Carlo Valerio Bellieni

Carlo Valerio Bellieni
Università degli Studi di Siena | UNISI · Department of Molecular & Developmental Medicine

MD

About

213
Publications
70,127
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3,195
Citations
Citations since 2017
56 Research Items
1580 Citations
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Introduction
Neonatologist and bioethicist, with experience in the field of neonatal analgesia, fetal sensoriality, environmental care

Publications

Publications (213)
Conference Paper
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Questo articolo è un commento al mio studio pubblicato su Nursing Reports sui sei modi di comunicare che ha il paziente verso i medico; il punto fondamentale è che il modo verbale non è il modo più importante, anche se è quello su cui ci si basa esclusivamente, verosimilmente sbagliando
Article
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Evidence shows that verbal communication is just one of the ways patients indicate their wishes. For a sufficiently careful communication, we should also grasp other five unusual though evident languages: (a) body language, (b) the way patients manage their environment, (c) unconscious language, (d) lab-evidenced language, and (e) the way they mast...
Article
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Objectives: Foetal surgery is a relatively new branch of medicine; the health providers involved are currently wondering what kind of anaesthesia should be provided to the foetuses. In the last few years, new advances have been reported on foetal sensoriality and capability for feeling pain; meanwhile alerts have been issued on the risks of prolong...
Article
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Circumcision-partial or total removal of the penile prepuce-requires cutting nerve-laden, sensitive genital tissue and is therefore liable to be painful. The aim of this review is to evaluate the evidence concerning pain felt by newborns during circumcision and to determine whether current analgesic methods can eliminate such pain. I performed a se...
Article
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Objectives To define and validate types of pain in critically ill neonates and infants by researchers and clinicians working in the neonatal intensive care unit (NICU) and high dependency unit (HDU). Design A qualitative descriptive mixed-methods design. Procedure/s Each stage of the study was built on and confirmed the previous stages. Stage 1 w...
Article
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Male circumcision (MC) is one of the most common surgical procedures performed on neonates. In the last decades, there have been consistent advances in the understanding of pain mechanisms in newborns, and analgesia has become a fundamental part of neonatal care. MC is still often performed with inappropriate analgesic methods, and there is still g...
Article
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Purpose Several studies have shown that oral sucrose reduces pain in newborns. However, sucrose has no efficacy in eliminating pain and long-term effects remain unclear. Breast milk may be useful as an alternative, safe sweet solution. Sensorial saturation (SS) is a multisensory analgesic non-pharmacological treatment, which includes touch and soun...
Article
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End-of-life decisions are taken daily in medicine, and the best interest principle (BIP) is one of the most-used criteria. The first aim of this paper is to review the BIP and its criticisms. The second is to propose an alternative criterion to decide when invasive therapies are excessive. We show that the BIP has been criticized for being vague an...
Article
The Congress "Yes to Life," devoted to the ethical problems in perinatology, has been an important carrefour for the intercultural dialogue on these themes. This paper describes the aim of the Congress and why it was proposed.
Article
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Resumen En el mundo todavía no existe un acuerdo sobre los criterios éticos para continuar o suspender los cuidados intensivos neonatales. Se usa muy a menudo el criterio del mejor interés o un criterio basado en las semanas de desarrollo fetal al nacimiento. Sin embargo, ambos criterios tienen defectos que serán explicados en el texto. Proponemos,...
Article
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Riassunto I criteri per le decisioni di fine-vita in pediatria sono difficili da acquisire e raramente vengono spiegati e insegnati compiutamente. Questo articolo vuole mostrare la debolezza di alcuni di essi, come il best interest principle, e proporre un criterio che più che al terminare l'esistenza del soggetto, è volto alla riduzione delle cure...
Article
Fetal pain is difficult to assess, because the main feature needed to spot pain, is the subject's capability of declaring it. Nonetheless, much can be affirmed about this issue. In this review we first report the epochs of the development of human nociceptive pathways; then we review since when they are functioning. We also review the latest data a...
