Our data show a wide variation among NICUs and countries, regarding the use of NSAIDs to treat PDA, and that no general guidelines are followed. Guidelines or recommendations are necessary to standardize treatment of PDA in Europe, in order to give to all newborns identical health care opportunities.

Vocalizations of full-term newborns occur in a short latency time during the neonatal period. Contingent response time of preterm babies is still unknown. An increase of preterm babies' vocalizations following exposure to parental speech was also observed. Mothers and babies co-modulate their vocalizations in preterm dyads. Purpose: To observe temporal features of maternal and infants' vocalizations in speaking and singing conditions in preterm dyads. Methods: In a NICU mothers (N = 36) were invited to speak and to sing to their preterm infants during Kangaroo Care. Microanalysis of temporal units were performed with ELAN Software. Results and conclusions: Preterm infants vocalize less often while their mothers speak and sing than during baseline and their vocalizations tend to be more alternating in the speaking condition and more overlapping in the singing condition. It is also concluded that preterm infants take more time to respond to maternal speaking than to maternal singing.

Growing evidence suggests that maternal microbiota can influence the neonates' gut colonization. However, the mechanisms of vertical bacterial transmission remain poorly defined. We believed that the first colonizers of the newborn come from the mother's gut and vagina during pregnancy and that this is independent of the mode of delivery. We conducted an observational longitudinal study to evaluate the link between the maternal gut microbiota and the meconium's microbiota in extremely and very preterm neonates. Bacterial DNA was extracted from samples and specific bacterial groups were quantified by RT-PCR. In this cohort of 117 preterm neonates, we detected bacterial DNA in 88% of meconium samples. Meconium microbiota of neonates born after 28 gestational weeks (very preterm neonates) showed stronger correlations with their mothers' fecal microbiota. However, neonates born before 28 gestational weeks (extremely preterm neonates) had more Lactobacillusgenus that dominated the vaginal microbiota-than very preterm neonates, regardless of the mode of delivery. Collectively, these data support the hypothesis that maternal bacteria from the gut and vagina can play a role in shaping neonates' gut microbiota and that mother-to-infant bacterial transmission is a controlled and time-specific process. ClinicalTrials.gov Identifier: NCT03663556 ARTICLE HISTORY

The aim of this study was to access evolution in care of very low birth weight (VLBW) infants after the implementation of a regionalization policy in Portugal. The data of the National Portuguese Network of VLBW infants are analyzed concerning mortality, morbidity, and quality of regionalization. A total of 12,826 VLBW infants born from 1 January 1994 to 31 December 2008 were enrolled, with a prevalence of 0.66%-0.99% of all live born. The global mortality was 11%. The major improvement in survival is in the babies more than 1000 g. Since 2004, the threshold of viability is 25 weeks, but the intact survival is around 28 weeks. In the last 10 years with more efficient regionalization more VLBW babies are born in the right place. The improvement in neonatal mortality rate was determinant in the good evolution of perinatal and infant mortalities. After reinforcement of regionalization policies, we found improvements in mortality for VLBW infants. The aims of regionalization were achieved. The reform of perinatal care in Portugal is an example of how a good diagnosis and adequate proposals combined with a strong political will is crucial for changing.

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The FEEDMI Study (NCT03663556) evaluated the influence of infant feeding (mother’s own milk (MOM), donor human milk (DHM) and formula) on the fecal microbiota composition and alkaline phosphatase (ALP) activity in extremely and very preterm infants (≤32 gestational weeks). In this observational study, preterm infants were recruited within the first 24 h after birth. Meconium and fecal samples were collected at four time points (between the 2nd and the 26th postnatal days. Fecal microbiota was analyzed by RT-PCR and by 16S rRNA sequencing. Fecal ALP activity, a proposed specific biomarker of necrotizing enterocolitis (NEC), was evaluated by spectrophotometry at the 26th postnatal day. A total of 389 fecal samples were analyzed from 117 very preterm neonates. Human milk was positively associated with beneficial bacteria, such as Bifidobacterium, Bacteroides ovatus, and Akkermancia muciniphila, as well as bacterial richness. Neonates fed with human milk during the first week of life had increased Bifidobacterium content and fecal ALP activity on the 26th postnatal day. These findings point out the importance of MOM and DHM in the establishment of fecal microbiota on neonates prematurely delivered. Moreover, these results suggest an ALP pathway by which human milk may protect against NEC.

Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infection (ALRI) in young children and is of considerable burden on healthcare systems. Our study aimed to evaluate ALRI hospitalizations related to RSV in children in Portugal. Methods:We reviewed hospitalizations potentially related to RSV in children aged <5 years from 2015 to 2018, using anonymized administrative data covering all public hospital discharges in mainland Portugal. Three case definitions were considered: (a) RSV-specific, (b) (a) plus unspecified acute bronchiolitis (RSV-specific & Bronchiolitis), and (c) (b) plus unspecified ALRI (RSV-specific & ALRI). Results: A total of 9697 RSV-specific hospitalizations were identified from 2015 to 2018-increasing to 26 062 for RSV-specific & ALRI hospitalizations-of which 74.7% were during seasons 2015/2016-2017/2018 (November-March). Mean hospitalization rates per season were, for RSV-specific, RSV-specific & Bronchiolitis, and RSVspecific & ALRI, respectively, 5.6, 9.4, and 11.8 per 1000 children aged <5 years and 13.4, 22.5, and 25.9 in children aged <2 years. Most RSV-specific hospitalizations occurred in healthy children (94.9%) and in children aged <2 years (96.3%). Annual direct costs of €2.4 million were estimated for RSV-specific hospitalizations-rising to €5.1 million for RSV-specific & ALRI-mostly driven by healthy children (87.6%). Conclusion:RSV is accountable for a substantial number of hospitalizations in children, especially during their first year of life. Hospitalizations are mainly driven by healthy children. The variability of the potential RSV burden across case definitions highlights the need for a universal RSV surveillance system to guide prevention strategies.

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