In the last decades, advances in neonatal care have improved the survival of preterm infants, but these newborns remain more susceptible to a wide range of short and long term complications. Bronchopulmonary dysplasia (BPD)- or chronic lung disease-, is the most frequent morbidity among surviving preterm infants and is associated with long term pulmonary and neurodevelopmental impairments. In this narrative review, we aimed to synthesize the existing literature on long term respiratory outcomes of preterm infants, from discharge to adult life, with or without BPD. Preterm infants and/or those diagnosed with BPD have an increased risk of respiratory infections in the first two years of life and are also more likely to require hospitalization. Preterm infants also have an elevated risk of SIDS; nevertheless, this risk seems to be related to prematurity itself rather than the presence of BPD. In the long term, it has been observed that these children more commonly experience sleep disturbances, reduced physical exercise capacity, wheezing, asthma, as well as changes in some echocardiographic parameters and respiratory function tests. In summary, premature patients, particularly those survivors of moderate-severe BPD, present a series of chronic pulmonary and extrapulmonary comorbidities that make their management complex, even in the phases following discharge from the neonatal intensive care unit and in preadolescence. Children, adolescents, and adults with this condition require comprehensive, multidisciplinary management and close follow up to address the burden of comorbidities associated with prematurity and chronic lung disease. Randomized therapeutic studies, in addition to longitudinal evaluation, remain essential to optimize care.

Aim: The purpose of this study was to evaluate the incidence of respiratory distress syndrome (RDS) in late preterm (LPT) infants. We also aimed to identify the risk factors associated with surfactant requirement and the clinical outcomes associated with surfactant therapy. Methods: We retrospectively analysed data from a single‐centre neonatology unit at the Fondazione Policlinico Universitario Agostino Gemelli, IRCCS in Rome, Italy over a 4 year period. For each risk factor, the odds ratio (OR) and the 95% confidence interval (95% CI) were reported. Results: The incidence of RDS among 1335 LPT infants was 7.8%. The percentage of infants who required the surfactant was 3.4%. Gestational age (OR 0.541, 95% CI 0.367–0.796, p = 0.002), birth weight (OR 1.001, 95% CI 1.000–1.003; p = 0.037), 1 min Apgar score (OR 0.631, 95% CI 0.440–0.905, p = 0.012) and congenital pneumonia (OR 28.931, 95% CI 9.139–91.597, p < 0.001) were the neonatal risk factors associated with surfactant requirement. Oncological disease (OR 4.116, 95% CI 1.081–15.672, p = 0.038) was the maternal risk factor associated with surfactant requirement. Conclusions: Maternal oncological disease and congenital pneumonia emerged as new risk factors for surfactant requirement in LPT infants. These findings expanded the understanding of the mechanisms underlying RDS in LPT infants, moving beyond the known risk factors.

Background/Objectives: Enteroviruses (EV) cause neonatal infections with variable incidence and severity, occasionally progressing to invasive disease. This study reports the experience of two Italian neonatal centers with invasive neonatal EV infection (NEVI), describing management and outcomes in relation to the existing literature. Methods: This retrospective study included neonates diagnosed with NEVI. Data related to clinical symptoms, treatment and outcomes were reported and compared to those available in the current literature. Results: All nine neonates presented with systemic infection symptoms; onset ranged from the second to the thirty-fourth day of life, with eight of nine infants presenting after 72 h, most following readmission after initial discharge rather than continuous hospitalization from birth. The transmission route (vertical versus horizontal) could not be determined with certainty. All nine neonates had central nervous system infection confirmed by RT-PCR detection of EV in cerebrospinal fluid; two presented seizures or epileptiform abnormalities, and one developed myocarditis. IVIG was administered upon diagnosis. All infants survived to discharge in stable condition; neuroimaging abnormalities were documented in two infants, and long-term neurodevelopmental outcome could not be assessed in most patients due to incomplete follow-up. Conclusions: Invasive NEVI cannot be clinically differentiated from severe bacterial infection, warranting a high index of suspicion, particularly when caregivers report symptoms of viral infection. Further studies are needed to clarify aspects of management, including the potential benefit of IVIG administration.

