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ABSTRACT: OBJECTIVES:: To compare the effects of continuous and intermittent bolus milk feeding on splanchnic oxygenation (rSO2S) in small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants. METHODS:: Infants with gestational age < 32 weeks were prospectively studied by near infrared spectroscopy (NIRS). Each infant were given a milk bolus in ∼10 minutes (intermittent feeding) followed after 3 hours by a 3-hour continuous feeding. rO2S and splanchnic fractional oxygen extraction ratio (FOES) were recorded 30 minutes before (T0) and 30 minutes after the beginning of bolus feeding (T1), 30 minutes before (T2), at the end (T3), and 30 minutes after the continuous feeding period (T4). RESULTS:: rSO2S increased at T1 in both AGA and SGA groups, while FOES did not vary during the study period. Moreover, we found that rSO2S was higher and FOES was lower at T1 and T3 in the AGA than in the SGA group. CONCLUSIONS:: Bolus milk feeding increases splanchnic oxygenation in both AGA and SGA infants, while continuous feeding does not. Splanchnic oxygenation is higher in AGA than in SGA infants both during bolus and continuous feeding. Continuous enteral feeding could help to limit the risk of hypoxic-ischemic gut damage in preterm infants in critical condition, especially in AGA infants.
Journal of pediatric gastroenterology and nutrition 01/2013; · 2.18 Impact Factor
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ABSTRACT: We carried out a survey of current practices of neonatal respiratory support in neonatal intensive care units (NICUs) in Italy with the aim of comparing the current reality with evidence from the literature. We sent a questionnaire by email to the 103 level III neonatal units in Italy. There was a 61 % (73/120) response rate to the questionnaire. We found that synchronized intermittent positive pressure ventilation is mostly used in infants in the acute phase of respiratory distress syndrome (RDS), while the majority of the units prefer volume-targeted ventilation for those in the weaning phase. Nasal continuous positive airway pressure is the most commonly used non-invasive mode of respiratory support, both in the acute and post-extubation phase of RDS. Surfactant is mainly given as rescue treatment. Infants receive caffeine before extubation and analgesia under mechanical ventilation, while post-natal steroids are given after the first week of life in the majority of the units. In conclusion, respiratory support strategies in Italian NICUs are frequently evidence-based. However, since there are areas where this does not occur, we suggest that focused interventions take place on these areas to help improve clinical practice and increase their adherence to evidence-based medical criteria.
European Journal of Pediatrics 11/2012; · 1.88 Impact Factor
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ABSTRACT: Abstract Objectives: Our aim was to assess whether non-invasive ventilation with heliox may decrease the incidence of extubation failure in preterm infants with RDS. Methods: Infants <29 weeks of gestation were treated immediately after extubation with heliox combined with nasal continuous airway pressure (Hx-NCPAP) or bilevel NCPAP (Hx-BiPAP) for 24 hours, while infants in the control groups were treated with conventional NCPAP or BiPAP. The primary endpoint was the comparison of the extubation failure rate in the two groups, where failure was defined as the need for MV during the 24h following extubation. Results: Eighteen infants were assigned to the heliox group and 18 to the control group. The extubation failure rate was similar (p=0.249) in the heliox (n=6; 33%) and in the control group (n=9; 50%), but required mean airway pressure (MAP: 4.0±1.0 vs. 4.8±1.2 cm H(2)O; p=0.037) and PaCO(2) (39±8 vs. 52±7 mmHg; p<0.001) at 24 h of treatment were lower in the heliox group. Conclusions: Non-invasive ventilation with heliox was not effective in decreasing extubation failure in preterm infants with RDS, but did improve their respiratory function. Our findings might support the planning of large randomized controlled studies to evaluate the effectiveness of heliox non-invasive ventilation for decreasing extubation failure in premature infants.
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 11/2012; · 1.36 Impact Factor
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ABSTRACT: Although the management of respiratory distress syndrome (RDS) in preterm infants has been characterized by significant progress in recent years, it is difficult to translate the research results into clinical practice. Previous surveys have demonstrated that in some areas, the current management of RDS does not reflect evidence from randomized trials. Therefore, the Pulmonology Study Group of the Italian Society of Neonatology decided to perform a similar survey in Italy with the aim of identifying possible aspects of respiratory management of preterm infants with RDS that merit improvement, and of suggesting focused interventions for their resolution.
