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Gianpaolo Maso,
Salvatore Alberico,
Lorenzo Monasta,
Luca Ronfani,
Marcella Montico,
Caterina Businelli,
Valentina Soini,
Monica Piccoli,
Carmine Gigli,
Daniele Domini, [......],
Simona Melazzini,
Secondo Guaschino,
Francesco De Seta, Sergio Demarini,
Laura Travan,
Diego Marchesoni,
Alberto Rossi,
Giorgio Simon,
Sandro Zicari,
Giorgio Tamburlini
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Gianpaolo Maso,
Salvatore Alberico,
Lorenzo Monasta,
Luca Ronfani,
Marcella Montico,
Caterina Businelli,
Valentina Soini,
Monica Piccoli,
Carmine Gigli,
Daniele Domini, [......],
Simona Melazzini,
Secondo Guaschino,
Francesco De Seta, Sergio Demarini,
Laura Travan,
Diego Marchesoni,
Alberto Rossi,
Giorgio Simon,
Sandro Zicari,
Giorgio Tamburlini
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ABSTRACT: Group B Streptococcus (GBS) is the most frequent cause of neonatal invasive disease. Two forms of GBS are recognized: early-onset and late-onset disease. The average incidence of late-onset disease is 0.24 per 1000, a figure that has remained substantially unchanged over time. Exposure to breast milk represents a potential source of infection, especially in late-onset and/or recurrent GBS disease. As a result, both breastfeeding and the use of breast milk have been questioned. We report for the first time the case of both simultaneous and recurrent infection in newborn preterm twins, born 3 weeks apart, resulting from ingestion of GBS positive breast milk. A genetically identical strain was found in both breast milk and her newborn infants. Transmission of GBS through breast milk should be considered in late-onset GBS sepsis. An eradicating antibiotic treatment of GBS positive mothers with ampicillin plus rifampin and temporary discontinuation of breastfeeding and/or the use of heat processed breast milk may represent preventive measures, although outcomes are inconsistent, for recurrent GBS disease. Guidelines on breastfeeding and prevention of recurrent neonatal GBS disease are needed. It is unfortunate that existing scientific literature is scarce and there is no general consensus. As a consequence, we propose a best practice approach on the topic.
Journal of Human Lactation 03/2013; · 1.15 Impact Factor
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ABSTRACT: Background:The immune modulator TNF-related apoptosis-inducing ligand (TRAIL) has been found at extremely high levels in human milk of women with normal gestation at day 5 after delivery.Objective:To investigate the presence and the levels of soluble TRAIL in human milk of women with preterm delivery at different time points post-partum (32, 34, and 36 weeks from conception).Methods:The levels of soluble TRAIL were analyzed by ELISA in the breast milk of a group of 25 women with preterm delivery at different gestational ages.Results:Soluble TRAIL was present at high levels in human milk since early post-conceptional ages (32 weeks). No significant differences in TRAIL levels were noticed with respect to different gestational ages, or with respect to time of collection when comparing, in a selected group of patients, samples obtained between 15 and 26 days with those obtained 27 and 40 days after birth.Conclusion:Due to the key immunoregulatory role of human soluble TRAIL, the presence of high levels of TRAIL in the milk of women with preterm delivery and its maintenance at high levels up to 72 days after birth support the importance of breastfeeding the preterm newborn.
Journal of Human Lactation 03/2013; · 1.15 Impact Factor
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ABSTRACT: OBJECTIVE: To compare 2 approaches in the management of neonates at risk for group B Streptococcus early-onset sepsis: laboratory tests plus standardized physical examination and standardized physical examination alone. STUDY DESIGN: Prospective, sequential study over 2 consecutive 12-month periods, carried out in the maternity hospitals of the region Friuli-Venezia Giulia (north-eastern Italy). All term infants were included (7628 in the first period, 7611 in the second). In the first period, complete blood count and blood culture were required for all infants at risk, followed by a 48-hour period of observation with a standardized physical examination. In the second period, only standardized physical examination was performed. Study outcomes were: (1) number of neonates treated with antibiotics; and (2) time between onset of signs of possible sepsis and beginning of treatment. RESULTS: There was no difference between the 2 periods in the rate of maternal colonization (19.7% vs 19.8%, P = .8), or in other risk factors. The interval between onset of signs of sepsis and starting of antibiotics was not different in the 2 periods. Significantly fewer infants were treated with antibiotics in the second period (0.5% vs 1.2%, P < .001). CONCLUSIONS: Laboratory tests together with standardized physical examination seem to offer no advantage over standardized physical examination alone; the latter was associated with fewer antibiotic treatments. Our results are in agreement with the Center for Disease Control and Prevention's 2010 recommendations.
