Journal of Pediatric and Neonatal Individualized Medicine (JPNIM)

Selected Lectures of the Meeting “Environment and Health: Messages from the Future”; Cagliari (Italy); October 26, 2024

--- Various Authors — Sat, 26 Oct 2024 00:00:00 +0200

Selected Lectures of the Meeting “Environment and Health: Messages from the Future”; Cagliari (Italy); October 26^th, 2024

The Meeting “Environment and Health: Messages from the Future” is a Satellite Meeting of the 20^th International Workshop on Neonatology and Pediatrics, Cagliari (Italy), October 23^rd-26^th, 2024.

LECT 1. MATERNAL MILK STEM CELLS: WHICH ROLE IN PERINATAL PROGRAMMING OF ADULT DISEASES? • G. Faa, G. Pichiri, P. Coni, M. Piras, M. Fraschini, A. Reali, V. Fanos (Cagliari, Italy; Philadelphia, Pennsylvania, USA)

LECT 2. MICROPLASTICS, ENVIRONMENT AND CHILDREN HEALTH • S. Bernasconi (Parma, Italy)

LECT 3. ENDOCRINE DISRUPTORS (EDs) AND PERINATAL PROGRAMMING • M.E. Street (Parma, Italy)

LECT 4. THE LIFE MILCH PROJECT: UPDATES AND PERSPECTIVES • P. Palanza, V. Fanos, A.M. Papini, S. Perrone, T. Ghi, S. Paterlini, M.M. Brambilla, D. Baccolo, C. Scopa, A. Ardenghi, A.M. Shulhai, C. Caffarelli, F. Nuti, F. Fernandez, C. Sartori, F. Alberghi, B. Righi, M. Fontana, L. Filonzi, C. Petrolini, B. Piccolo, E. Turco, R. Pintus, C. Piras, S. Petza, A. Dessì, F. Nonnis Marzano, S. Angioni, S. Vitale, D. Ponzi, A. Pelosi, M.E. Street (Parma, Cagliari, Florence and Reggio Emilia, Italy)

LECT 5. POTENTIAL OF TERPINEN-4-OL AS AN ADDITIVE FOR THE PREVENTION OF BACTERIAL INFECTIONS IN NEONATAL BREASTFEEDING • D. Romeo (Milan, Italy)

LECT 6. KANGAROO CARE AND NEW HAND MANAGEMENT TECHNIQUES • M. Melis (Cagliari, Italy)

LECT 7. POTENTIAL OF ESSENTIAL OILS IN THE MANAGEMENT OF MICROBIAL INFECTIONS • F. Mondello, M. Di Vito, M.L. Ricci (Rome, Italy)

LECT 8. AFLATOXIN M1 IN MILK: SITUATION AND ANALYTICAL METHODS • E. Arletti (Modena, Italy)

LECT 9. TOXICANTS AND TOXINS • C. Marzetti (Bologna, Italy)

LECT 10. ONE HEALTH IN MEDICINE • A. Colangelo (Trento, Italy)

LECT 11. EPIGENETIC MODULATION OF INFLAMMATION IN THE AGE OF POLLUTION • M. Greco, G. Terziani (Rivalta di Torino and Brescia, Italy)

Selected Lectures of the Meeting “From the First Thousand Days to Aging: Life is a Continuum. Epigenetics, Artificial Intelligence and Environmental Impact”; Cagliari (Italy); October 25, 2024

--- Various Authors — Fri, 25 Oct 2024 00:00:00 +0200

Selected Lectures of the Meeting “From the First Thousand Days to Aging: Life is a Continuum. Epigenetics, Artificial Intelligence and Environmental Impact”; Cagliari (Italy); October 25^th, 2024

The Meeting “From the First Thousand Days to Aging: Life is a Continuum. Epigenetics, Artificial Intelligence and Environmental Impact” is a Satellite Meeting of the 20^th International Workshop on Neonatology and Pediatrics, Cagliari (Italy), October 23^rd-26^th, 2024.