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 10/2012; 25 Suppl 4:58-9. · 1.36 Impact Factor
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ABSTRACT: Aim: to monitor the incidence of cases of kernicterus and severe hyperbilirubinemia in Italy over time, and to describe each single registered event with sufficient information in order to identify one or more possible failures in the management of jaundice. Methods: the Task Force on hyperbilirubinemia of the Italian Society of Neonatology will draw up national guidelines for management of jaundice in the newborn and a national registry of kernicterus and hyperbilirubinemia for newborns with a gestational age greater than 34. Results and Conclusions: the choice of the inclusion criteria for the registry and the minimum information necessary to describe each single event registered are reported and will be discussed at the national congress of the Italian Society of Neonatology next October 2012.
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 10/2012; 25 Suppl 4:110-2. · 1.36 Impact Factor
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ABSTRACT: It has been reported that low platelet count may increase the risk of patent ductus arteriosus (PDA) in preterm infants. Moreover, high mean platelet volume (MPV) has been found to be associated with the development of prematurity complications due to enhanced platelet reactivity. Our aim was to assess the relationship between platelet count and MPV and the occurrence of PDA and its resistance to ibuprofen closure in a cohort of extremely preterm infants. Platelet count <100 (×103/mm3; odds ratio 4.50; 95% confidence limits 1.39 to 14.61) at birth is an independent risk factor for PDA but does not affect its response to ibuprofen. MPV values did not influence PDA fate. Low platelet count increases the risk of developing a hemodynamically significant PDA but does not affect the ibuprofen closure rate. MPV is unrelated to the DA outcome.
American Journal of Perinatology 08/2012; · 1.32 Impact Factor
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ABSTRACT: OBJECTIVE: The present study aims to assess if use of a silver zeolite-impregnated umbilical catheter (AgION technology) can decrease the occurrence of catheter-related bloodstream infection (CRBSIs) in preterm infants. STUDY DESIGN: Infants with gestational age<30weeks were randomized to receive an AgION impregnated or non-impregnated polyurethane umbilical venous catheter (UVC). The primary endpoint was the incidence of CRBSIs during the time the UVC was in place. RESULTS: We studied 86 infants, 41 of whom received the AgION catheter and 45 the non-impregnated catheter. During umbilical venous catheterization 2% of infants in the AgION group developed CRBSI in comparison with 22% of infants in the control group (p=0.005). AgION catheters were well tolerated and none of the patients showed signs attributable to silver toxicity. CONCLUSIONS: The AgION-impregnated UVCs were effective in decreasing the development of CRBSIs in preterm infants compared to non-impregnated polyurethane UVCs.
Early human development 07/2012; · 2.12 Impact Factor
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ABSTRACT: Objectives: Laser therapy is effective in the treatment of severe forms of retinopathy of prematurity (ROP), and aggressive posterior ROP (APROP), but always damages the retina. We report our preliminary findings in seven premature infants with complicated ROP or APROP who were treated with intravitreal bevacizumab (IVB) as first line monotherapy or rescue therapy combined with laser treatment. Methods: We studied retrospectively seven preterm infants, who were affected by APROP (n = 4) or pre-threshold ROP (n = 3). Infants were treated with IVB (0.625 mg; Avastin®, Roche, Basel, Switzerland) monotherapy (n = 2) when they were too sick to undergo lengthy laser treatment. Results: Monotherapy IVB (n = 3 eyes) and IVB combined with laser therapy (n = 3 eyes) of APROP cases were followed by regression of the ROP and complete peripheral vascularization. The combined therapy with IVB and laser therapy of pre-threshold ROP (5 eyes) produced a regression of neovascularization and good retinal anatomical outcome. Conclusions: In our series, IVB was successful in treating ROP in a small cohort of extremely preterm infants with APROP or pre-threshold ROP, both as monotherapy or rescue treatment after laser therapy, without the development of ocular and systemic short- and long-term adverse effects.
