Introduction: COVID-19 is the disease caused by the novel coronavirus SARS-CoV-2, responsible of the pandemic declared in March 2020 and still ongoing. COVID-19 affects all ages but presents less complications and fatalities in children. Neonatal infections have rarely been reported worldwide, and vertical transmission is uncertain. Methods: We conducted a prospective cohort study of all infants born to SARS-CoV-2-positive mothers admitted to 2 hospitals in South (Bari) and North (Varese) of Italy from April to December 2020. A molecular nasopharyngeal swab for SARS-CoV-2 using a reverse transcriptase polymerase chain reaction was made at birth for all enrolled newborns to evaluate vertical transmission of infection. We also evaluated postnatal transmission with a second nasopharyngeal swab made at 1 month of life and described maternal and neonatal clinical findings and short-term outcomes. Results: 176/179 (97%) newborns were SARS-CoV-2 negative at birth and 151/156 (97%) infants were still negative at 1 month of life. All newborns were asymptomatic. Seventy percent of newborns were breastfed during hospitalization. At 1 month of life, 76% of infants were breastfed. Conclusion: According to our results, vertical and perinatal infection is very rare. Breastfeeding does not increase the risk of COVID-19 and should be encouraged.

Early onset sepsis (EOS) is a potentially fatal condition in neonates, and its correct management is still challenging for neonatologists. Early antibiotic administration in the neonatal period may carry short- and long-term risks. Neonatal EOS calculator has been recently introduced as a new strategy to manage infants at risk of sepsis, and has shown promising results. Methods: In this single-center observational retrospective study, 1000 neonates ≥ 34 weeks’ gestation were enrolled with the aim to evaluate our standard protocol for the management of suspected EOS compared to the EOS calculator. Outcome measures included the following: (1) incidence of EOS and (2) proportion of infants in need of sepsis evaluations and antibiotics using our standard protocol versus theoretical application of EOS calculator. Results: A total of 223/1000 infants underwent blood investigations versus 35/1000 (3.5%) if EOS calculator had been applied (p < 0.0001; k = 0.18). Furthermore, 48/1000 infants received antibiotics with our protocol versus 35/1000 with EOS calculator (p = 0.12; k = 0.58). Three infants had a positive blood culture that EOS calculator would have missed. Conclusions: In our study, EOS calculator could have reduced investigations but not antibiotic therapy. EOS calculator is an effective and promising tool, but further studies are required to improve it.

Background: Enterovirus is a well-known cause of infection in all age groups, with particular importance for neonates with both vertically and horizontally transmission. Neonatal clinical manifestations are highly variable and mostly is asymptomatic, but severe infections are described such as myocarditis, meningitis, encephalitis, hepatitis, coagulopathy, pneumonia and viral sepsis. Since 2022, The World Health Organization has recently reported an increasing number of severe neonatal infection associated with a new variant of Echovirus-11 (E-11). Many of the infants described with E-11 infections in a case reports series were preterm, male and twins. Despite the criticality of neonatal disease, the clinical management remains primarily supportive and therapeutic options are unfortunately few. Case presentation: We present the case of male dichorionic diamniotic late-preterm twins, born in December 2023 at Filippo del Ponte Hospital in Varese (Northen Italy) with early Echovirus-11 infection. They had two dramatically different clinical scenarios and one of them developed a severe and fatal hemorrhage-hepatitis syndrome. Conclusions: Our experience has the purpose to emphasize public health attention to Echovirus-11 neonatal infections and their rare dramatically neonatal clinical presentations. Prematurity, host genetic predisposition and vertical transmission seem to be strong risk factors for severe infections, but it still need to be elucidated. According to previous Italian report, a surveillance protocols in all cases with unexpected clinical presentations and sequencing complete genome in order to better understand typing and molecular characterization of emerging and re-emerging pathogenic variants and new strains are strongly recommend in Italy.

