under the reactance curve (AX)) at a median age of 5.2 years in a cohort of 194 children born at 22‐31 weeks of gestational age (GA) in Tuscany, Italy. Respiratory symptoms and hospitalizations were also assessed. Results Mean (SD) lung function Z‐scores were impaired in preterm children for Rint (0.72 (1.13)), Xrs8 (‐0.28 (1.34)), and AX (0.29 (1.41)). However, only a relatively small proportion of children (14.5‐17.4%) had values beyond the 95th centile or below the 5th. Children with bronchopulmonary dysplasia (BPD) (n = 24) had slightly but not significantly impaired lung function indices in comparison with those without BPD (n = 170). In a multivariable analysis, lower GA was associated with worse lung function indices. Fifty‐five percent of children had a history of wheezing ever and 21% had been hospitalized in their lifetime because of lower respiratory infections; 31% had wheezing in the last 12 months and this was associated with increased Rrs8 (P = 0.04) and AX (P = 0.08), and with decreased Xrs8 (P = 0.04) Z‐scores. Conclusions Irrespectively of BPD preschool children born very preterm had impaired lung function indices, as measured by Rint and FOT, and a slightly higher burden of respiratory problems than the general population. GA seems to be crucial for lung development.

We have observed less advanced disease in HIV and HCV-HIV patients compared with HBV-HIV coinfected patients. Moreover, our results show a higher prevalence of HIV/HCV among drug addicts and in the age-group 35-59, corresponding to those born in years considered most at risk for addiction. This study also confirms the finding of a less advanced HIV disease in HIV/HCV coinfected patients.

Children are protected both in terms of susceptibility to SARS-CoV-2 infections and of serious illnesses. 1,2 However, the negative effect of the pandemic on children health has been widely described, from an increase of mental health problems 3 to a decreased attendance to health services. 4 A decrease in emergency department (ED) attendance has been reported in children in several countries since the early phases of the pandemic, together with a case series of delayed presentations to hospital care and subsequent critical illnesses, because

Objective To compare the estimates of preterm birth (PTB; 22–36 weeks' gestational age, GA) and stillbirth rates during COVID‐19 pandemic in Italy with those recorded in the three previous years. Design A population‐based cohort study of live‐ and stillborn infants was conducted using data from Regional Health Systems and comparing the pandemic period (1 March 2020–31 March 2021, n = 362 129) to an historical period (January 2017–February 2020, n = 1 117 172). The cohort covered 84.3% of the births in Italy. Methods Poisson regressions were run in each Region and meta‐analyses were performed centrally. We used an interrupted time series regression analysis to study the trend of preterm births from 2017 to 2021. Main outcome measures The primary outcomes were PTB and stillbirths. Secondary outcomes were late PTB (32–36 weeks' GA), very PTB (<32 weeks' GA), and extremely PTB (<28 weeks' GA), overall and stratified into singleton and multiples. Results The pandemic period compared with the historical one was associated with a reduced risk for PTB (risk ratio [RR] 0.91, 95% confidence interval [CI] 0.88–0.93), late PTB (RR 0.91, 95% CI 0.88–0.94), very PTB (RR 0.88, 95% CI 0.84–0.91) and extremely PTB (RR 0.88, 95% CI 0.82–0.95). In multiples, point estimates were not very different, but had wider CIs. No association was found for stillbirths (RR 1.01, 95% CI 0.90–1.13). A linear decreasing trend in PTB rate was present in the historical period, with a further reduction after the lockdown. Conclusions We demonstrated a decrease in PTB rate after the introduction of COVID‐19 restriction measures, without an increase in stillbirths.