Article
Il dibattito sul fine-vita in pediatria negli ultimi tempi ha mostrato di incagliarsi quando viene usato come principio decisionale il cosiddetto best interest del bambino, dato che esso è solitamente invocato sia dai fautori della prosecuzione delle cure sia da quelli della sospensione. Il best interest è un principio troppo elastico per essere us...
Article
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Aim This review informed pain control guidelines for clinicians performing mechanical ventilation, nasal continuous positive airway pressure and endotracheal intubation on term and preterm newborn infants. Methods We reviewed literature published between 1986 and June 2017 on analgesia and sedation during assisted ventilation and before endotrache...
Article
End‐of‐life issues involving small babies are particularly challenging for doctors, particularly pediatricians as there are complex issues involved, including long‐term disabilities (1) and the parents’ wishes (1). Evaluations can be based on statistical risks (2) and case‐by‐case issues. Some authors (3) suggest that intensive care can be withheld...
Article
Aim The aim of this study was to carry out a literature review and develop clinical guidelines for pain prevention and control during screening and laser photocoagulation for retinopathy of prematurity (ROP) in neonatal intensive care units (NICUs). Methods The Italian Society of Neonatology assessed papers published between 1986 and June 2017 and...
Article
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In order to overcome the risks of both euthanasia and therapeutic obstinacy, a new principle is proposed.
Article
Background: Informing the patient is a base of modern medicine; nonetheless, a great discrepancy exists between hospitals on the way this information should be administered. This is particularly important when the patient are babies: the information should be given to their parents who should approve or disapprove the treatment. Aim of this study...
Article
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When somebody asks me what is ethical in pain treatment, my first answer is the latin motto "primum non nocere" (first, do not harm"). That's good, but too often this is confused with following protocols, thus it can become misleading. What have I against protocols? That they explain all about what you have to do, but nothing about how to do it. Th...
Article
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Studies on neonatal pain have skyrocketed in the last 10 years, according to a PubMed search, but pain treatment is still insufficient despite this high level of research. More than 50 pain scales have been validated and published for newborn infants, but only a few of these are used and not to any great extent (1). In addition, analgesic drugs and...
Article
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Background: Neonatal incubators are important tools for sick newborns in the first few days of life. Nevertheless, their electric engine, often very close to the newborn’s body, emits electromagnetic fields (EMF) to which newborns are exposed. Aim of this paper is to review the available literature on EMF exposure in incubators, and the effects of...
Article
Mortazavi's comment (1) on our letter (2) on whether electromagnetic fields (EMF) in incubators are a risk factor for autism contains several points that need to be corrected. First, we did not base our observations just on our previous papers as Mortazavi maintains. In fact, our observations were also based on several more papers about EMF in incu...
Article
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Aim: Sensorial saturation (SS) is an analgesic approach to babies' pain that includes three types of stimulations: oral sugar, massage and caregivers' voice. The aim of this review is to assess its efficacy. Methods: We performed an analysis of scientific literature from 2001 to 2017, retrieving those clinical trials where SS had been compared with...
Article
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Aim: Sensorial saturation (SS) is an analgesic approach to babies' pain that includes three types of stimulations: oral sugar, massage and caregivers' voice. The aim of this review is to assess its efficacy. Methods: We performed an analysis of scientific literature from 2001 to 2017, retrieving those clinical trials where SS had been compared w...
Chapter
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Is scoring pain mandatory in newborns? Sometimes it is, and some others it is not [1]. We shall describe when and how in this chapter.
Chapter
A heel prick cannot be an automatic procedure. Patients should always be protagonists of their cure even when they are small and nonverbally autonomous, and their parents should never be discouraged from participating in these procedures. Some exceptions are obvious, but the main rule in procedural treatments is “involving the patient” [1–5].
Chapter
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Fetal behavior can be defined as fetal activities observed or recorded with ultrasonic equipment. The introduction of three-dimensional (3D) and four-dimensional (4D) ultrasonography has enabled a more detailed morphological evaluation of the fetus, improving not only the definition but also the perception of certain fetal attitudes, such as facial...
