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ABSTRACT: Considering the high frequency of bleeding complications following fibrinolytic treatment in neonates, peripheral nerve blockade (PNB) has been proposed alone or in association with lower doses of tissue plasminogen activator, as a possible new therapeutic approach in the management of neonatal limb ischemia (LI) secondary to vasospasm and/or thrombosis. The present article provides a review of the current knowledge about the topic, in order to evaluate the efficacy and safety of this therapeutic approach. According to the few case reports documented in literature and to our experience, PNB could be considered as valid procedure for the treatment of LI, especially during neonatal period, when the risk of serious bleeding associated with fibrinolytic or anticoagulant therapy is higher. Peripheral nerve blockade resulted in a safe and effective procedure for the treatment of neonatal vascular spasm and thrombosis.
Clinical and Applied Thrombosis/Hemostasis 09/2012; · 1.33 Impact Factor
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Archives of Disease in Childhood - Fetal and Neonatal Edition 09/2012; 97(5):F376. · 3.05 Impact Factor
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European Journal of Pediatric Surgery 07/2012; · 0.81 Impact Factor
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ABSTRACT: We describe a case of neonatal cerebral sinovenous thrombosis associated with the presence of anti-phospholipid antibodies (aPL). We recommend that in all cases of neonatal thrombosis, the couple mother-infant should be extensively tested for the presence of both acquired (aPL) and congenital thrombophilia.
Indian pediatrics 05/2012; 49(5):411-2. · 1.05 Impact Factor
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ABSTRACT: Arterial oxygen saturation (SaO(2)) and partial arterial pressure of carbon dioxide (PaCO(2)) are important respiratory parameters in critically ill neonates. A sensor combining a pulse oximeter with the Stow-Severinghaus electrode, required for the measurement of peripheral oxygen saturation (SpO(2)) and transcutaneous partial pressure of carbon dioxide (PtcCO(2)), respectively, has been recently used in neonatal clinical practice (TOSCA(500Ò)Radiometer). We evaluated TOSCA usability and reliability in the delivery room (DR), throughout three different periods, on term, late-preterm, and preterm neonates. During the first period (period A), 30 healthy term neonates were simultaneously monitored with both TOSCA and a MASIMO pulse oximeter. During the second period (period B), 10 healthy late-preterm neonates were monitored with both TOSCA and a transcutaneous device measuring PtcCO(2) (TINA(Ò) TCM3, Radiometer). During the third period (period C), 15 preterm neonates were monitored with TOSCA and MASIMO after birth, during stabilization, and during transport to the neonatal intensive care unit (NICU). Blood gas analyses were performed to compare transcutaneous and blood gas values. TOSCA resulted easily and safely usable in the DR, allowing reliable noninvasive SaO(2) estimation. Since PtcCO(2) measurements with TOSCA required at least 10 min to be stable and reliable, this parameter was not useful during the early resuscitation immediately after birth. Moreover, PtcCO(2) levels were less precise if compared to the conventional transcutaneous monitoring. However, PtcCO(2) measurement by TOSCA was useful as trend-monitoring after stabilization and during transport to NICU.
Sensors 01/2012; 12(8):10980-9. · 1.74 Impact Factor
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ABSTRACT: To describe a series of ex-preterm infants admitted to pediatric intensive care unit due to impending hypoxaemic respiratory failure complicated by pulmonary hypertension (PH) who were treated electively combining noninvasive ventilation (NIV) and nebulized iloprost (nebILO).
Open uncontrolled observational study.
Pediatric Intensive Care Unit, University Hospital.
Ten formerly preterm infants with impending hypoxaemic respiratory failure and PH, of whom eight had moderate to severe bronchopulmonary dysplasia.
Median age and body weight were 6.0 (2.75-9.50) months and 4.85 (3.32-7.07) kg, respectively. We observed a significant early oxygenation improvement in terms of PaO(2) /FiO(2) increase (P = 0.001) and respiratory rate reduction (P = 0.01). Hemodynamic also improved, as shown by heart rate (P = 0.002) and pulmonary arterial pressure systolic/systolic systemic pressure (PAPs/SSP) ratio reduction (P = 0.0137). NebILO was successfully weaned in positive response cases: 4 infants were discharged on oral sildenafil. Three patients failed noninvasive modality and needed invasive mechanical ventilation; hypoxic-hypercarbic patients were most likely to fail noninvasive approach. Only one patient requiring invasive ventilation died and surviving babies had a satisfactory 1-month post-discharge follow-up. CONCLUSIONS.: The noninvasive approach combining NIV and nebILO for ex-preterm babies with impending respiratory failure and PH resulted to be feasible and quickly achieved significant oxygenation and hemodynamic improvements.
