Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

The substantial improvement in survival in France for newborns born at 25 through 31 weeks' gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.

Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of “European Guidelines for the Management of RDS” by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12^, 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).

Marine litter is one descriptor in the EU Marine Strategy Framework Directive (MSFD). This study provides the first account of an MSFD indicator (Trends in the amount of litter deposited on coastlines) for the north-western Adriatic. Five beaches were sampled in 2015. Plastic dominated in terms of abundance, followed by paper and other groups. The average density was 0.2 litter items m(-2), but at one beach it raised to 0.57 items m(-2). The major categories were cigarette butts, unrecognizable plastic pieces, bottle caps, and others. The majority of marine litter came from land-based sources: shoreline and recreational activities, smoke-related activities and dumping. Sea-based sources contributed for less. The abundance and distribution of litter seemed to be particularly influenced by beach users, reflecting inadequate disposal practices. The solution to these problems involves implementation and enforcement of local educational and management policies.

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