LECT 1. THE POWER OF EPIGENETICS IN THE FIRST THOUSAND DAYS • V. Fanos (Cagliari, Italy)

LECT 2. EPIGENETICS DETERMINING CHILD DEVELOPMENT AND ADULT HEALTH • M. Stanton (Lübeck, Germany)

LECT 3. EPIGENETIC FACTORS INFLUENCING LONGEVITY: A PRELIMINARY STUDY • B. Pische, A.M. Posadino, P. Maccioccu, V. Tanca, G. Terziani, G. Fenu Pintori (Sassari and Brescia, Italy)

LECT 4. MITOCHONDRIAL EPIGENETIC APPROACH IN NEURODEVELOPMENTAL IMPAIRMENTS • M. Greco, G. Terziani, G. Damaschi (Rivalta di Torino and Brescia, Italy)

LECT 5. MANAGING LIFE BEFORE, DURING AND AFTER PREGNANCY • S. Nava (Milan, Italy)

LECT 6. INTEGRATED CLINICAL APPROACH • B. Allegrini (Monopoli, Italy)

LECT 7. EPIGENETIC MODULATION OF INFLAMMATION • K. Wulhfard (Turin, Italy)

LECT 8. NUTRACEUTICALS AND PHYSIOLOGICAL OXYGEN MODULATION • S. Benedetti, F. Palma, B. Nuvoli, R. Galati, G. Fenu Pintori, M. Greco, G. Terziani (Urbino, Rome, Sassari, Rivalta di Torino and Brescia, Italy)

Selected Lectures of the Congress of Pediatrics; Cagliari (Italy); October 25, 2024

--- Various Authors — Fri, 25 Oct 2024 00:00:00 +0200

Selected Lectures of the Congress of Pediatrics; Cagliari (Italy); October 25, 2024

The Congress of Pediatrics is a Satellite Meeting of the 20th International Workshop on Neonatology and Pediatrics, Cagliari (Italy), October 23^rd-26^th, 2024.

LECT 1. TH2 INFLAMMATION AND INBORN ERRORS OF IMMUNITY (IEI): AN EVER-EXPANDING UNIVERSE. FOCUS ON STAT6 GAIN-OF-FUNCTION MUTATIONS • I. Taietti, R. Castagnoli, A. Licari, G.L. Marseglia (Pavia, Italy)

LECT 2. ANTIBIOTICS AND PROBIOTICS: WHEN TO USE THEM TOGETHER IN PEDIATRICS • S. Esposito (Parma, Italy)

LECT 3. THE LONG-TERM FOLLOW-UP OF PRETERM INFANTS • M. Agosti (Varese, Italy)

LECT 4. LOW DOSE MEDICINE AND RECURRENT RESPIRATORY INFECTIONS: A DELPHI CONSENSUS SURVEY • G. Bona, M. Agosti, A. Arrighi, S. Bernasconi, G. Ciprandi, S. Leonardi, G.L. Marseglia (Novara, Varese, Arezzo, Genoa, Catania, and Pavia, Italy)

LECT 5. RATIONAL USE OF NUTRACEUTICALS IN PEDIATRICS • G. Trapani (Sanremo, Italy)

LECT 6. THE PAST, THE PRESENT: WHAT FUTURE FOR PEDIATRICS AND PEDIATRIC SOCIETIES? • S. Vendemmia, I. Pezone, D. Perri, V. Ferrara, M. Vendemmia (Aversa, Rome and Naples, Italy)

LECT 7. THE FAMILY PEDIATRICIAN AND THE FUTURE • A. D’Avino (Naples, Italy)

LECT 8. ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD): NEWS AND UPDATES • M. Carotenuto (Caserta, Italy)

LECT 9. FEVER IN PEDIATRIC PATIENTS: AN EAR-NOSE-THROAT (ENT) PERSPECTIVE • A. Varricchio, F.P. Brunese, A. Varricchio (Campobasso, Caserta and Milan, Italy)

LECT 10. THROMBOCYTOPENIA IN CHILDREN • S. Barella (Cagliari, Italy)

LECT 11. EXPOSURE TO DIGITAL DEVICES IN CHILDHOOD: A STUDY OF 1,332 CHILDREN AND PREADOLESCENTS • L. Pisano, O. Al Jamal (Cagliari, Italy)

LECT 12. PRESENTATION OF THE BOOK “PEDIATRIC ELECTROCARDIOGRAPHY – A SIMPLIFIED APPROACH” • F. De Luca (Catania, Italy)

