Objectives. Our aim was to identify the clinical characteristics which could distinguish infants who can be managed with INSURE (intubatio-surfactant-extubation) method for preventing mechanical ventilation (MV) and which could predict INSURE success or failure. Methods. Inborn infants with gestational age <30 weeks were Infants were categorised into three groups: (1) infants who needed MV in the delivery room; (2) infants spontaneously breathing who were treated only with NCPAP; (3) infants who were treated with INSURE method. Results. We studied 125 infants: 30 (24%) required MV, 75 (60%) received INSURE treatment, and 20 (16%) were treated with NCPAP. Sixty-eight (91%) infants were successfully treated with the INSURE method. Infants in the success group had less severe RDS and less occurrence of sepsis and pneumothorax, lower mortality, and shorter duration of stay in the NICU than infants in the failure group. A birth weight <750 g, pO₂/FiO₂ <218, and a/ApO₂ <0.44 at the first blood gas analysis were independent risk factor for INSURE failure. Conclusions. The INSURE method can be applied to the majority of extremely preterm infants and is followed by a high percentage of success.

Our aim was to assess the hypothesis that a high‐dose regimen of ibuprofen is more effective than the standard‐dose regimen in closing patent ductus arteriosus (PDA) without increasing adverse effects. Infants of gestational age <29 weeks, with respiratory distress syndrome (RDS) and echocardiographic evidence of significant PDA at 12–24 h of life, were randomized to receive a standard (10–5–5 mg/kg/day) or high‐dose (20–10–10 mg/kg/day) course of ibuprofen. We studied 70 infants, 35 of whom received the standard dose of ibuprofen and the other 35 the high dose. Of the infants treated with the standard‐dose regimen, 37% had persistent PDA as compared with 14% of those treated with the high‐dose regimen (P = 0.03). No differences in the occurrence of adverse effects were observed between the two groups. The high‐dose ibuprofen regimen is more effective than the standard‐dose regimen in closing PDA in preterm infants <29 weeks of gestation without increasing the adverse effect rate. Clinical Pharmacology & Therapeutics (2012); 91 4, 590–596. doi:10.1038/clpt.2011.284

Hyperbilirubinemia is a frequent condition affecting newborns during the first two weeks of life and when it lasts more than 14 days it is defined as prolonged jaundice. This condition requires differential diagnosis between the usually benign unconjugated hyperbilirubinemia and the pathological conjugated hyperbilirubinemia, that is mainly due to neonatal cholestasis. It is important that the diagnosis of neonatal cholestasis be well-timed to optimize its management, prevent worsening of the patient’s outcome, and to avoid premature, painful, expensive, and useless tests. Unfortunately, this does not always occur and, therefore, the Task Force on Hyperbilirubinemia of the Italian Society of Neonatology presents these shared Italian guidelines for the management and treatment of neonatal cholestasis whose overall aim is to provide a useful tool for its assessment for neonatologists and family pediatricians.