Pediatric Pulmonology 12/2011; 47(8):757-62. · 2.53 Impact Factor
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ABSTRACT: We report the successful and safe use of levosimendan, a new calcium-sensitizing agent with positive inotropic and vasodilatory action, in 2 critically ill term newborns with acute heart failure and pulmonary hypertension in the absence of any underlying heart malformation and/or previous cardiosurgical procedures. During the neonatal period, levosimendan may represent an ideal drug for immature myocardium characterized by a higher calcium-dependent contractility than in adults.
Neonatology 11/2011; 101(3):201-5. · 2.66 Impact Factor
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ABSTRACT: Patent ductus arteriosus (PDA) complicates the clinical course of preterm infants. Nonsteroidal anti-inflammatory drugs, especially Indomethacin and Ibuprofen, have been widely used for both prevention and treatment of PDA. Short-term efficacy of Indomethacin or Ibuprofen is equivalent, while Ibuprofen results show a higher safety profile. Ibuprofen is associated with fewer clinical gastrointestinal and renal side effects with respect to Indomethacin even if subclinical potential effects are reported. When administered as prophylaxis, Ibuprofen has no effects on prevention of intraventricular haemorrhage unlike Indomethacin. Considering the potential adverse effects of both these drugs, a careful monitoring during and after the treatment period is highly recommended.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 07/2011; 24 Suppl 3:10-3. · 1.36 Impact Factor
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ABSTRACT: Hypertensive disorders in pregnancy account for increased perinatal morbidity and mortality when compared to uneventful gestations.
To analyze perinatal outcome of pregnancies complicated by different kinds of hypertension to uncomplicated pregnancies in a series of Italian women and to compare our data with series from other countries.
The sample was divided into four groups of hypertensive women: chronic hypertension (CH), gestational hypertension (GH), preeclampsia (PE), and chronic hypertension complicated by preeclampsia (CHPE). One thousand normal pregnancies served as controls.
Neonatal features of the offspring of 965 Italian women with hypertension in pregnancy were evaluated.
Gestational age, birthweight and the rate of small for gestational age were the outcomes. Perinatal asphyxia and mortality were also assessed.
Gestational age, the mean of birth weight and birth percentile were significantly lower in all groups with hypertensive complications when compared with controls. The rate of very early preterm delivery (<32 weeks) was 7.8% in CH, 5.9% in GH, 21.2% in PE and 37.2% in CHPE while it was to 1.2% in the control group. The rate of SGA was globally 16.2% in CH, 22.8% in GH, 50.7% in PE, 37.2% in CHPE and 5% in controls. The rate of SGA in PE was much higher than reported in series from other countries.
Comparing our data with those reported from other countries, it is evident that the rate of fetal growth restriction in PE we found in our center, is significantly higher even in the presence of a global lower incidence of PE.
Early human development 06/2011; 87(6):445-9. · 2.12 Impact Factor
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Archives of dermatology 04/2011; 147(4):512-4. · 4.76 Impact Factor
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ABSTRACT: Bariatric surgery has become a common therapeutic approach for severe obesity, in case of unsuccessful behavioural and/or medical interventions. During the past years, the number of obese women who underwent bariatric surgery in childbearing age has progressively increased. We report a case of vitamin K deficiency, due to maternal biliopancreatic diversion, resulting in a symptomatic clinical presentation in the mother and in a hypocoagulable state in her neonate.
Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 03/2011; 22(4):334-6. · 1.25 Impact Factor
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ABSTRACT: During the foetal-neonatal period, rhabdomyomas represent the majority of cardiac tumours and are closely associated with tuberous sclerosis. Cardiac rhabdomyomas may be completely asymptomatic and are incidentally discovered during an echocardiogram, or may cause cardiac dysfunctions requiring medical and/or surgical intervention. During foetal life and the early neonatal period, life-threatening conditions, mostly due to arrhythmias, cardiac failure or obstruction, do occur on rare occasions. We reviewed the medical records of all cases of cardiac rhabdomyomas diagnosed prenatally or postnatally over an 8-year period. The present study reviews 7 cases of life-threatening conditions. Arrhythmic episodes were described in 5 patients, and blood flow obstruction was reported in 2 cases. Antiarrhythmic agents successfully controlled the clinical and electrophysiological conditions. Obstructive conditions were associated with poor outcomes. In conclusion, when prenatal diagnosis of rhabdomyoma is made, appropriate planning at delivery for the management of potential haemodynamic complications may prevent adverse neonatal outcomes. The clinical outcome is more influenced by obstructive rather than by dysrhythmic complications. Appropriate antiarrhythmic treatment is of primary importance. In all cases discovered through prenatal and/or neonatal life-threatening conditions, an accurate follow-up should always be performed to anticipate the development of tuberous sclerosis.
