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ABSTRACT: Aim: INSURE (INtubation, SURfactant, Extubation) is a proven complement of nasal CPAP (nCPAP) for respiratory distress syndrome (RDS) treatment of preterm infants. Early administration is characterized by greater success. We aimed to determine the efficacy and failure or other respiratory outcomes of INSURE administration during nasal continuois positive airway pressure (nCPAP) treatment of RDS. Methods: Among 824 premature infants neonatal intensive care unit (NICU) admitted at Padua University Hospital during 2007-2009, 209 (25.4%) were managed by surfactant replacement (200 mg/kg, Curosurf®) if required >45% oxygen ("rescue" treatment), including 42 (20.1%) during nCPAP. Each premature infant treated with INSURE during nasal CPAP was compared to 2 consecutive control infants treated with surfactant during mechanical ventilation, matched for antenatal steroids, delivery route, gestational age, and sex. Results: Infants with RDS, treated with nCPAP and INSURE-complement (N.=25), were comparable in Apgar score, need of PPV at birth, birth weight, pre-surfactant FiO2 and timing of surfactant replacement to controls. However, nCPAP and INSURE-complement was superior in terms both of oxygenation, evaluated as post-treatment FiO2 (Median, [IQR], 26 [21-40] vs. 21 [21-29]; P=0.03) and (a-A) pO2 (0.48 [0.45-0.60] vs. 0.58 [0.53-0.72]; P=0.03). The improved oxygenation was sustained over the following days. In addition, premature infants treated with nCPAP and INSURE-complement developed less respiratory co-morbidities, including pneumothorax, borncopulmonary disease (BPD), and BPD and death (P=0.04). Conclusion: INSURE-complement of nasal CPAP has a superior efficacy in terms of oxygenation improvement, maintenance of optimal oxygenation, and reduction of respiratory comorbidities respect to "rescue" surfactant administration during mechanical ventilation.
Minerva pediatrica 04/2013; 65(2):187-92.
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Obstetric Anesthesia Digest 08/2011; 31(3):185–186.
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Placenta 04/2011; 32(11):921. · 3.69 Impact Factor
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ABSTRACT: Meconium obstruction has been viewed as a cause of bowel dysfunction and poorer outcome in preterm neonates. This study investigated whether the need of meconium induction over the 7th postnatal day would relate with later bowel habit development. The study was carried out at the Department of Pediatrics, University of Padua, Italy.
This was a prospective study, performed on 80 premature infants, separately analyzed in three subgroups according to the gestational ages (Subgroup A [16]: 23-26/6; Subgroup B [26]: 27/0-30/6; and Subgroup C [38]: 31/0-34/6 weeks), after the induction from 7th day of life of meconium evacuation by saline enema. To evaluate stooling habit development, data on constipation occurrence were obtained via a telephone interview with parents six months after neonatal care.
At the 23-26/6 weeks subgroup A there was a significant increased risk (RR; 95%, CI) of saline enema to induce meconium passage as compared to subgroups B (2.27; 1.11-4.47) and subgroup C (2.28; 1.04-4.94), with a significant P per trend decrease (P<0.05) with increasing gestational age. Even, at six months of life, subgroup A showed a significant increased risk of constipation as compared to subgroups B (3.25; 1.04-9.75) and C (3.73; 1.19-11.63), respectively.
The results of this study indicate that meconium retention over the first week of life is a relatively common features in premature subgroup infants of 23-26/6 weeks of gestation. These premature infants at 6 months of age show a stooling habit characterized by frequent constipation.
Minerva pediatrica 12/2010; 62(6):545-9.
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ABSTRACT: in adults, noninvasive ventilation via a helmet is associated with significantly greater noise than nasal and facial masks. We hypothesized that noise exposure could be increased with neonatal helmet continuous positive airway pressure (CPAP) in comparison with conventional nasal CPAP (nCPAP). Our primary objective was to compare the noise intensity produced by a neonatal helmet CPAP and a conventional nCPAP system. Furthermore, we aimed to evaluate the effect of the gas flow rate and the presence of the humidifier and the filter on noise levels during neonatal helmet CPAP treatment.
in this bench study, noise intensity was measured in the following settings: helmet CPAP, nCPAP, incubator and the neonatal intensive care unit. In helmet CPAP, noise measurements were performed at different gas flow rates (8, 10 and 12 l/min), while in nCPAP, the flow rate was 8 l/min. For both CPAP systems, the level of pressure was maintained constant at 5 cmH(2) O.
during neonatal helmet CPAP, the median (interquartile range) noise levels were significantly higher than those during nCPAP: 70.0 dB (69.9-70.4) vs. 62.7 dB (62.5-63.0); P<0.001. In the helmet CPAP, the noise intensities changed with increasing flow rate and with the presence of a humidifier or a filter.
noise intensities generated by the neonatal helmet CPAP were significantly higher than those registered while using a conventional nCPAP system. In the helmet, the noise intensity depends on the gas flow rate, and the presence of a humidifier and a filter in the system.