The Journal of pediatrics 03/2013; · 4.02 Impact Factor
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Gianpaolo Maso,
Salvatore Alberico,
Lorenzo Monasta,
Luca Ronfani,
Marcella Montico,
Caterina Businelli,
Valentina Soini,
Monica Piccoli,
Carmine Gigli,
Daniele Domini, [......],
Simona Melazzini,
Secondo Guaschino,
Francesco De Seta, Sergio Demarini,
Laura Travan,
Diego Marchesoni,
Alberto Rossi,
Giorgio Simon,
Sandro Zicari,
Giorgio Tamburlini
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ABSTRACT: Caesarean delivery (CD) rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS) can be used in case-mix adjustment.
Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index), obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight) and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC) curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC) were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction.
Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS) identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively). In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024).
The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the predictive discrimination of the risk adjusted model.
PLoS ONE 01/2013; 8(6):e62364. · 4.09 Impact Factor
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ABSTRACT: Background: Human milk is the optimal form of nutrition for infants, especially sick or compromised infants, yet international data suggest that breastfeeding (feeding at the breast) and the use of expressed human milk (mother's and donor's milk) are limited in patients cared for in the Neonatal intensive care unit (NICU). Objectives: The goal of this study was to examine feeding status at hospital discharge among high risk infants.Methods: We used the 1991 World Health Organization infant feeding definitions, applied to the 72 hour period preceding discharge from the NICU. The study sample consisted of all high risk infants discharged from July 1, 2005, to June 30, 2006 from 13 Italian NICUs. Data on infant feeding in the last 72 hours were collected at discharge from the medical records. Results: We recorded data from 2948 subjects with a median gestational age of 35 weeks (IQR 32-38), a median birth weight of 2200g (IQR 1630-2920) and a median length of stay of 16 days (IQR 8-33). At discharge, 28% of all infants were fed exclusively with human milk: 31%, 25%, 22% and 33% respectively in the <1500g, 1500-2000g, 2000-2499g and ≥2500g birth weight categories. The proportion of infants not fed with human milk varied from 6 to 82% across different centers.Conclusions: Our study found limited breastfeeding and use of human milk among the NICU infants at discharge. At discharge, infants with a birth weight 1500-2499g were fed exclusively with human milk less than those in higher or lower birth weight categories.
Journal of Human Lactation 07/2012; · 1.15 Impact Factor
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ABSTRACT: Background: Neonatal weight loss is universally recognized, yet poorly understood. Limited professional consensus exists on the definition of lower limit of safe weight loss.Objective: Our aim was to assess the extent of neonatal weight loss and its association with selected clinical variables in a population of healthy term infants cared for using a specific protocol on weight loss.Methods: We retrospectively considered 1003 infants consecutively admitted to the regular nursery of the Institute for Maternal and Child Health "Burlo Garofolo" (Trieste, Italy). We studied the relationship of selected variables with neonatal weight loss recorded during the hospital stay. We also analyzed all readmissions in the first month of life as a result of weight loss and its complications.Results: We observed a mean absolute weight loss of 228 g ± 83g, and a mean percent weight loss of 6.7% ± 2.2%. Weight loss ≥ 10% and > 12% were 6% and 0.3%, respectively. In multivariate logistic regression, cesarean section, hot season, any formula feeding, and jaundice not requiring phototherapy were independently associated with neonatal weight loss ≥ 8%. Conversely, low gestational age status was associated with lower weight loss. Readmission within the first month of life because of dehydration occurred in 0.3% of infants.Conclusions: Breastfeeding, compared to formula feeding, may not be a risk factor for greater early neonatal weight loss, at least in contexts in which weight is routinely monitored, breastfeeding is repeatedly assessed and appropriately supported, and careful supplementation is prescribed to limit and promptly treat excess weight loss and its related complications.