Fetal Diagnosis and Therapy 11/2010; 29(2):169-77. · 1.05 Impact Factor
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ABSTRACT: We report a case of hypertrabeculated left ventricular myocardium associated with congenital hypothyroidism in a preterm infant. The myocardical anomalies and long QT interval, absent at birth, appeared simultaneously to abnormal thyroid hormones and progressively improved until complete recovery during Levo-Thyroxine treatment. We speculate that thyroid dysfunction could be the potential cause of transient hypertrabecular aspect of the left ventricle.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 07/2010; 23(7):732-5. · 1.36 Impact Factor
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ABSTRACT: To assess if being small for gestational age impacts parenteral nutrition-associated cholestasis (PNAC) development.
We reviewed all the very low-birth weight infants exposed to parenteral nutrition for >14 days from 1996 to 2006, comparing auxological and clinical data, as well as nutritional history, during the first 4 weeks of life of infants with cholestasis and control subjects.
Of 445 very low-birth weight infants, 55 had development of PNAC. Infants with cholestasis had lower birth weight and gestational age but similar birth weight z-score compared with infants without cholestasis, and they received a lower amount of enteral feeds (25.8 +/- 20.7 vs 67.9 +/- 33.0 mL/kg, P < .001), a greater amount of intravenous glucose (10.6 +/- 1.3 vs 7.5 +/- 2.5 g/kg, P < .0001), lipids (1.8 +/- 0.4 vs 1.3 +/- 0.5, P < .0001) and proteins (2.7 +/- 0.5 vs 1.9 +/- 0.7, P < .0001), and needed a higher number of days of fasting (13.2 +/- 6.7 vs 6.5 +/- 4.8, P < .001). Enteral intake between 0 and 21 days of life (OR 0.66; 95% CI 0.53, 0.81, P < .0001) and oxygen therapy (OR 1.05; 95% CI 1.01, 1.09; P = .030) were identified as the best independent predictors of PNAC.
Enteral feeding remains the main factor for the prevention of PNAC, whereas small for gestational age infants do not have a higher risk of PNAC.
The Journal of pediatrics 04/2010; 156(4):575-9. · 4.02 Impact Factor
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ABSTRACT: INTRODUCTION: Limbs ischaemia represents a rare event during the neonatal period. The present paper reports an unusual case of precocious arm ischemia that occurred immediately after birth and successfully treated with a peripheral nerve blockade. CONCLUSIONS: Peripheral nerve blockade resulted in an effective and safe therapeutic approach able to allow the salvaging of the limbs.
European Journal of Pediatrics 03/2010; 169(10):1267-9. · 1.88 Impact Factor
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Antonio Alberto Zuppa,
Paola Sindico,
Sabrina Perrone,
Chiara Carducci,
Eleonora Antichi,
Giovanni Alighieri,
Francesco Cota,
Patrizia Papacci, Maria Pia De Carolis,
Costantino Romagnoli,
Valentina Cardiello
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ABSTRACT: We describe three different fetal or neonatal outcomes in the offspring of a mother who had persistent circulating thyrotropin receptor antibodies despite having undergone a total thyroidectomy several years before.
The three different outcomes were an intrauterine death, a mild and transient fetal and neonatal hyperthyroidism and a severe fetal and neonatal hyperthyroidism that required specific therapy.
The three cases are interesting because of the different outcomes, the absence of a direct correlation between thyrotropin receptor antibody levels and clinical signs, and the persistence of thyrotropin receptor antibodies several years after a total thyroidectomy.
Journal of Medical Case Reports 02/2010; 4:59.
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ABSTRACT: The authors report a case of minimal prenatal trauma producing a large subdural hematoma in the fetus, which was diagnosed in utero by MR imaging. The occurrence of such a complication is extremely rare in the absence of significant maternal trauma. Prenatally diagnosed intracranial hemorrhages, particularly those that are subdural in origin, have a poor prognosis in most cases. After birth, brain compression required a complex neurosurgical intervention because simple hematoma evacuation was not possible. The clinical and neurological outcome at 6 months was excellent, as confirmed by the neuroimaging findings.