Book
This completely revised and updated edition offers a comprehensive overview of neonatal pain assessment and treatment. It includes the field of fetal surgery, and many other topics have been updated or added, such as circumcision analgesia, new drugs, new insights into neurophysiologic pathways of neonatal pain and new drawbacks of analgesic drugs....
Article
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Hugo Lagercrantz recently argued (1) that a possible cause of infantile autism was the unnatural isolation that babies experienced in neonatal incubators. Atypical brain connectivity has been detected in children with autism and it is possible that this may be also due to environmental factors, including the lack of physiological stimuli that is ty...
Article
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Most animals can cry but only humans have psychoemotional shedding of tears, also known as “weeping”. The aim of this review is to analyze and discuss the available data on the function and significance of weeping. It emerged that weeping is a behavior distinct from crying. Crying is the immediate reaction to pain or anger, it is not always associa...
Article
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An anterior myelomeningocele had been suspected in a female fetus on the basis of fetal ultrasonography; prenatal MRI at the 24 th week of gestation confirmed a cystic mass in the anterior sacrococcygeal
Article
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Purpose: Neonatal pain management has made a great step forward over the last several years. Despite the drafting of International guidelines, an under-treatment of neonatal pain is still reported. Materials and methods: Medical and paramedical personnel working in 5 Italian NICUs were asked to complete a questionnaire about pain management. The...
Article
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Fetal anesthesia is still matter of debate: some authors hypothesize that several intrauterine endogenous neuroinhibitors (ENIn) anesthetize the fetus, keeping it in a constant state of sleep, and making pharmacological fetal anaesthesia useless for fetal surgery. Aim: To retrieve evidences about fetal pain, fetal arousability and about the level o...
Article
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Background: Today, few studies have been accomplished in order to determine serum creatine kinase (CK) activity in newborns by considering small groups of babies and without taking into account gestational age (GA) differences. Some authors have demonstrated that neonatal CK activity value at birth is higher than the normal range of CK activity co...
Article
The aim of this literature review was to develop clinical guidelines for the prevention and control of needle-related pain in newborn infants. The guidelines were developed by the Italian Society of Neonatology, using the Grading of Recommendations, Assessment, Development and Evaluation approach, based on the assessment of 232 papers published bet...
Article
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This research paper aims to investigate if oxidative stress biomarkers increase after a painful procedure in term newborns and if nonpharmacological approaches, or sex, influence pain degree, and the subsequent OS. 83 healthy term newborns were enrolled to receive 10% oral glucose or sensorial saturation (SS) for analgesia during heel prick (HP). T...
Article
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External factors can interfere with pregnancy; some of them are factors of parental origin, such as active or passive smoking or alcohol use; some are of environmental origin such as air or water pollution; some are due to medical errors that expose the developing being to harm. Sometimes these factors cause the death of the fetus; sometimes they j...
Chapter
According to bioethical principles, babies and older patients should be treated according to the same standards. In practice, newborn infants are treated differently in ways which show that they are valued less than older individuals. We provide six specific examples of this differential treatment and analyse the possible consequences of this deval...
Article
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In western countries we assist to the paradox that fertility is socially discouraged by a mindset that depicts fertility as a resource to exploit as late as possible. So, couples have high expectative about the advantages of delayed parenthood, but they are scarcely informed about its risks. Scientific data suggests to anticipate the first pregnanc...
Article
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Neonatal pain treatment requires personalization, and pain assessment should be contextualized to be effective. Here we summarize the available tools in neonatal analgesia, paying a special attention to highlight the personalization of antalgic behavior, both in assessment and in treatment of neonatal pain. Proceedings of the 11th International Wor...
Article
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The first 1,000 days, from conception to the end of the second year after birth, are crucial for the future of any human being. They are crucial for health, for the development of diseases, for learning. In this process, epigenetics and precocious sensory development are the principal routes. Several organizations throughout the globe have highligh...