LECT 13. PRESENTATION OF THE BOOK “NUTRACEUTICALS IN CLINICAL PRACTICE: SUPPLEMENTATION AND PREVENTION, A REASONED APPROACH TO HEALTH AND WELLNESS” • G. Trapani (Sanremo, Italy)

LECT 14. PRIMARY HYPEROXALURIA TYPE 1 • V. Manca, G. Masnata (Cagliari, Italy)

LECT 15. HEREDITARY HOMOZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA (HoFH) • S. Muntoni, C. Piras, L. Atzori (Cagliari, Italy)

LECT 16. PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS • A. Pietrobattista (Rome, Italy)

LECT 17. ALFA MANNOSIDOSIS: A CHALLENGING DIAGNOSIS FOR A TREATABLE DISEASE • M. Balzarini, F. Zanco, C. Sbaffi (Cagliari, Italy)

LECT 18. LYSOSOMAL ACID LIPASE (LAL) DEFICIENCY: CLINICAL SPECTRUM, DIFFERENTIAL DIAGNOSIS AND SPECIFIC THERAPY • V. Casotti (Bergamo, Italy)

LECT 19. AROMATIC L-AMINO ACID DECARBOXYLASE (AADC) DEFICIENCY • T. Foiadelli (Pavia, Italy)

LECT 20. ROLE OF ALKALINE PHOSPHATASE IN THE DIAGNOSIS OF HYPOPHOSHATASIA • S. Savasta (Cagliari, Italy)

LECT 21. DONKEY MILK BETWEEN PAST AND FUTURE • V. Fanos, M. Corridori (Cagliari and Quartu Sant’Elena, Italy)

LECT 22. THE QUALITY OF DONKEY MILK • M. Martini (Pisa, Italy)

LECT 23. DONKEY MILK: A RESOURCE IN PRETERM INFANTS NUTRITION • E. Bertino, G. Maiocco, L. Cavallarin, M. Giribaldi, S. Deantoni, C. Peila, A. Coscia (Turin and Grugliasco, Italy)

LECT 24. METABOLOMICS OF DONKEY MILK • F. Cesare Marincola, V. Fanos (Cagliari, Italy)

LECT 25. THE VIRTUAL KIDNAPPING OF YOUTH BY SOCIAL MEDIA • M. Leiner (El Paso, Texas, USA)

Selected Lectures of the Balkan Meeting of Neonatology; Cagliari (Italy); October 25, 2024

--- Various Authors — Fri, 25 Oct 2024 00:00:00 +0200

Selected Lectures of the Balkan Meeting of Neonatology; Cagliari (Italy); October 25^th, 2024

The Balkan Meeting of Neonatology is a Satellite Meeting of the 20^th International Workshop on Neonatology and Pediatrics, Cagliari (Italy), October 23^rd-26^th, 2024.

LECT 1. MORTALITY RATE OF PRETERM BABIES BORN IN THE TERTIARY MEDICAL CENTER IN TIRANA AND THE IMPACT OF THE IMPROVEMENT OF THE KNOWLEDGE AND SKILLS OF THE HEALTH STAFF • A. Hoxha-Qosja (Tirana, Albania)

LECT 2. THE IMPACT OF EARLY CPAP IN THE DELIVERY ROOM IN PRETERM INFANTS WITH A GESTATIONAL AGE OF 31-36⁺⁶ WEEKS • M. Meta, A. Hoxha-Qosja (Fier and Tirana, Albania)

LECT 3. IMPACT OF NEONATAL EARLY-ONSET SEPSIS CALCULATOR IN OUR CLINICAL PRACTICE • G. Koroveshi-Gora, A. Hoxha-Qosja, S. Damo (Tirana, Albania)

LECT 4. MATERNAL DIET AND BREASTFEEDING • S. Deantoni, E. Bertino, C. Peila, S. Gandino, A. Coscia (Turin and Moncalieri, Italy)

LECT 5. NUTRITION AND GROWTH OF PRETERM BABIES IN NICUs • E. Hatzidaki (Heraklion, Greece)

LECT 6. NEONATAL SKIN AND RARE DISEASES • S. Savasta (Cagliari, Italy)

LECT 7. PREVENTION AND EARLY CARE OF PRESSURE ULCERS IN THE NICU SETTING: A QUALITY IMPROVEMENT PROJECT • G. Ciprandi (Rome, Italy)