Journal of Human Lactation 05/2012; · 1.15 Impact Factor
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ABSTRACT: Background: TNF-related apoptosis inducing ligand (TRAIL) is a pleiotropic cytokine, which plays a key role in the immune system as well as in controlling the balance of apoptosis and proliferation in various organs and tissues.Objective: To investigate the presence and levels of soluble TRAIL in human colostrum and milk.Methods: The levels of soluble human TRAIL were measured in human colostrum (day 2 after delivery) and breast milk (day 5 after delivery). The presence of TRAIL was also measured in infant formula.Results: Levels of soluble TRAIL in the colostrum and mature human milk were, respectively, at least 400 and 100 fold higher than those detected in human serum. No TRAIL was detected in formula.Conclusion: Human soluble TRAIL is present at extremely high levels in human colostrum and human milk and might have a significant role in mediating the anti-cancer activity of human milk.
Journal of Human Lactation 04/2012; · 1.15 Impact Factor
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ABSTRACT: Abstract Aim: The aims of this study were to analyze the relationship between the LATCH score assessed in the first 24 hours after delivery and non-exclusive breastfeeding at discharge and to identify a cutoff for the LATCH score in order to identify women with higher risk of non-exclusive breastfeeding who may need additional breastfeeding support. Subjects and Methods: We conducted a prospective observational study in the Maternity Ward of the Institute for Maternal and Child Health "Burlo Garofolo" (Trieste, Italy) and collected data from 299 mother-infant dyads. Results: The rate of nonexclusive breastfeeding was inversely related to the LATCH score (p<0.001) with non-exclusive breastfeeding infants scoring less (6.9) than infants exclusively breastfed at discharge (7.6) (p=0.001). In multivariate analysis, non-exclusive breastfeeding was also associated with cesarean section, primiparity, and infant phototherapy. In order to support maternity staff in providing targeted interventions, we identified four LATCH score cutoffs associated with as many risk groups for non-exclusive breastfeeding at discharge. Conclusions: The LATCH score is a useful tool to identify mother-infant pairs who might benefit from additional skilled support in specific subgroups at risk of non-exclusive breastfeeding at discharge. Future research is needed to explore if the LATCH score assessed in the first days of life can also predict the duration of breastfeeding.
Breastfeeding Medicine 02/2012; · 1.65 Impact Factor
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ABSTRACT: We evaluated the effect of prone and supine position on cerebral blood flow (CBF) in stable preterm infants. CBF, PO(2), and PCO(2) were measured in the two positions. Peripheral oxygenation increased and CBF decreased in prone position. We speculate that CBF autoregulation may compensate for increased peripheral oxygenation, by decreasing CBF.
The Journal of pediatrics 01/2012; 160(1):162-4. · 4.02 Impact Factor
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The Journal of pediatrics 12/2011; 160(5):878. · 4.02 Impact Factor
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ABSTRACT: The Wada test is usually used for pre-surgical assessment of language lateralization. Considering its invasiveness and risk of complications, alternative methods have been proposed but they are not always applicable to non-cooperative patients. In this study we explored the possibility of using optical topography (OT)--a multichannel near-infrared system--for non-invasive assessment of hemispheric language dominance during passive listening.
Cortical activity was monitored in a sample of healthy, adult Italian native speakers, all right-handed. We assessed changes in oxy-haemoglobin concentration in temporal, parietal and posterior frontal lobes during a passive listening of bi-syllabic words and vowel-consonant-vowel syllables lasting less then 3 minutes. Activated channels were identified by t tests.
Left hemisphere showed significant activity only during the passive listening of bi-syllabic words. Specifically, the superior temporal gyrus, the supramarginal gyrus and the posterior inferior parietal lobe were activated.
During passive listening of bi-syllabic words, right handed healthy adults showed a significant activation in areas already known to be involved in speech comprehension. Although more research is needed, OT proved to be a promising alternative to the Wada test for non-invasive assessment of hemispheric language lateralization, even if using a particularly brief trial, which has been designed for future applications with non-cooperative subjects.
Medical science monitor: international medical journal of experimental and clinical research 12/2011; 17(12):CR692-7. · 1.70 Impact Factor
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ABSTRACT: Opitz trigonocephaly C syndrome (OTCS) is a rare malformation syndrome with the following features: synostosis of metopic suture, craniofacial abnormalities, severe mental retardation and a multitude of pathological findings affecting almost every organ system. OTCS is associated with a high mortality rate.