Acta Anaesthesiologica Scandinavica 11/2010; 55(1):35-8. · 2.19 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2010; 36(S1):165-166. · 3.01 Impact Factor
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Ultrasound in Obstetrics and Gynecology 10/2010; 36(S1):106-107. · 3.01 Impact Factor
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BJOG An International Journal of Obstetrics & Gynaecology 03/2010; 117(4):497-8. · 3.41 Impact Factor
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ABSTRACT: To evaluate the relationship between the antiphospholipid profile and clinical characteristics of pregnant women with antiphospholipid syndrome (APS) and neonatal outcome.
We retrospectively considered 109 treated pregnancies of 93 patients with primary APS and reviewed the medical records of their 111 infants. Neonatal outcome was assessed using the following variables: weeks of gestational age at delivery, percentiles of birth weight, Apgar score at 5 minutes, need for cardiopulmonary resuscitation in the delivery room, time in the neonatal intensive care unit, infections, and other neonatal complications. Univariate statistical analysis was performed to evaluate the relationship between APS maternal features and neonatal outcome parameters.
When maternal APS features and variables of infant outcome were analyzed, it was evident that lupus anticoagulant (LAC), triple antiphospholipid positivity, and history of vascular thrombosis were significantly associated with some parameters of a poor infant outcome. History of pregnancy morbidity alone was, instead, significantly correlated to the variables of favorable neonatal outcome.
There seems to be more than one kind of pregnant woman with APS. Even when treated with a second-line therapy plan, mothers with LAC and/or triple antiphospholipid positivity and/or previous thromboembolism seem to have a high probability of poor neonatal outcome, whereas those with pregnancy morbidity alone, treated with conventional drugs, seem to have a high probability of favorable outcome.
Arthritis care & research. 03/2010; 62(3):302-7.
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ABSTRACT: In a recent short-term physiological study, we demonstrated a new continuous positive airway pressure (CPAP) system (neonatal helmet-CPAP) that could be a feasible device for managing preterm infants needing continuous distending pressure with better tolerability than nasal-CPAP. However, its application for a long-term period has never been reported in neonates. Here, we describe the use of neonatal helmet-CPAP in a neonate with persistent pulmonary hypertension of the newborn. Twenty minutes after neonatal helmet-CPAP placement, the baseline post-ductal tcSaO2 (66%) and alveolar-arterial gradient O2 improved from 66% and 648 mmHg to 100% and 465 mmHg, respectively. The neonatal helmet-CPAP was applied for 48 hours and was well-tolerated by the patient without complications. Long-term use of neonatal helmet-CPAP appears feasible and well-tolerated. Comparative trials are needed.
Minerva anestesiologica 12/2009; 75(12):750-3. · 2.66 Impact Factor
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ABSTRACT: To evaluate whether histological chorioamnionitis (HCA), in the setting of preterm premature rupture of membranes (PPROM), affects infant respiratory outcome.
A prospective histological study on 287 consecutive placentas was performed in preterm infants (<or=32(+6) weeks gestation), categorised into four groups: according to the presence or absence of HCA, in the setting or in absence of PPROM.
Neonatal intensive care unit, Department of Pediatrics, Padua University, Padua, Italy from January 2001 to December 2006.
Among the 287 NICU admitted preterm infants, 68/287 (23.6%) presented with HCA, 16/68 (23.5%) with a coexisting fetal inflammatory response, and 74/287 (25.7%) with PPROM. HCA was associated with a greater frequency of vaginal delivery (P < 0.0001), lower gestational age (P < 0.0001) and lower birth weight (P < 0.01). HCA had no effect on fetal lung maturation, however, it was a significant risk factor for CLD (RR; 95% CI 2.08; 1.30-3.33). HCA and the fetal inflammatory response were also significant risk factors for PPROM (RR; 95% CI 2.07; 1.42-3.03 and 2.64; 1.71-4.09 respectively). Conversely, HCA in the setting of PPROM failed to reveal any RDS protection or subtype CLD risk. Multivariate analysis demonstrated significant independent effects of presence of maternal HCA (P = 0.04), gestational age (P < 0.0001) and interaction HCA-gestational age (P = 0.04) on CLD development, regardless of the presence of fetal HCA or fetal HCA-gestational age interaction, PPROM or PPROM-gestational age interaction.