LECT 8. SEPSIS AND ITS TREATMENT FROM NEWBORNS TO ADULTS • G. Finco (Cagliari, Italy)

LECT 9. ARTIFICIAL INTELLIGENCE IN NEONATOLOGY • K.K. Kopeć, A. Noto, C. Piras, M. Spada, L. Atzori, V. Fanos (Cagliari, Italy)

LECT 10. AUTISTIC SPECTRUM DISORDERS IN NICU CANDIDATES • E. Tsekoura (Athens, Greece)

LECT 11. RESPIRATORY SYNCYTIAL VIRUS (RSV) INFECTION: NOT ONLY PRETERM INFANTS • E. Lanfranchi (Urbino, Italy)

Selected Lectures of the 20th International Workshop on Neonatology and Pediatrics; Cagliari (Italy); October 23-26, 2024

--- Various Authors — Thu, 24 Oct 2024 00:00:00 +0200

Selected Lectures of the 20^th International Workshop on Neonatology and Pediatrics; Cagliari (Italy); October 23^rd-26^th, 2024

CHILDREN’S HEALTH: MESSAGES FROM THE FUTURE

The Workshop has been organized with the patronage of Autonomous Region of Sardinia, City of Cagliari, Azienda Ospedaliera di Cagliari, University of Cagliari, Board of Physicians of the Province of Cagliari, Italian-Albanian Pediatric Society, AMBO (Alleanza per un Ambiente a misura di Bambino: alliance for a child-friendly environment), European Project Better4u, Eropean Project Life Milch, National Confederation of Pediatrics Heads (CONAPP), Italian Federation of Family Pediatricians (FIMP), Italian-Arabian Pediatric Society (IAPS), Italian-Romanian Pediatric Society (IRPS), Norman Group of Neonatal and Pediatric Nephrology, International Academy of Perinatal Medicine, Italian Society of Pediatric Allergology and Immunology (SIAIP), Italian Society of Clinical Biochemistry (SIBioC), Italian Society of Gynecology of Infancy and Adolescence (SIGIA), Italian Society of Neonatology (SIN), Italian Society of Hospital Pediatricians (SIPO), Association SIPO in the World, Italian Society of Pediatric Psichology (S.I.P.Ped.), Romanian Society of Pediatrics, Italian Society for Research on Essential Oils (SIROE), Italian Society of Neonatal Nursing (SIN INF), Union of European Neonatal and Perinatal Societies (UENPS).

LECT 1. NEONATOLOGY FROM THE PAST TO THE FUTURE • G. Buonocore (Siena, Italy)

LECT 2. HUMAN BREAST MILK MICROBIOTA AND CHILDREN’S HEALTH • G. Corsello (Palermo, Italy)

LECT 3. DEVELOPMENTAL NEUROBIOLOGY: THE EVOLUTION OF NEONATAL BRAIN • M. Ruggieri (Catania, Italy)

LECT 4. FETAL PROGRAMMING OF ADULT DISEASES • G. Faa, M. Fraschini, F. Cau, V. Fanos (Cagliari, Italy; Philadelphia, PA, USA)

LECT 5. SKIN MICROBIOTA IN ATOPIC DERMATITIS: IS IT POSSIBLE AN INTERVENTION? • D. Peroni (Pisa, Italy)

LECT 6. SKINOMICS: SKIN METABOLOMICS AND MICROBIOMICS • A. Dessì, A. Bosco (Cagliari, Italy)

LECT 7. PULMONARY HYPERTENSION IN THE NEWBORN • P.P. Bassareo (Dublin, Ireland )

LECT 8. LOOKING FOR A VEIN? THERE IS A LIGHT AT THE END OF THE TUNNEL • A. Lai, C. Lobina (Cagliari, Italy)

LECT 9. NEONATAL TRANSPORT BY HELICOPTER • S. Rugolotto (Rovigo, Italy)

LECT 10. THE NUTRIENT CYCLE: FROM MATERNAL NUTRITION TO HUMAN MILK COMPOSITION VIA PLACENTA-FETAL EXCHANGES • I. Ten-Doménech, A.C.C. Hodgson, P. Refinetti, J. Kuligowski, S. Rezzi (Valencia, Spain; Lausanne and Monthey, Switzerland)