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 04/2012; 25(11):2194-7. · 1.36 Impact Factor
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ABSTRACT: The INSURE method, which consists of an intubation-surfactant-extubation sequence, is effective in reducing the need for mechanical ventilation (MV), the duration of respiratory support, and the need for surfactant replacement in preterm infants with respiratory distress syndrome. Although beneficial, the INSURE method fails to avoid MV in selected patients. We demonstrated that body weight <750 g, pO(2)/FiO(2) <218, and a/ApO(2) <0.44 at the first blood gas analysis are independent risk factors for INSURE failure in infants with gestational age <30 weeks. Moreover, we demonstrated that the INSURE treatment can be safely repeated with the aim to avoid MV, since the respiratory outcome did not differ between infants treated with single or multiple INSURE procedures.
Early human development 01/2012; 88 Suppl 1:S3-4. · 2.12 Impact Factor
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Carlo Dani,
Ilaria Lori,
Federica Favelli,
Saverio Frosini,
Hubert Messner,
Petra Wanker,
Sergio De Marini,
Chiara Oretti,
Antonio Boldrini,
Ciantelli Massimiliano,
Patrizia Bragetti,
Cristiana Germini
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ABSTRACT: Lutein and its isomer zeaxanthin (L/Z) function in the eye as antioxidant agents and blue-light filters. Our aim was to evaluate whether their administration could help decrease the occurrence of retinopathy of prematurity (ROP) in preterm infants.
Infants with gestational age ≤32 weeks were randomly assigned to receive a daily dose of L/Z (0.14 + 0.006 mg) or placebo until discharge.
ROP occurrence was similar in the L/Z (11/58; 19%) and placebo (15/56; 27%) groups, as the occurrence of ROP at each stage and the need of eye surgery.
L/Z supplementation was ineffective in preventing ROP in preterm infants and did not affect the outcome at discharge of our patients.
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 11/2011; 25(5):523-7. · 1.36 Impact Factor
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Carlo Dani
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 11/2011; 24 Suppl 3:1. · 1.36 Impact Factor
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Carlo Dani
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ABSTRACT: In the present manuscript we will focus our attention on the drug choice and its dosage.some studies suggest that the failure of pharmacologic pda closure might be due to the inadequacy of the standard dose regimen, because of large interindividual pharmacokinetics and pharmacodynamic variations in premature infants. we discuss the possibility that the early treatment of pda with ibuprofen doses higher than those actually recommended might increase the closure rate in preterm infants.
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 10/2011; 24 Suppl 1:32-3. · 1.36 Impact Factor
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Carlo Dani
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ABSTRACT: A high percentage of preterm infants fails to respond to a single course of indomethacin or ibuprofen. Thus, it has been suggested that the actual dose regimens of these drugs could be inadequate because of large interindividual pharmacokinetics variations in premature infants. We tested the hypothesis that a high-dose regimen of ibuprofen was more effective than the current regimen in closing PDA. We demonstrated that a single course of ibuprofen at 20-10-10 mg/kg/day is more effective than a 10-5-5 mg/kg/day course in closing PDA without significant adverse effects. Many other questions regarding the pharmacological treatment of PDA are still debated.
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 08/2011; 24 Suppl 3:5-6. · 1.36 Impact Factor
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ABSTRACT: Our aim was to evaluate whether single and multiple intubation-surfactant-extubation (INSURE) procedures have similar effects on the need of mechanical ventilation (MV) and occurrence of bronchopulmonary dysplasia (BPD) in extremely preterm infants.
We studied infants of <30 weeks of gestation with respiratory distress syndrome (RDS) who were treated with single (FiO(2)>0.30 without need of MV) or multiple (FiO(2)>0.40 without need of MV) INSURE procedures.
Seventy-five infants were studied: 53 (71%) received single INSURE and 22 (29%) received multiple INSURE procedures. Infants in the single and multiple groups had similar rates of need of MV (15 vs. 23%) and occurrence of BPD (9 vs. 9%), although the latter were more immature and affected by more severe RDS (higher FiO(2), lower a/ApO(2), and pO(2)/FiO(2)) than the former.
Single and multiple INSURE procedures were followed by similar respiratory outcome in a cohort of extremely preterm infants. Further studies are warranted to evaluate whether the multiple INSURE strategy enhances the success rate of INSURE in preventing the need of MV and the occurrence of BPD.
