Improved survival from advances in neonatal care has resulted in an increased number of infants at risk for chronic lung disease (CLD). Recently, it was reported that inflammatory mediators such as interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha and IL-8 are present in higher concentrations in lung lavage from babies who develop CLD. Previously, we found that melatonin reduced the rises in proinflammatory cytokines (IL-6, IL-8 and TNF-alpha) and nitrite/nitrate levels in the serum of preterm newborns with respiratory distress syndrome (RDS). The values correlated with gestational age and iatrogenic trauma in the form of oxygen exposure and mechanical ventilation. Increased concentrations of proinflammatory cytokines may, therefore, be the most valuable early indicator of developing CLD and these measurements may assist in selecting infants for interventions such as melatonin treatment or more selective blockage of components of inflammation. In the current study, we extend the original observations and report results in which 120 newborns diagnosed with RDS were either treated with melatonin (60 children) or given placebo (60 children). The cytokine measures were consistent with the previously reported findings and showed that melatonin reduced these values and also lowered nitrite/nitrate levels in serum of newborns with respiratory distress. Furthermore, when nonmelatonin-treated newborns who developed CLD (eight infants) were examined separately, they had levels of IL-6, IL-8, TNF-alpha and nitrite/nitrate values much higher than those in children who did not develop CLD. Two of the nonmelatonin-treated newborns died while no children who received melatonin died. Melatonin was well tolerated by the newborns.

Erythrocyte surface sialic acid was measured in 94 full-term new-born infants and in 20 premature infants of different ages, varying from 1 to 16 post-natal days. After the first 3 days of life, the amount of sialic acid, both per cell and per gramme of haemoglobin, was rapidly reduced to 70–80% of the initial value; these lower levels were maintained on the following days. The decrease observed on the 4th day may represent an expression of the mechanism by which a large amount of fetal red blood cells is eliminated from the circulation during the same period. Therefore, the relationship between sialic acid decrement and red cell sequestration exists also in fetal erythrocytes, and this may contribute to clarify the exact role of sialic acid in red cell survival time.

Abstract. The neonatal intensive care of twins has seen many changes over later years. In fact, major improvements in prenatal evaluation and neonatal management techniques have greatly increased the possibility of survival for infants at risk, especially those born from multiple pregnancies. Our study reports the results of a retrospective survey for the years 1990 to 1993, on the outcome of 76 twin infants (ie. 11,4% of the 661 newborns admitted to our unit over that period) correlating the clincial symptoms observed with the modality of birth.

Introduction: Systemic fungal disease, by Candida species, are a much feared complication in NICU. Objectives: We evaluated the higher incidence of Candida A. infection and not particularly in VLBW and ELBW infants. Methods: Infection cases by Candida albicans and not recorded in NICU of Messina. Results: The cases were reported 42/1839 (2%) 21 premature infants , G.A. 30.5± 3.78 , weight 1550.4 ± 906.9, 14 term infants , G.A. 38.42 ± 1:45,weight 3128.9 ± 290.8 , 7 pediatric patients. The fungus most frequently isolated was Candida parapsilosis (19/42-46%), followed by C. albicans (13/42-32%), by C. lambica (5/42-12%), C. tropicalis (2/42-4%), C.zeylanoides (1/42-2%), C.krusei (1/42-2%), C.guillermondi (1/42-2%). Of the 15 preterm with GA ≤ 32, in 8 / 15 (53%) was isolated C.parapsilosis, in 4 / 15 (27%) C. albicans ,in 2 / 15 (13%) C.lambica, in one case (1 / 15-7%) C.zeylanoides. About patients studied 7 / 42 died (17%) which 6 / 21 preterm infants (28%), 1 / 7 pediatric patients (14%), no term baby died. We have registered two cases of mycetoma in a preterm baby. Conclusions: The increased incidence of Candida parapsilosis is a main cause of infections, linked to fungal adherence ability to prosthetic materials and to proliferate in presence of high glucose concentrations , especially in preterm infants in parenteral nutrition. Our study shown the problem of colonization,the selection of resistant strains of Candida in NICU and its new therapeutic options.

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