LECT 11. IS IT STILL TIME FOR SUSTAINED INFLATION IN THE DELIVERY ROOM? • G. Lista, F. Castoldi, F. Cavigioli (Milan, Italy)

LECT 12. INFECTIONS AND ANTIMICROBIAL USE • A. Charitou (Athens, Greece)

LECT 13. NEUROPROTECTIVE STRATEGIES FOR ASPHYXIATED NEWBORNS IN THE EARLY NEONATAL PERIOD: A FOCUS ON BRAIN-ORIENTED INTERVENTIONS • E. Gitto, F. D’Amico, A. Carcione, S. Calabrese (Messina, Italy)

LECT 14. METABOLOMICS IN NECROTIZING ENTEROCOLITIS • A. Bosco, A. Dessì (Cagliari, Italy)

LECT 15. LEVERAGING PREDICTIVE ANALYTICS FOR MATERNAL IMMUNIZATION • P. Jog, V. Joshi (Pune, Maharashtra, India)

LECT 16. RESPIRATORY SYNCYTIAL VIRUS (RSV) PREVENTION: MESSAGES FROM THE PRESENT • L. Folgori, L. Barcellini, G.V. Zuccotti (Milan, Italy)

LECT 17. GENETICS AND EPIGENETICS OF THE FUTURE • L. Stuppia (Chieti, Italy)

LECT 18. MENINGITIS TODAY • G. Kuli-Lito, R. Petrela, B. Nezaj, B. Gjonaj, D. Shtembari, J. Zdrave, E. Hysenaj, R. Gjini, V. Mano, N. Gjylameti, E. Rustja, D. Cela (Tirana, Albania)

LECT 19. BODY DYSMORPHIC DISORDER • F. Velardi (Rome, Italy)

LECT 20. DECODING THE MIND: GENETIC INNOVATIONS IN PSYCHIATRIC RESEARCH AND TREATMENT • A. Ciubară (Galați, Romania)

Selected Lectures of the 3rd Course of Perinatal and Pediatric Cardiology; Cagliari (Italy); October 23, 2024

--- Various Authors — Wed, 23 Oct 2024 00:00:00 +0200

Selected Lectures of the 3^rd Course of Perinatal and Pediatric Cardiology; Cagliari (Italy); October 23, 2024

The 3^rd Course of Perinatal and Pediatric Cardiology is a Satellite Meeting of the 20th International Workshop on Neonatology and Pediatrics, Cagliari (Italy), October 23^rd-26^th, 2024.

LECT 1. PRENATAL DIAGNOSIS OF CONGENITAL HEART DISEASES: HOW AND WHERE TO GIVE BIRTH? • P. Neroni, A. Atzei (Cagliari, Italy)

LECT 2. CARDIOVASCULAR HEALTH AND EXERCISE IN CHILDREN WITH CONGENITAL HEART DISEASES • F. De Luca (Catania, Italy)

LECT 3. HEART AND MIND: THE HIDDEN LINK • G. Concas, E. Esposito, A. Atzei, P. Neroni (Cagliari, Italy)

LECT 4. INTERCURRENT PATHOLOGIES, CONGENITAL HEART DISEASES AND CLINICAL MANAGEMENT: WHAT ELSE? • A. Atzei, G. Concas, C. Trenta, R. Pintus, P. Neroni (Cagliari, Italy)

LECT 5. ARTERIAL HYPERTENSION IN THE CHILD • P.P. Bassareo (Dublin, Ireland)

LECT 6. CONGENITAL HEART DISEASE: HOW TO MANAGE THE TRANSITION FROM CHILDHOOD TO ADULTHOOD • M. Chessa, S. Flocco, A. Magon (Milan, Italy)

LECT 7. SPORTS CERTIFICATION: DIFFERENCES BETWEEN ITALY AND OTHER COUNTRIES • R. Solinas (Cagliari, Italy)

LECT 8. METABOLOMICS AND PEDIATRIC CARDIOLOGY • R. Pintus (Cagliari, Italy)

A systematic review and meta-analysis on the safety and efficacy of premedication prior to elective intubation in neonates

Fri, 23 Aug 2024 00:00:00 +0200

Objective: Endotracheal intubation, as an emergent but also as an elective procedure, can be stressful and painful, causing hypoxemia, bradycardia, acidosis or increased intracranial pressure. We aimed to investigate the safety and efficacy of premedication prior to elective intubation in order to contribute to the development of a more standardized strategy.