Journal of Neurosurgery Pediatrics 12/2009; 4(6):543-6. · 1.53 Impact Factor
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ABSTRACT: The aim of this study was to investigate whether ibuprofen exposure was associated with increased hyperbilirubinemia in preterm infants.
Since 2000, ibuprofen has been administered to all infants at <30 weeks of gestation who are admitted to our unit, to prevent patent ductus arteriosus. We retrospectively compared data for 418 infants subjected to ibuprofen prophylaxis (2000-2007) and 288 infants not exposed to ibuprofen (1993-1999).
The ibuprofen group had a significantly higher peak total serum bilirubin level (9.0 +/- 2.5 mg/dL vs 7.3 +/- 3.3 mg/dL), more need for phototherapy (398 infants [95%] vs 254 infants [87.6%]), and a longer phototherapy duration (94.3 +/- 43.6 hours vs 87.2 +/- 38.6 hours). Groups did not differ with respect to gestational age, birth weight, gender ratio, glucose-6-phosphate dehydrogenase deficiency incidence, or hypoalbuminemia (<2.5 g/dL) incidence. Hemolytic isoimmunization was diagnosed with similar incidences (no-ibuprofen group: 7 of 288 infants; ibuprofen group: 8 of 418 infants). The rates of exchange-transfusion also were similar between the groups (no-ibuprofen group: 14 infants [4.8%]; ibuprofen group: 19 infants [4.5%]).
Ibuprofen administration was associated with higher peak total serum bilirubin levels, and the more-pronounced hyperbilirubinemia led to longer phototherapy. The potential role of competition between ibuprofen and bilirubin in the hepatic glucuronidation pathway is discussed.
PEDIATRICS 08/2009; 124(2):480-4. · 4.47 Impact Factor
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ABSTRACT: Secrecy and anonymity related to heterologous assisted reproduction may hide basic newborn data to neonatologists. Secrecy and anonymity are discussed in view of their possible consequences on relational dynamics and on developmental psychology. Nevertheless, they can also involve the offspring's genetic status regarding inheritable diseases. International guidelines have been recently published on this topic. Because no guidelines are ‘ideal’ unfortunate and possibly dramatic consequences can occur. We aimed to embark on a debate about this matter starting with a real clinical experience. In our case a rarely fatal but widespread disease, together with the lack of knowledge about parental status led, in a fast succession of clinical events, to the unavoidable insurgence of kernicterus.
07/2009; 21(4):219-222.
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Daniela Ricci,
Laura Cesarini,
Domenico M M Romeo,
Francesca Gallini,
Francesca Serrao,
Michela Groppo,
Agnese De Carli,
Francesco Cota,
Domenico Lepore,
Fernando Molle,
Roberto Ratiglia, Maria Pia De Carolis,
Fabio Mosca,
Costantino Romagnoli,
Francesco Guzzetta,
Frances Cowan,
Luca A Ramenghi,
Eugenio Mercuri
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ABSTRACT: The objectives of this study were to (1) assess visual function in low-risk preterm infants at 35 and 40 weeks' postmenstrual age, (2) compare preterm visual abilities at term-equivalent age with term-born infants, and (3) evaluate effects of preterm extrauterine life on early visual function.
Visual function was assessed by using a validated test battery at 35 and 40 weeks' postmenstrual age in 109 low-risk preterm infants who were born at <31 weeks' gestation. The preterm findings were compared with data from term-born infants collected by using the same test protocol.
All preterm infants completed both assessments. The 35-week responses were generally less mature than those at 40 weeks. Preterm infants at both ages were significantly more mature than term-born infants for ocular movements and vertical and arc tracking and at 40 weeks for stripe discrimination. In contrast, tracking a colored stimulus, attention at distance, and stripe discrimination were more mature at term age (in both term-born and preterm infants) than at 35 weeks.
Our findings provide data for visual function at 35 and 40 weeks' postmenstrual age in low-risk preterm infants. The results suggest that early extrauterine experience may accelerate the maturation of aspects of visual function related to ocular stability and tracking but does not seem to affect other aspects that may be more cortically mediated.
PEDIATRICS 01/2009; 122(6):e1193-8. · 4.47 Impact Factor