We describe the case of a Caucasian male baby who died at five months of age during surgical correction of the craniofacial anomaly.
As previously reported, OTCS may have an increased mortality rate during craniofacial surgery. Careful evaluation of surgery risk-benefit ratio is warranted in such patients.
Journal of Medical Case Reports 06/2011; 5:222.
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The Journal of pediatrics 06/2011; 159(4):699-699.e1. · 4.02 Impact Factor
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MARINA BUSETTI,
LUCIANA GERMANIS,
FULVIO BRADASCHIA,
MARCO CARBONE,
GABRIELLA CLARICH, SERGIO DEMARINI,
STEFANO FURLAN,
ANTONIO GIANNOTTA,
SECONDO GUASCHINO,
STEFANO PENSIERO,
GIUSEPPE RICCI,
FABIO SAVRON,
JURGEN SCHLEEF,
ELISABETTA ZOCCONI,
FEDERICO MARCHETTI
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ABSTRACT: Surgical Site Infection (SSI) is one of the most common healthcare associated infections (HAI). A correct prophylactic administration of antibiotics to surgical patients is able to reduce the incidence of SSI, minimising adverse effects. The selection of the procedures for which prophylaxis is indicated as well as the appropriate type of antimicrobial agent, timing and dosage have to be supported by evidence of effectiveness. The aim of this work is to provide evidence-based procedures for antimicrobial prophylaxis in a hospital with paediatric, obstetrics and gynaecological surgery (IRCCS Burlo Garofolo, Trieste, Italy). The international literature on surgical prophylaxis and local, national and international guidelines have been revised, with particular regard to specific paediatric data and recommendations.
Medico e Bambino 01/2011; 14(7):http://www.medicoebambino.com/?id=IPS1107_10.html.
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ABSTRACT: Although bitter taste has a crucial role in nutrition by preventing the ingestion of toxic foods, there are few studies on bitter taste neuroimaging. To identify cortical areas involved in bitter taste perception and to determine if individual differences in taste sensitivity to 6-n-propylthiouracil (PROP) are represented in the brain by different cortical activation patterns, we examined 48 healthy volunteers using functional near-infrared spectroscopy. Participants rated the perceived intensity of filter paper disks impregnated with PROP and NaCl during the imaging procedure and were then classified as PROP tasters and nontasters. We monitored cortical activity in both the anterior and posterior regions of the dorsolateral prefrontal cortex (DLPFC) and in the ventrolateral prefrontal cortex (VLPFC). No activity was detected in the anterior DLPFC in any of the participants. However, during the administration of PROP, significant cortical activation was detected in the more posterior regions of the left DLPFC and in the left and right VLPFC but only in PROP tasters. PROP nontasters showed no cortical activity in these areas. These data suggest that the prefrontal cortex is involved in the conscious perception of the bitter taste of PROP and that the pattern of activity is consistent with individual differences in the ability to taste this compound. Thus, the PROP phenotype is associated with fundamental differences in cortical taste processing.
Chemical Senses 11/2010; 35(9):801-12. · 2.60 Impact Factor
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Journal of Human Lactation 08/2010; 26(3):233-4. · 1.15 Impact Factor
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ABSTRACT: Defect of the intestinal musculature is a rare condition. It may cause intestinal perforation or obstruction. It manifests itself mainly in the neonatal period and usually affects preterm infants. We describe one such case, which was first diagnosed as a spontaneous isolated intestinal perforation. Emergency laparotomy was performed and showed multiple perforations, with accompanying peritonitis and ascites. Pathologic examination showed partial or complete absence of the musculature, particularly of the inner circular layer, with fibrous tissue in the regions of missing muscle, and abnormal vasculature. The myenteric plexus was absent in areas of muscle loss but present in other sites. These findings suggest that the absence of muscle may not represent a congenital malformation but may be secondary to ischemic injury.
Journal of Pediatric Surgery 08/2010; 45(8):E25-7. · 1.45 Impact Factor
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Journal of pediatric gastroenterology and nutrition 03/2010; 50(3):352-3. · 2.18 Impact Factor