Method: A systematic review and meta-analysis was conducted. The PubMed database was searched using the PICO method and keywords according to MeSH terms were used. Only studies with control groups were included (randomized controlled trials, prospective observational and case-control studies).

Results: Our search procedure yielded 722 potentially eligible studies. Finally, 26 studies were included for qualitative and quantitative analysis. Blood pressure during intubation was found lower for neonates that received premedication compared to controls (SMD = -1.27; 95% CI [-2.59; 0.05]; p < 0.01). Heart rate change was found higher in the control group (SMD = -0.26; 95% CI [-1.07; 0.55]; p = 0.54). Intervention groups were found to have higher odds for bradycardia (OR = 1.13; 95% CI [0.79; 1.62]; p = 0.51), and less odds for desaturation compared to control groups (OR = 0.69; 95% CI [0.33; 1.45]; p = 0.33). The odds for adverse events were found 3 times lower in the intervention group, in relation to controls (OR = 0.71; 95% CI [0.55; 0.73]; p = 0.012). Intubation time for the intervention groups was lower than controls (SMD = -0.59; 95% CI [-1.06; -0.11]; p < 0.02). Intubation attempts were found marginally increased in the intervention group (ROM = 1.10; 95% CI [0.79; 1.53]; p = 0.57). No difference was found regarding mortality rate between groups.

Conclusion: Most Neonatal Intensive Care Units should consider premedication prior to intubation for vigorously and active term and preterm infants as a safe and efficient procedure that buffers serious physiological responses and assures better procedural conditions.

Laryngomalacia and failure to thrive – A case report

Tue, 27 Aug 2024 00:00:00 +0200

Introduction: Laryngomalacia (LGM) is the most common congenital anomaly of the larynx and the most frequent cause of stridor in the newborn. Even though it can be a source of concern and anxiety to parents, a large majority of cases usually resolve spontaneously within 18 months of life. However, in infants with signs of severity, a multidisciplinary approach and surgical intervention might be necessary.

Case report: We report the case of a full-term 7-week-old infant girl, previously hospitalized in the Neonatal Intensive Care Unit and diagnosed with type II LGM (Olney’s classification). She presented to the Paediatric Emergency Department with stridor at rest, vigorous chest wall retractions and poor weight gain (increase of 10 g/day, weight under the 3^rd percentile). The infant was admitted to monitor respiratory symptoms and investigate her failure to thrive. However, irrespective of feeding modifications, and after exclusion of other causes of failure to thrive, the infant maintained an insufficient weight gain. Additionally, respiratory symptoms remained exuberant and surgical intervention was determined as the optimal treatment. At 3 months old, supraglottoplasty was performed. At 18 months, she has a weight in the 3^rd-15^th percentile range (WHO curves) and is clinically asymptomatic.

Conclusion: LGM is a remarkably frequent cause of stridor in infants, but only a rare number of cases require other interventions beyond symptomatic measures. In this report, surgical intervention was of paramount importance to ensure normal growth, emphasising the impact of a multidisciplinary approach in such cases.

Hemodynamics guided care during extracorporeal membrane oxygenation (ECMO): a case report

Wed, 28 Aug 2024 00:00:00 +0200

Congenital diaphragmatic hernia (CDH) represents a population of high risk of major cardiopulmonary decompensation. Maintenance of patency of the patent ductus arteriosus (PDA), using intravenous prostaglandin, is a strategy used by some clinicians to decrease the risk of right ventricular dysfunction. A term infant with CDH presented with pulmonary hypertension unresponsive to aggressive hemodynamic support. Within 12 hours of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) initiation, circuit chugging occurred that was refractory to multiple volume boluses. Targeted neonatal echocardiography (TnECHO) revealed a high-volume left-to-right shunt across the PDA, resulting in decreased blood return to the right atrium. Interventions aimed at reducing the left-to-right PDA shunt led to the resolution of circuit chugging. This report highlights the unique challenge of VA-ECMO flow in the setting of a large PDA and the consequences of interventions, increasing PDA diameter or lowering pulmonary vascular resistance, on the magnitude of systemic-pulmonary shunting and systemic blood flow. TnECHO played a vital role in monitoring hemodynamics and guiding ECMO adjustments.