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 04/2011; 24(12):1427-31. · 1.36 Impact Factor
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ABSTRACT: The possible correlation between the mean platelet volume (MPV) and the occurrence of bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH) in a cohort of preterm infants was assessed. We studied infants with gestational age <30 weeks. Enrolled infants were divided into BPD and no-BPD groups and IVH and no-IVH groups. MPV was evaluated at birth and at 24 to 48 hours of life. MPV measured at birth was similar in BPD and no-BPD groups, but at 24 to 48 hours of life was higher in the BPD than in the no-BPD group (11.1 ± 0.9 versus 10.8 ± 0.9 fL, P = 0.033) and multivariate analysis demonstrated that MPV >11 fL increases (relative risk 1.40, 95% confidence interval 1.08 to 1.80) the risk of developing BPD. MPV was similar in infants with or without IVH. We concluded that high MPV in the first days of life is a risk factor for the development of BPD in extremely preterm infants. This might be because high MPV could favor inflammatory and oxidative lung damage. On the contrary, our data indicate that MPV is not associated with the development of IVH in our population.
American Journal of Perinatology 03/2011; 28(7):551-6. · 1.32 Impact Factor
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ABSTRACT: To assess the current practices existing in Italy for the management of jaundice in preterm infants as preliminary achievement to a call for national guidelines and establishment of a kernicterus registry.
A questionnaire (in Supporting Information online) was sent to the 109 level III neonatal units in Italy to ascertain existing guidelines for total bilirubin monitoring and treatment of hyperbilirubinaemia in preterm infants and occurrence of kernicterus.
There was a 61% (67/109) response rate. Eighty-five per cent of responding units had either written guidelines coming from different literature sources or locally developed. The monitoring of bilirubin varied greatly in timing before, during and after jaundice development. Phototherapy and exchange transfusion were given to 56.0 ± 21.0% and 0.2 ± 0.4% of admitted preterm infants in participating centres. Five cases of kernicterus in preterm infants and eleven cases in term infants were documented over the last 10 years.
The management of hyperbilirubinaemia in preterm infants is not uniform in Italy and would benefit from shared national guidance together with establishment of a kernicterus registry to guide therapy.
Acta Paediatrica 02/2011; 100(5):666-9. · 2.07 Impact Factor
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ABSTRACT: Natural surfactant combined with beclomethasone decreases pulmonary oxidative stress in preterm lambs with respiratory distress syndrome (RDS).
To test the hypothesis that this occurs through a decrease in pulmonary inflammation.
Preterm lambs received 200 mg/kg of natural surfactant or 200 mg/kg of natural surfactant combined with 400 or 800 μg/kg of beclomethasone. Interleukin 8 (IL-8) and macrophage migration inhibitory factor (MIF) were assayed in bronchial aspirate samples and lung mechanics were evaluated.
IL-8 increased in all the groups, but the increase was lower in the groups treated with surfactant plus 400 and 800 μg/kg of beclomethasone. MIF decreased in the surfactant group, did not vary in the surfactant plus 400 μg/kg beclomethasone group, and decreased in the surfactant plus 800 μg/kg beclomethasone group. MIF concentration was higher in the surfactant plus 800 μg/kg beclomethasone group than in the other groups.
Natural surfactant combined with beclomethasone at 800 μg/kg is effective in reducing lung inflammation in an animal model of RDS, thus explaining the associated decrease in lung oxidative stress. The increase in MIF in animals treated with surfactant plus 800 μg/kg of beclomethasone might be an important maturative and protective factor for neonatal lungs.
Respiration 01/2011; 82(4):369-76. · 2.26 Impact Factor
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ABSTRACT: Sustained lung inflation (SLI) applied at birth has been demonstrated to lead to clearance of lung fluid and achievement of a precocious functional residual capacity in animal studies.
To verify if the application of SLI in preterm infants at birth may reduce the need for mechanical ventilation and improve their respiratory outcome.
We prospectively studied 89 infants with respiratory distress (gestational age (GA) 28.1 ± 2.2 weeks) treated at birth with a SLI (25 cm H(2)O, sustained for 15 s) in addition to AAP recommendations versus a historical control group (n = 119; GA 28.1 ± 2.0 weeks) treated without SLI with the same device (controlled positive end-expiratory pressure of 5 cm H(2)O).
