[Show abstract][Hide abstract] ABSTRACT: Background Although life-saving, intubation and mechanical ventilation can lead to complications including bronchopulmonary dysplasia (BPD). In order to reduce the incidence of BPD, non-invasive ventilation (NIV) is increasingly used.
Objective The aim of our study was to describe changes in ventilator strategies and outcomes between 2006 and 2010 in the Italian Neonatal Network (INN).
Design Multicentre cohort study.
Settings 31 tertiary level neonatal units participating in INN in 2006 and 2010.
Patients 2465 preterm infants 23–30 weeks gestational age (GA) without congenital anomalies.
Main outcomes measures Death, BPD and other variables defined according to Vermont Oxford Network. Logistic regressions, adjusting for confounders and clustering for hospitals, were used.
Results Similar numbers of infants were studied between 2006 and 2010 (1234 in 2006 and 1231 in 2010). The baseline risk of populations studied (GA, birth weight and Vermont Oxford Network Risk-Adjustment score) did not change. After adjusting for confounding variables, infants receiving invasive mechanical ventilation decreased (OR=0.72, 95% CI 0.58 to 0.89) while NIV increased (OR=1.75, 95% CI 1.39 to 2.21); intubation in delivery room decreased (OR=0.64, 95% CI 0.51 to 0.79). Considering outcomes, there was a significant reduction in mortality (OR=0.73, 95% CI 0.55 to 0.96) and in the combined outcome mortality or BPD (OR=0.76, 95% CI 0.62 to 0.94).
Conclusions Despite a stable baseline risk, from 2006 to 2010, we observed a lower level of invasiveness, a reduction of mechanical ventilation and an increase of NIV use, and this was accompanied by a decrease in risk-adjusted mortality and BPD.
Archives of Disease in Childhood - Fetal and Neonatal Edition 07/2014; 99(4):F321-4. DOI:10.1136/archdischild-2013-305165 · 3.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the past two decades exogenous surfactant administration has been a cornerstone of therapy for preterm infants and is known to be effective either given prophylactically in the delivery room or later as selective therapy to infants with estabilished respiratory distress syndrome. Its introduction in neonatal practice in the early 90s was followed by a significant decrease in overall neonatal mortality. With the evolution and refinement of intensive care for preterm infants, the role of exogenous surfactant therapy is changing. The more widespread use of nasal continuous positive airway pressure (n-CPAP) as a primary mode of respiratory support means that many preterm infants now avoid intubation in the delivery room or in early post-natal life. Still, about 50% of them, will require intubation for surfactant delivery for evolving respiratory distress syndrome (RDS) during the course of hospitalization. In view of the difficulties and side effects that may be associated with intubation for surfactant delivery, less invasive ways of surfactant administration have been pursued. The rationale and the available evidences inherent the administration of surfactant via a thin endotracheal catheter during spontaneous breathing will be discussed.
[Show abstract][Hide abstract] ABSTRACT: The establishment of the Italian Pediatric Federation Newborn Hearing Screening Network and the Italian Society of Neonatology Infant Hearing Study Group is the result of an international collaboration between Parents and Medical Professionals in order to promote an effective model in developing Early Hearing Detection Intervention Programs that recognize the role of parents as partners in the process. Among other factors, one important component frequently underestimated in most early intervention programs, both in the USA and other countries, involves the role of parental involvement within the Early Hearing Detection Intervention (EHDI) process. When a parent receives the news of their child's hearing loss, reactions may include, but are not limited to denial, grief, guilt, shame, fear and impotency. A parent may begin to ask certain questions: How do we know if the professionals in our children's lives are capable, educated, trained, up to date in their chosen fields of expertise? Do they respect our children and us as parents? Do they understand the needs of children who are deaf or hard of hearing? A life-long health professional - parental collaboration begins at the moment of the diagnosis of that child. When analyzing the habilitation process of a deaf child, the relationship between health professionals and the crucial role of parents in raising that child is a 50-50 shared responsibility. An objective of EHDI programs must be to empower parents by providing support from the beginning of the process. Distributing informative literature regarding the newborn hearing screening process and providing parents with access to resources such as parental support groups upon diagnosis equips parents with the tools necessary to immediately begin advocating for their children. The Italian Federation Pediatric Audiology Network was created by combining the parental perspective and medical protocols in order to establish the roots for stronger EHDI programs.
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(S4):106-7. DOI:10.3109/14767058.2012.715016 · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim: To evaluate the relationship between arterial saturation values determined by pulse oximetry in the first weeks of life on the incidence of retinopathy of prematurity (ROP). Methods: Randomized and observational studies were sought that compare the incidence of ROP in babies with high or low oxygen saturation targeting assisted by pulse oximetry. Results: Over the last 15 years, evidence from experimental models of ROP and clinical studies, albeit not randomized trials, has shown a reduction in the incidence of ROP and other neonatal morbidities when very preterm newborns were targeted to a lower level of arterial oxygen saturation during their hospitalization, particularly in the first few weeks after birth. More recent evidence from randomized controlled trials confirms that targeting to a lower vs higher level of oxygenation from birth to 36 weeks postmenstrual age (PMA) or to hospital discharge reduces the incidence of ROP requiring treatment by 50% but is correlated with higher mortality rates. Conclusion: Future randomized, controlled trials should be designed including a cohort of infants in which a more dynamic approach to saturation targeting is adopted, i.e. lower saturation levels in the first few weeks of life and higher saturation levels after the 32 weeks of PMA.