Article
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Figure 1. The simultaneous use of touch, voice and taste stimulation, inhibits pain to attain the brain during common painful procedures. This is due to endorphin release in the brain and to neuronal gate-control in the spinal cord. Babies feel pain more than adults, and common strategies, like the isolated use of oral sugar, are not effective enou...
Chapter
Diarrhea can threaten babies’ health and life. A rapid diagnosis should be done to assess whether fluid replacement should be started and the appropriate route of administration. This chapter illustrates an easy way to recognize the grade of dehydration and the appropriate rehydration.
Chapter
Evidence indicates that the experience of pain begins in the second trimester, well before the third and last trimester of human gestation: thus preterm babies can perceive pain. When babies are born preterm, they undergo painful experiences as a necessary component of their care. These experiences can result in important short-term stress response...
Article
Objective: Prenatal heart adaptations to congenital diaphragmatic hernia (CDH) could help define postnatal outcome. Methods: We retrospectively analyzed post-mortem tissues from fetuses with severe CDH (n = 7). Histology and immunohistochemical distribution of desmin, muscle actin [HHF35], endothelin-1 [ET-1] and TGF-β were evaluated. Results:...
Article
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Conclusion: Despite international guidelines, neonates included in control groups during painful procedures do not receive analgesia in the majority of cases. Several historical reasons can explain this, but in the light of present knowledge, this should not continue. Ethical committees are thereof invited since now to not permit clinical trials t...
Article
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Paralympic Games (PG), involving people with disabilities (PWD), are a manifestation of excellence in sport. They show that athletics performed by PWD counts as genuine sport. They also support a wider meaning of the term ‘health,’ understood not just like a utopian state of perfection, but like the ability to realize oneself in the projects and ac...
Article
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Phototherapy is the use of light for reducing the concentration of bilirubin in the body of infants. Although it has become a mainstay since its introduction in 1958, a better understanding of the efficacy and safety of phototherapy applications seems to be necessary for improved clinical practices and outcomes. This study was initiated to evaluate...
Article
Abstract Background: Prenatal surgery represents a multifactorial stressor event for mother and fetus. The stress response to fetal surgery was evaluated by measuring maternal plasma and amniotic fluid (AF) cortisol levels in the myelomeningocele (MMC) sheep model. Subjects and methods: Pregnant ewes (n = 8) underwent general anesthesia for MMC-ind...
Article
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Objective: Neonates undergo many painful procedures daily, in particular venipunctures and heelpricks. Our aim was to assess how painful these procedures actually are, and how effective are the common analgesic strategies to blunt this pain. Methods: We performed a MEDLINE/PubMed research from 1999 to 2013. We retrieved all papers in English langua...
Chapter
Pain in newborns is a diffuse and severe problem, leading in some cases to threatening the integrity of their central nervous system. This risk is mediated by several events, among which is the production of free radicals (FR) induced by pain. Several studies show that FR are important in pain perception and that FR scavengers can antagonize pain p...
Article
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Newborn infants' pain should be scored indirectly using dedicated pain scales. Unfortunately, while some scales for prolonged pain have given good results, a gold standard to assess acute pain does not exist. Acute pain scales still have weak points, most are complex and are scarcely used in neonatal departments. Moreover, carefully scoring pain in...
Article
Full-text available
Newborn infants' pain should be scored indirectly using dedicated pain scales. Unfortunately, while some scales for prolonged pain have given good results, a gold standard to assess acute pain does not exist. Acute pain scales still have weak points, most are complex and are scarcely used in neonatal departments. Moreover, carefully scoring pain in...
Article
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Dolore neonatale. Negli ultimi anni è stata proposta e vali-data la tecnica della "Saturazione Sen so -riale" (SS), entrata in uso in diversi ospe-dali italiani e nelle Linee Guida della Società Italiana di Neonatologia [5-6]. Per la sua semplicità, efficacia e capacità di interazione con il bambino, merita di essere approfondita e diffusa. La SS è...
