Adverse reactions to cow's milk in the first year of life occur in 2-7%. There is an increase in the incidence of cow's milk protein allergy (CMA) in newborn population including premature infants. We report two cases of CMA in preterm twins. The first one developed recurrent episodes of proctocolitis and the second one two necrotizing enterocolitis (NEC) -like episodes. Our cases demonstrate different clinical presentations of the same disease and add to literature the peculiarity of the early onset, the recurrence of episodes of enterocolitis associated with increasing systemic eosinophilia and episodes clinically and radiologically mimicking NEC.

Therapeutic hypothermia is a recognized treatment for term infants with hypoxic-ischemic encephalopathy (HIE) in reducing rate of death or neurodevelopmental disabilities. Little is known about applications of this treatment to preterm newborns. Studies in animal experimental models demonstrated the efficacy of hypothermia in preterm fetuses but clinical application to newborn infants are limited to restricted cases, as severe necrotizing enterocolitis (NEC). We present a case of therapeutic whole body cooling in a baby at 34 weeks and 6 days of gestational age with HIE.

Several studies have shown that small for gestational age (SGA) babies have a different hormonal profile than those born with a birth weight appropriate for gestational age (AGA). Thyroid hormones play an important role in growth and neurocognitive development. Only few studies analyzed the concentrations of thyroid-stimulating hormone (TSH) and thyroxine (T4) during fetal and extrauterine life in SGA and AGA newborns, and the existing data on the possible alterations of these hormones in postnatal life are controversial. It remains to be established whether SGA newborns have different blood concentrations of thyroid hormones as compared with AGA infants and if so, whether these findings play a role in the development of obesity, short stature, hypertension, and diabetes - disorders, already known to be related with SGA birth. It has also not yet been established whether and when substitutive therapy with levothyroxine (LT4) should be initiated in preterm and full-term SGA newborns. Further trials are needed to determine the thyroid hormone profile in both preterm and full-term SGA newborns and also to evaluate the effectiveness and safety of LT4 treatment in these infants.Conflict of interest:None declared.

InTrODUZIOneCirca il 15% dei neonati nasce piccolo per l'età gestazionale (SGA). Si definisce SGA il neonato il cui peso alla nascita è almeno 2DS inferiore alla media del peso dei neonati in quella fascia di età. Molti sono i fattori implicati nella nascita di un neonato SGA, tra cui: il potenziale genetico, lo stato di nutrizione e la presenza di malattie nella madre, la funzione placentare, il trasferimento di nutrienti, gli ormoni e i fattori di crescita intrauterini [1][2][3]. Il neonato SGA presenta fin dall'epoca di vita fetale, alterazioni endocrino-metaboliche che determinano un aumentato rischio di mortalità e morbidità perinatali [4][5][6]15] e , secondo alcuni AA., di sviluppare malattie cardiovascolari in età adulta [7][8][9][10]. Pochi sono i lavori che hanno valutato i livelli degli ormoni tiroidei (TH) in neonati SGA sia durante la vita fetale, che nel cordone, che nelle prime epoche di vita e i risultati ottenuti sono discordanti [11][12][13][14][15][16][17][18].In considerazione dell'importante ruolo degli ormoni tiroidei nello sviluppo dell'apparato respiratorio, del SNC e dell'intero metabolismo del soggetto, risulta fondamentale stabilire l'effettiva funzionalità tiroidea del neonato SGA, al fine di ottimizzare una eventuale terapia ormonale sostitutiva [19][20][21][22][23][24]. SCOPOValutare se la funzionalità tiroidea del neonato a termine e pretermine SGA in 2°-3° giornata di vita differisce da quella del neonato AGA di pari età gestazionale. Abstract. The small for gestational age newborn (SGA), which compared the adapted for gestational age newborn (AGA), has a higher risk of perinatal mortality and morbidity, also according to some authors of developing cardiovascular disease in adulthood. To establish if thyroid function of the newborn term and preterm SGA, in 2nd and 3rd day of life differs from that of the AGA infant of the same gestational age (GA). The levels of TSH and tT4 in 2nd and 3rd day of life were examined and obtained with the Screening for Congenital Hypothyroidism in a population of 1,958 infants, of which 1,671 resulted in AGA and 287 resulted in SGA. The overall population was divided into eight groups in relation to different [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. For each age range or group (AGA and SGA) in which the population was divided, the median of the values obtained for TSH and tT4 was measured. TSH levels were higher in SGA infants at different GAs considered (significantly 31-32 wks: p=0.0428 and 37-38 wks: p=0.0149), with the exception of infants aged 26-28 wks, whose TSH levels were significantly lower: p=0.0591 compared with AGA infants of the same GA. Instead, in the levels of tT4 in the SGA, newborn findings were lower than those of AGA infants at all gestational ages considered, but significantly only at 26-28 wks: p=0.0001 and 39-42 wks: p=0.0190. tT4 levels show a linear and significant increase with the advancing of GA, reaching the highest values in term newborns at 39-42 wks, both in overall populations (AGA and SG...