The SLI group had less need for (51 vs. 76%, p < 0.0001) and shorter duration of mechanical ventilation (5 ± 11 vs. 11 ± 19 days, p = 0.008), a more frequent occurrence of exclusive nasal continuous airway pressure support (49 vs. 24%, p < 0.0001) and INtubation-SURfactant-Extubation (INSURE) treatment (16 vs. 3%, p = 0.01), less need for surfactant (45 vs. 61%, p = 0.027) and postnatal steroids (10 vs. 25%, p = 0.01), a shorter duration of oxygen therapy (21 ± 27 vs. 31 ± 31 days, p = 0.016), and, finally, a lower occurrence of bronchopulmonary dysplasia in survivors (7 vs. 25%, p = 0.004). Multiple regression analysis showed that 23-27 weeks of GA and birth weight <750 g increased the risk of mechanical ventilation, while a clinical risk index for babies (CRIB) score <3 as well as INSURE strategy and SLI treatment in the delivery room decreased it.
The application of a SLI at birth in preterm infants with respiratory distress may decrease the need for mechanical ventilation without inducing evident adverse effects.
Neonatology 01/2011; 99(1):45-50. · 2.66 Impact Factor
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ABSTRACT: Multiprobe near infrared spectroscopy (NIRS) has been used to study regional cerebral (rSO(2)C), splanchnic (rSO(2)S), and renal (rSO(2)R) tissue oxygenation in newborns. We used this method to study the effects of red blood cell (RBC) transfusions in anemic preterm infants to assess if thresholds for transfusions were appropriate for recognizing a clinical condition permitting tissue oxygenation improvement.
Multiprobe NIRS (INVOS 5100, Somanetics) was applied during transfusion to 15 preterm infants with symptomatic anemia of prematurity (hematocrit level of <25%). rSO(2)C, rSO(2)S, and rSO(2)R were recorded at selected times, and then fractional oxygen cerebral extraction ratio [FOEC: (SaO(2)-rSO(2)C)/SaO(2)], fractional oxygen splanchnic extraction ratio [FOES: (SaO(2)-rSO(2)S)/SaO(2)], fractional oxygen renal extraction ratio [FOER: (SaO(2)-rSO(2)R)/SaO(2)], cerebrosplanchnic oxygenation ratio [CSOR: (rSO(2)S/rSO(2)C)], and cerebrorenal oxygenation ratio [CROR: (rSO(2)R/rSO(2)C)] were calculated. In addition, we used Doppler ultrasonography for evaluating cerebral blood flow (CBF), splanchnic blood flow (SBF), and renal blood flow (RBF) velocity.
rSO(2)C, rSO(2)S, and rSO(2)R significantly increased during transfusions, while FOEC, FOES, and FOER decreased. CSOR and CROR increased during transfusions. CBF velocity decreased during the study period, while SBF and RBF velocities did not vary.
RBC transfusions performed at used thresholds permitted an increase in cerebral, splanchnic, and renal oxygenation. The associated decreases in oxygen tissue extraction might suggest that transfusions were well timed for preventing tissue hypoxia or too early and theoretically prooxidant. Further studies could help to clarify this issue.
Transfusion 06/2010; 50(6):1220-6. · 3.22 Impact Factor
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ABSTRACT: It has been reported that caesarean delivery (CD) protects against intraventricular haemorrhage (IVH) in the extremely preterm infant, but it is not known whether this effect involve the more severe grades of IVH. Thus, our aim was to confirm the correlation between the occurrence of IVH and the mode of delivery, and to evaluate this correlation for each grade of IVH.
All infants with gestational age (GA) ≤ 28 weeks admitted to the neonatal intensive care unit of a tertiary hospital were studied for each grade IVH and major complications rate.
We found that vaginally born infants had a higher rate of each grade of IVH, but the increase was statistically significant only for grade 3 IVH (18% vs. 2%, p < 0.0001) and all grades IVH (45% vs. 20%, p < 0.0001). Multivariate analysis demonstrated that CD (RR: 0.42, 95% CI 0.28-0.63), birth weight ≥ 800 g (RR: 0.48, 95% CI 0.32-0.73), 27-28 weeks of GA (RR: 0.38, 95% CI 0.25-0.60) and antenatal steroids (0.66, 95% CI 0.22-0.46) decrease independently the risk of developing IVH.
Our study demonstrates that CD decreases the risk of developing IVH in extremely preterm infants including the most severe grades of IVH.
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 03/2010; 23(12):1419-23. · 1.36 Impact Factor