Histological chorioamnionitis is a significant PPROM and CLD risk factor, but it fails to provide any protection from RDS. HCA in the setting of PPROM also failed to reveal any RDS protection or subtype CLD risk.
BJOG An International Journal of Obstetrics & Gynaecology 09/2009; 117(1):94-8. · 3.41 Impact Factor
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ABSTRACT: When compared with the Classic laryngeal mask airway (cLMA), the recently introduced ProSeal laryngeal mask airway (PLMA) has modified features to produce higher airway seal pressures and enable ventilation in circumstances where the cLMA might fail. The first neonatal size 1 PLMA recently became available. This study was designed to compare the effectiveness of the size 1 cLMA and PLMA during positive pressure ventilation in anesthetized neonates and infants.
Forty-six consecutive patients undergoing elective cardiac surgical procedures were randomized for initial airway management with the cLMA or PLMA. Insertion time (IT), number of placement attempts, ease of placement, quality of the initial airway, maximum tidal volume (TVmax), and airway pressure at which an audible leak in the mouth (P(leak)) occurred were collected. All data were recorded before performing tracheal intubations.
IT and success rate were similar for both LMAs. The initial quality of the airway was significantly better for the PLMA (P<0.05). TVmax and P(leak) were significantly higher for PLMA (77 vs 58 ml, P<0.02 and 29.8 vs 24.4 cm H2O, P<0.02). No adverse events were recorded during the study.
The size 1 PLMA forms a more effective seal than size 1 cLMA in neonates. This might allow the PLMA to be used in those newborn infants requiring high airway pressures for ventilation.
BJA British Journal of Anaesthesia 06/2009; 103(2):263-7. · 4.24 Impact Factor
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Archives of Disease in Childhood - Fetal and Neonatal Edition 10/2008; 93(5):F396-7. · 3.05 Impact Factor
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Ultrasound in Obstetrics and Gynecology 09/2007; 30(4):381 - 381. · 3.01 Impact Factor
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ABSTRACT: The classic laryngeal mask airway (cLMA) has been demonstrated to be effective for airway management during neonatal resuscitation. However, high airway pressures, when required, cannot be achieved with this device. A neonatal prototype of the LMA-ProSeal (PLMA), which might improve the oropharyngeal leak pressure, has recently been produced. The airway sealing pressures of the cLMA and the PLMA were compared in a neonatal manikin.
A neonatal PLMA and a neonatal cLMA were positioned at random in a neonatal intubation manikin (Neonate Airway Trainer; Laerdal, Norway). A Dräeger pressure controlled ventilator (Dräeger 8000; Dräegerwerk AG, Germany) was connected to the airway tubes and increasing inspiratory pressures (from 10 to 40 cm H2O) of positive pressure ventilation applied. The peak and the mean airway pressures obtained with each device were recorded.
The airway pressures obtained with PLMA were significantly higher than those obtained with cLMA (p < 0.01) at levels of positive pressure ventilation of 25, 30, 35 and 40 cm H2O.
The neonatal PLMA allows higher airway pressure ventilation than the cLMA, in a neonatal intubation manikin. If confirmed clinically, this may have important implications during neonatal resuscitation when high airway pressures are required.
Resuscitation 01/2007; 72(1):124-7. · 3.60 Impact Factor
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ABSTRACT: It is estimated that 3–5% of newborn infants (about 4–7 million infants worldwide annually) require resuscitation at birth,
making this one of the most commonly performed medical interventions [1].
12/2006: pages 377-384;
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Archives of Disease in Childhood - Fetal and Neonatal Edition 12/2006; 91(6):F466. · 3.05 Impact Factor
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International Journal of Gynecology & Obstetrics 11/2006; 95(1):52-3. · 2.05 Impact Factor
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European Journal of Anaesthesiology 06/2006; 23(5):445-6. · 2.23 Impact Factor
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ABSTRACT: Delivery room management of extremely low birthweight infants (ELBWIs) has been little studied. A questionnaire was sent to the heads of the 86 Italian neonatal intensive care units provided with on site delivery. The practice of and approach to the resuscitation of ELBWIs were very different among the centres surveyed, reflecting a paucity of evidence and consequent uncertainty among clinicians.
Archives of Disease in Childhood - Fetal and Neonatal Edition 04/2006; 91(2):F123-4. · 3.05 Impact Factor