Article
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This research studied, 25 adult patients who underwent physical therapy to assess the analgesic effect of distraction with the use of music during physical therapy. Patients randomly underwent physical therapy once with music provided by an iPod and once without music. In both sessions patients underwent identical physical procedures. At end of bot...
Article
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Inadequate pain management in neonatal life impairs the neurodevelopmental outcome. It alters pain thresholds, pain and stress-related behavior, and physiologic responses in later life. At the same time, there are emerging animal experimental and human epidemiologic data on the impact of analgosedatives on neuroapoptosis and impaired neurodevelopme...
Article
Pain is an adverse effect that must be prevented and controlled at any age. Numerous guidelines consider the administration of sweet solutions as a standard of care for controlling pain during minor invasive procedures in neonates (1,2). According to the latest Cochrane Review, sucrose is safe and effective in reducing single episodes of minor proc...
Article
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Abstract Aim: To assess whether blood values of C-reactive protein (CRP) in healthy term newborns, are influenced by stress. Material and methods: Since different types of delivery [vaginal delivery (VD), emergency C-section (EMCS) and elective C- section (ELCS)] are notoriously characterized by different levels of stress for the baby, these three...
Article
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The risk that abortion may be correlated with subsequent mental disorders needs a careful assessment, in order to offer women full information when facing a difficult pregnancy. All research papers published between 1995 and 2011, were examined, to retrieve those assessing any correlation between abortion and subsequent mental problems. A total of...
Article
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Male circumcision (MC) is one of the oldest and most common operations performed all over the world. It can be performed at different ages, using different surgical techniques, for different religious, cultural and medical reasons. Our aim is to examine and compare the various methods of analgesia and different surgical procedures reported in liter...
Article
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Delayed childbearing (DC) is common in most Western countries. The average age of first-time mothers increased in United States from 21.4 years in 1970 to 25.0 years in 2006 and from 25.4 to 30.8 years in Australia in the same period. It is commonly believed that this has no ominous consequences. But several negative consequences of this behavior a...
Article
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Prevention and treatment of pain during procedures in newborns are currently limited. Recently, it has been proposed and validated a non-pharmacological technique used for the relief of procedural pain both in term and preterm infants, called "Sen so -rial Saturation" (SS). It consists in attracting the baby's attention with positive stimuli (tacti...
Article
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Abstract Aim: To compare the analgesic effect of 3 treatments to relieve the pain produced by intramuscular injections (IMI) in term newborns, and to assess sex-linked differences in their response to pain. Material and methods: We studied 62 babies. Each baby received antibiotic IMIs for clinical aims. During each IMI, one of the following analges...
Article
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Aim To assess the normal values of C reactive Protein (CRP) in our population. We included only those babies in which we had no retrospective doubt of having no infection. Material and Methods We studied all babies born in the year 2010 in the Siena hospital, in whom PCR was measured for the risk of neonatal infection. we excluded from this retrosp...
Article
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Aim Fetal surgery is increasingly performed in many centers. Nevertheless, in most cases, analgesic treatment is still absent with the risk of brain damage in the newborn, due to the sudden rise in blood pressur and intracranial pressure due to pain. We performed a review on the present state of direct fetal analgesia, to show the importance to pre...
Article
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Aim To compare pain during intramuscular injections (IMI) of antibiotics, with different analgesic methods. Material and Methods We have studied 30 term babies who had to receive several IMI of antibiotic in the first week of life. During the IMI, an analgesic treatment was performed using EMLA cream is an analgesic cream to be applied topically at...
Article
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Aim To review the most recent data on the outcome of very premature babies (22–25 weeks gestational age - GA). Material and Methods We performed a PubMed search using as key words the following “extremely preterm baby” and “outcome”. We did not utilise the studies where outcomes were not given in relationship with the exact gestational age at birth...
Article
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Objective: Recent progresses in fetal surgery have raised concern on fetal pain, its long-term consequences and the risks of sudden fetal movements induced by pain. In several studies, surgeons have directly administered opioids to the fetus, while others have considered sufficient the maternally administered analgesics. We performed a review of th...