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(S4):100-2. DOI:10.3109/14767058.2012.714982 · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The organization of perinatal care has been a pivotal mean for improvement in neonatal survivals. Despite the excellent standard of assistance in Lombardy, Obstetrics and Neonatal Units of MBBM Foundation-Monza, Manzoni Hospital-Lecco and Niguarda Hospital-Milan put forward a pilot project proposing reorganization of perinatal care in the northern part of Lombardy. The main goals of the project are implementation of maternal transport system and use of neonatal back transport as a system to increase the availability of intensive care beds. The project's fundamental steps and critical points will be discussed.
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(S1):122-5. DOI:10.3109/14767058.2011.607670 · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Early surfactant followed by extubation to nasal continuous positive airway pressure (nCPAP) compared with later surfactant and mechanical ventilation (MV) reduce the need for MV, air leaks, and bronchopulmonary dysplasia. This randomized, controlled trial investigated whether prophylactic surfactant followed by nCPAP compared with early nCPAP application with early selective surfactant would reduce the need for MV in the first 5 days of life.
A total of 208 inborn infants who were born at 25 to 28 weeks' gestation and were not intubated at birth were randomly assigned to prophylactic surfactant or nCPAP within 30 minutes of birth. Outcomes were assessed within the first 5 days of life and until death or discharge of the infants from hospital.
Thirty-three (31.4%) infants in the prophylactic surfactant group needed MV in the first 5 days of life compared with 34 (33.0%) in the nCPAP group (risk ratio: 0.95 [95% confidence interval: 0.64-1.41]; P = .80). Death and type of survival at 28 days of life and 36 weeks' postmenstrual age and incidence of main morbidities of prematurity (secondary outcomes) were similar in the 2 groups. A total of 78.1% of infants in the prophylactic surfactant group and 78.6% in the nCPAP group survived in room air at 36 weeks' postmenstrual age.
Prophylactic surfactant was not superior to nCPAP and early selective surfactant in decreasing the need for MV in the first 5 days of life and the incidence of main morbidities of prematurity in spontaneously breathing very preterm infants on nCPAP.
[Show abstract][Hide abstract] ABSTRACT: To study anti-Ro/La-negative congenital heart block (CHB).
Forty-five fetuses with CHB were evaluated by analysis of anti-Ro/La antibodies using sensitive laboratory methods.
There were 9 cases of anti-Ro/La-negative CHB; 3 died (33.3%). Only 3 (33.3%) were complete in utero and 5 (55.5%) were unstable. No specific etiology was diagnosed. Six infants (66.6%) were given pacemakers. There were 36 cases of anti-Ro/La-positive CHB. All except 2 infants (94.4%) had complete atrioventricular block in utero. Ten died (27.8%), one (2.7%) developed severe dilated cardiomyopathy, and 26 (72.2%) were given pacemakers.
Nine of the 45 consecutive CHB cases (20%) were anti-Ro/La-negative with no known cause. They were less stable and complete than the anti-Ro/La positive cases.
The Journal of Rheumatology 07/2009; 36(8):1744-8. DOI:10.3899/jrheum.080737 · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Antenatal and postnatal treatment with dexamethasone (DEX) may negatively affect the neuropsychological development in children. Maternal anti-Ro/Sjögren's syndrome A (SSA) antibodies may also be associated with learning disabilities in offspring.
To assess neuropsychological development in babies exposed to very high dosages of DEX in utero, whose mothers were anti-Ro/SSA positive.
13 children with congenital complete heart block (CHB) (11 exposed and 2 not exposed to DEX) and 3 healthy siblings, all of anti-Ro/SSA-positive women, were evaluated. 11 preschool-aged children (5 boys) were assessed using Griffiths Mental Development Scales. 5 school-aged children (2 boys) were examined using Wechsler Intelligence Scale for Children-Revised to check IQ and reading tests to explore the existence of learning disabilities or dyslexia. None of the children had had major neonatal complications, although those with CHB had to be paced at different intervals from birth.
The children had been exposed in utero to a mean total dose of 186.6 mg DEX. IQ levels were always normal (mean IQ 105.1, standard deviation (SD) 9.5). Only one child had a learning disability, of borderline clinical significance, but this child had never been exposed to DEX.
No negative effects were found on the neuropsychological development in this cohort of children, even if they had been exposed to maternal anti-Ro/SSA antibodies and to very high dosages of DEX (much higher than those used to improve fetal lung maturity). These findings might be of interest in view of the large number of infants exposed in the past to repeated antenatal courses of steroids.
Annals of the Rheumatic Diseases 12/2006; 65(11):1422-6. DOI:10.1136/ard.2005.049866 · 10.38 Impact Factor