Background: Great variability in enteral feeding practices for very preterm (<32 weeks gestational age-GA) and very low birth weight infants (VLBW; ≤1,500 g) have been reported. We aimed to describe data on enteral feeding in Tuscany (Italy), where a network of 6 donor milk banks is in place.Methods: A 4-years (2012–2015) observational study was performed analyzing the database “TIN Toscane online” on very preterm and VLBW infants. The database covers all 25 hospitals with a neonatal unit.Results: Data concerning the beginning of enteral nutrition were available for 1,302 newborns with a mean (standard deviation) GA of 29.3 (2.9) weeks, while information at the time of full enteral nutrition was available for 1,235 and at discharge for 1,140. Most infants (74.1%) started enteral feeding during the first 24 h of life. Overall, 80.1% of newborns were fed exclusive human milk, donor milk having the larger prevalence of use (66.8%). Few infants (13.3%) started with exclusive mother's milk. Full enteral feeding was achieved using exclusive human milk in most cases (80%). Full enteral feeding was reached earlier in newborns who were fed human milk than in those fed formula, regardless of GA. Sixty-four percent of infants were still fed with any human milk at discharge. When data at the achievement of full enteral nutrition and at discharge were analyzed stratified by the type of milk used to start enteral feeding, newborns initially fed donor milk presented the highest prevalence (91.3%) of exclusive human milk at full enteral feeding, an important period to prevent necrotizing enterocolitis, while no differences were observed at discharge.Conclusions: Donor milk was widely used for newborns during the first hours of life, when mother's milk availability may be quite challenging. Starting enteral nutrition with donor milk was associated with early start of enteral feeding and early achievement of full enteral nutrition without affecting mother lactation. The overall prevalence of human milk at discharge (when donor milk is not available anymore) was high (64%), irrespective of the type of milk used to start nutrition.

Aim: All women delivering a preterm infant should receive antenatal corticosteroid prophylaxis, but many miss this opportunity. We determined the risk factors associated with missed prophylaxis in a geographically defined area of Italy. Methods:We prospectively studied all mothers who delivered babies between 24 and 31 completed weeks of gestation, from 2009 to 2013, in all maternity units in Tuscany.Results: Of 1232 mothers, 186 (15.1%) did not receive prophylaxis. The risk was higher in migrant mothers, with an adjusted risk ratio (RR) of 1.28 and 95% confidence interval (95% CI) of 1.04-1.56, and in mothers hospitalised for less than 24 hours (RR 4.09, 95% CI: 2.90-5.78). Preterm prelabour rupture of membranes (RR 0.63, 95% CI: 0.41-0.96) and maternal antepartum transfer (RR 0.24, 95% CI: 0.18-0.32) were protective. Hospital level at birth and gestational age did not influence the prophylaxis rate. The populationattributable fractions were 50.4% for late hospital admissions and 10.2% for migrant status. Conclusion:In a highly organised network of hospitals, neither level of care nor gestational age influenced prophylaxis. Timely arrival of women in hospital, better recognition of the imminence of delivery and tighter steroids administration guidelines are the most relevant targets to further increase prophylaxis.

Objective. Evaluating the rates of childbirth in women over 40 years of age in Tuscany (Italy) outlining the indications for caesarean section in this parturient population. Methods. 227,871 women who delivered in Tuscany from 2011 to 2018 using data of Birth Assistance Certificate linked with hospital discharge registry were observed. Caesarean section indications were reported as dismissal diagnoses. Logistic models (adjusted for parity, ART and BMI) were carried out for the maternal age risk factor. Results. The caesarean section rate increases significantly with age. Multivariate analysis confirmed that women over 40 years of age have a higher risk of a caesarean section due to pathologies such as diabetes or eclampsia which are clearly more frequent in these categories of women. Furthermore, the data shows that the caesarean section in some cases was carried out due solely to the age of a primiparous woman. Conclusions. The phenomenon affects health services and social costs and should make us reflect upon the underlying reasons that bring women to delay their reproductive project and where necessary implement appropriate political strategies. SOMMARIO Scopo. Valutare il parto nelle donne over 40 in Toscana e descrivere le indicazioni al taglio cesareo in questa popolazione. Metodi. Da Certificato di Assistenza al Parto linkato con la SDO sono state estratte 227.871 donne che hanno partorito in Toscana tra il 2011 e il 2018. Attraverso le diagnosi di dimissione è stato possibile identificare le principali indicazioni al cesareo. Per queste sono stati effettuati dei modelli logistici (univariati e multivariati aggiustati per parità, PMA e BMI) per il fattore di rischio età materna. Risultati. Aumenta significativamente all'aumentare dell'età il ricorso al taglio cesareo, soprattutto quello di elezione e quello in urgenza, a testimonianza di una maggiore incidenza di condizioni patologiche. L'analisi multivariata conferma per le over 40 un rischio maggiore di taglio cesareo a causa di patologie come il diabete o l'eclampsia che risultano chiaramente più frequenti in queste categorie di donne. I dati mostrano inoltre che in alcuni casi il cesareo viene effettuato solo per indicazione materna. Conclusioni. Questo incide sui servizi sanitari e sui costi sociali e dovrebbe fare riflettere sulle motivazioni che conducono le donne a ritardare il loro progetto riproduttivo mettendo in atto scelte politiche conseguenti e adeguate.