From 2020 to today, considerable knowledge on SARS-CoV-2 has been collected, even on pregnant women and their fetuses and newborns, and clinical guidelines have been written and implemented worldwide. Vaccination has considerably improved outcomes, but hesitancy amongst pregnant patients and the emergence of variants remain challenging, and SARS-CoV-2 positivity during pregnancy continues to be associated with an increased risk of maternal complications, premature delivery, and higher neonatal mortality and morbidity. A body of data now exists on the effect of SARS-CoV-2 during pregnancy on early neonatal outcomes, medical education in obstetrics and pediatrics, and longer-term developmental outcomes. This review aimed to present important findings on clinical outcomes and health recommendations for neonate born from a SARS-CoV-2-positive mother in order to summarize effective preventive healthcare guidelines.

Background Enterovirus is a well-known cause of infection in all age groups, with particular importance for neonates with both vertically and horizontally transmission. Neonatal clinical manifestations are highly variable and mostly is asymptomatic, but severe infections are described such as myocarditis, meningitis, encephalitis, hepatitis, coagulopathy, pneumonia and viral sepsis. Since 2022, The World Health Organization (WHO) has recently reported an increasing number of severe neonatal infection associated with a new variant of Echovirus 11 (E-11). Many of the infants described with E-11infections in a case reports series were preterm, male and twins. Despite the criticality of neonatal disease, the clinical management remains primarily supportive and therapeutic options are unfortunately few. Case presentation We present the case of male dichorionic diamniotic (DCDA) late-preterm twins, born in December 2023 at Filippo del Ponte Hospital in Varese (Northen Italy) with early Echovirus 11 infection. They had two dramatically different clinical scenarios and one of them developed a severe and fatal hemorrhage-hepatitis syndrome. Conclusion Our experience has the purpose to emphasize public health attention to Echovirus 11 neonatal infections and their rare dramatically neonatal clinical presentations. Prematurity, host genetic predisposition and vertical transmission seem to be strong risk factors for severe infections, but it still need to be elucidated. According toprevious Italian report, a surveillance protocols in all cases with unexpected clinical presentations and sequencing complete genome in order to better understand typing and molecular characterization of emerging and re-emerging pathogenic variants and new strains are strongly recommend in Italy.

Early onset sepsis (EOS) is a potentially fatal condition in neonates and its correct management is still a challenge for neonatologists. Early antibiotic administration in the neonatal period may carry risks and reducing unnecessary antibiotic therapy remains a key objective. It is well known that EOS risk calculator has reduced investigations and antibiotics for suspected EOS, but many limitations have been identified (e.g. strong value to respiratory symptoms, lack of standardized neonatal monitoring). To develop a new protocol, called Neosafe, for the management of newborn ≥ 35 weeks at risk of EOS based on the EOS risk calculator and serial physical examination with the aim of reducing blood investigations and unnecessary antibiotic therapy. In this single-center observational retrospective study 2000 Neonates ≥ 35 weeks were enrolled. A new protocol called Neosafe has been developed, which deviates from the original for two major changes: (1) different serial physical examination (SPE) recommendation for each risk situations (2) clinical scenario revisited with multiple signs. Comparison between Neosafe protocol and EOS risk calculator simulated data were performed using McNemar's test (statistical significance p < 0,05) and the Cohen's kappa coefficient was used to assess the degree of agreement among them. 48/2000 infants (2,4%) would have performed blood investigations versus 82/2000 (4,1%) whether Neosafe protocol would have been applied (p < 0,0001). 43/2000 infants (2,2%) with Neosafe protocol would have received antibiotics versus 80/2000 (4,0%) with EOS risk calculator (p < 0,0001). All infants who would not receive antibiotics for Neosafe protocol were infants with equivocal signs and isolated mild to moderate respiratory distress, but predisposed to advanced medical monitoring. Proven sepsis during the study period were 4, 2 of them were lost by both (no symptoms at birth, blood tests performed for non-infectious reasons). 1829 infants (91,5%) would receive routinal nursing SPE monitoring, 128 advanced medical SPE monitoring and 43 advanced medical SPE+vital for neonatal intensive care unit (NICU). In our study Neosafe protocol could have reduced blood investigations and antibiotic therapy. Neosafe protocol could be a promising tool that integrates the use of digital technologies and direct attention to the patients. More trials are needed for further improvements.