Background: Oxidative stress plays a key role in the pathogenesis of complications in preterm infants, including bronchopulmonary dysplasia (BPD). Thymosin β4 (Tβ4) and thymosin β10 (Tβ10) are proteins involved in tissue repair and responses to oxidative stress, but their role in extremely preterm neonates remains poorly understood. Methods: A total of 149 saliva samples from 18 infants with gestational age < 30 weeks were analyzed. Salivary proteins and their proteoforms were characterized using an integrated proteomic platform based on nano-HPLC-ESI-MS. Relative quantification was performed using extracted ion current (XIC) peak areas. Associations with postmenstrual age, oxygen requirement, and BPD development were assessed, including longitudinal analysis using generalized estimating equation (GEE) models. Results: Significant correlations were found between postmenstrual age and total Tβ4 (p = 0.001), oxidized Tβ4 percentage (p = 0.025), and total Tβ10 (p = 0.043). Higher oxygen requirement was associated with lower levels and percentages of oxidized Tβ10 (p = 0.005; p < 0.001). No significant differences were observed during the first week of life between neonates who later developed BPD and those who did not. However, longitudinal analysis showed that in neonates without BPD, total and oxidized Tβ10 and total Tβ4 increased over time, whereas in neonates with BPD, these biomarkers remained stable or decreased. The increase in oxidized Tβ10 percentage was slower in infants with BPD. Conclusions: Although no early differences were detected, longitudinal trajectories of Tβ4 and Tβ10 differed between infants with and without BPD. Postnatal changes in these proteins may be associated with differences in clinical course and exposure to postnatal oxidative stress.

Background/Objectives: Congenital chylous ascites is a rare neonatal condition characterized by the accumulation of lymphatic fluid within the peritoneal cavity. The disorder can be difficult to manage, as many infants show limited response to standard conservative strategies such as dietary modification and supportive care. Currently, no universally accepted therapeutic guidelines exist. We report the successful use of propranolol in the management of refractory congenital chylous ascites. Methods: Clinical data were collected from a 35-week preterm male infant who had prenatal ultrasound evidence of fetal ascites from the 28th week of gestation. Postnatal management initially included fasting, total parenteral nutrition, and from day 9 of life, continuous infusion of octreotide. Due to the persistent ascites, oral propranolol was added to the therapy on the 31st day of life. Current literature was reviewed to compare our findings with those available. Results: Following the addition of propranolol to ongoing octreotide therapy, the infant demonstrated gradual clinical improvement with decreased abdominal distension and reduction of ascitic fluid; as propranolol and octreotide were administered concurrently for approximately 30 days, a causal effect could not be isolated to propranolol alone. Oral propranolol was administered at 0.5 mg/kg every 6 h (2 mg/kg/day total), with heart rate, blood pressure, and glucose monitored throughout treatment; no propranolol-related adverse events (bradycardia, hypotension, bronchospasm, hypoglycemia, or feeding intolerance) occurred. Ultrasonographic resolution of ascites was achieved by day 48, the peritoneal drainage catheter having already been removed on day 34; propranolol was subsequently tapered and discontinued by day 68, and the patient was discharged in stable condition on day 93, with no recurrence on serial ultrasound over the 45 days from resolution to discharge. A narrative review of the literature identified nine infants with lymphatic disorders successfully treated with propranolol. Conclusions: This case suggests a possible temporal association between propranolol administration and clinical improvement in a neonate with congenital chylous ascites refractory to conventional management; no propranolol-related adverse events were observed during treatment. Given the rarity of this condition and the absence of standardized treatment guidelines, further studies—potentially through multicenter registries or prospective case series—are warranted to establish optimal dosing strategies, evaluate long-term outcomes, and clarify the role of propranolol in this setting.

Bronchopulmonary dysplasia (BPD) remains a major complication of extreme prematurity, driven in part by persistent inflammation. Interleukin (IL)-1–mediated signaling plays a central role in sustaining lung injury, making IL-1 blockade a potential therapeutic target. Evidence on the use of anakinra, a recombinant IL-1 receptor antagonist, in neonatal BPD is still limited. We report the case of a female preterm infant (28⁺² weeks’ gestation, birth weight 800 g, −1.41 zs) affected by BPD requiring prolonged respiratory support. Due to persistent respiratory failure despite standard therapies, off-label treatment with subcutaneous anakinra (5 mg/kg twice daily) was initiated at 150 days of life. Clinical respiratory parameters and exploratory salivary inflammatory biomarkers (IL-6 and soluble urokinase plasminogen activator receptor, suPAR) were longitudinally monitored. Following anakinra initiation, the patient showed a gradual improvement in respiratory parameters, with reduction in oxygen requirement, mean airway pressure, and improved gas exchange. Respiratory support was gradually de-escalated from nasal intermittent positive pressure ventilation to continuous positive airway pressure and subsequently to high-flow nasal cannula. Salivary suPAR levels demonstrated a decreasing trend, while IL-6 showed transient fluctuations, partly associated with intercurrent infections. Treatment was generally well tolerated during the observation period. The infant was discharged on minimal respiratory support, with continued improvement during follow-up. This case suggests a possible role of IL-1 blockade in the modulation of persistent inflammation in BPD with a refractory clinical course, although the observed clinical course may also reflect the natural evolution of the disease. Longitudinal salivary biomarkers may represent a feasible, exploratory, non-invasive approach to describe inflammatory dynamics over time. Larger prospective studies are needed to evaluate the efficacy, safety, and optimal treatment protocols of anakinra.