C Bellan

Ospedali Riuniti di Bergamo, Bérgamo, Lombardy, Italy

Are you C Bellan?

Claim your profile

Publications (15)11.06 Total impact

  • Source
    C Bellan · A Auriemma · M Teani · C Mora · D Alberti · P Menghini
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The prognosis of babies with CDHremains unsatisfactory despite recent advances inmedical and surgical treatment.Recent studies have proved that mortality rate inhigh risk patients is around 50-60%.Methods: 148 neonates affected with CDH weretreated in the NICU of Bergamo, from 1994 to2009.In the case of pulmonary hypertension iNO isgiven, if neonates show severe hypoxia refractoryto conventional therapies, they are treated withECMO.Only when a stable situation is reached, can surgicalrepair be performed, in the NICU, during HFOV.In the case of wide defects or complete agenesisof the diaphragm (53 cases), prosthetic material isused (Gore-Tex).After the surgical operation HFO ventilation iscarried out, followed by weaning of the conventionalventilation until extubation.Results: Antenatal echographyc diagnosis wasmade in 91 cases.Gestational age was 38 ± 2.2weeks. There were116 left CDH and 18 right CDH; 14 hemidiaphragmagenesis.Major associated anomalies have been identified in33 patients and 9 newborns had a gestational ageof < 35 w.In 18 cases stabilization was not obtained andneonates died before undergoing surgery. 5neonates underwent ECMO. 49 babies were treatedwith iNO.102 neonates survived (68.9 %) and survivalreaches 75.8 % if we exclude neonates with majorassociated anomalies and 80.5% if we also excludepreterm infants.Conclusions: The use of advanced techniques ofventilation assistance, associated with pre-surgicalclinical stabilization and surgery performed in theNICU, during HFOV, have improved the outcomeand the CDH neonatal survival.
    Preview · Article · Nov 2010 · Pediatric Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: The prognosis of babies with congenital diaphragmatic hernia (CDH) remains unsatisfactory despite recent advances in medical and surgical treatment. Most authors agree that the best way to improve outcomes for this disease is to focus on pulmonary hypoplasia and persistent pulmonary hypertension (PPH), the 2 most unfavorable prognostic factors for patient survival. However, controversy remains regarding the best treatment of CDH. In the past decade, several institutions have developed treatment protocols that include high-frequency oscillatory ventilation (HFOV), preoperative stabilization, and no thoracic drain. This strategy is 1 of several “gentle ventilation” strategies. We describe our 10-year experience in treating a cohort of 111 infants with CDH managed with this “gentle ventilation” strategy.
    No preview · Article · Sep 2007 · Journal of Pediatric Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sonography is a reliable tool for the evaluation of the most severe congenital abnormalities of the brain; in the present case it provided an early demonstration of hemimegalencephaly in hypomelanosis of Ito in a newborn affected by body hemihypertrophy and skin lesions. Serial magnetic resonance (MR) examinations confirmed the asymmetry of the cerebral hemispheres, and documented the evolution of the hemispheric growth and the presence of unusual aspects.
    No preview · Article · Oct 2000 · European Journal of Ultrasound
  • [Show abstract] [Hide abstract]
    ABSTRACT: Congenital misalignment of pulmonary vessels (MPV) with alveolar capillary dysplasia is a rare condition consisting of anomalous veins in bronchovascular bundles, a decreased number of alveolar capillaries, and increased muscularization of pulmonary arterioles. In the literature, infants reported as having such a malformation developed respiratory distress with persistent pulmonary hypertension and ultimately died. We report the case of an infant with MPV and alveolar capillary dysplasia who was unresponsive to maximal cardiorespiratory support, including high-frequency oscillatory ventilation and inhaled nitric oxide; the infant died of pulmonary hemorrhage after 19 days, during venoarterial extracorporeal membrane oxygenation bypass. We conclude that the diagnosis of MPV and alveolar capillary dysplasia should be considered during autopsy of infants who have died of irreversible persistent pulmonary hypertension. If a lung biopsy in infants with prolonged refractory hypoxemia confirms such diagnosis before death, expensive and invasive treatments such as extracorporeal membrane oxygenation could be avoided.
    No preview · Article · Apr 2000 · Journal of Perinatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Term and near-term newborn infants with congenital diaphragmatic hernia (CDH), symptomatic in the first 24 h of life or diagnosed antenatally, without other significant malformations were treated at our hospital with high-frequency oscillatory ventilation (HFOV) as a primary modality of ventilation and elective delay in surgical repair after a period of stabilisation. When unresponsive to HFOV, infants were treated with surfactant, inhaled nitric oxide (iNO) and extracorporeal membrane oxygenation (ECMO) to achieve pre-operative stabilisation. From October 1994 to August 1998, 28 newborn infants with CDH were managed with such treatment; mean birth weight was 3184 ± 535 g and gestational age 38.5 ± 1.85 weeks. Age at operation was 68 ± 35 h. In 9 cases, large diaphragmatic defects required the use of a prosthetic patch (Gore-tex). HFOV was used for primary ventilation in inborn patients (n = 16); outborn infants (n = 12) were placed on HFOV at admittance. A total of 15 patients (53%) were stabilised using only HFOV. Bovine surfactant was administered in 12 infants and 4 responded. iNO was used in eight infants and five responded. ECMO was used in three outborn patients and one survived. Overall, out of 28 infants, 25 survived (89%). Neurological examination (Amiel-Tison and Grenier) of 15 infants showed transient anomalies at 6 months in 40% of infants, while a normal neurological examination was present in all patients at 1 year. The development quotient (Griffiths scales) was within normal values in ten and mildly abnormal in two infants tested at 1 year. Conclusion Management based on early HFOV, eventually associated with surfactant, iNO and ECMO to achieve preoperative stabilisation, resulted in a good survival rate (89%) and good neurodevelopmental outcome at 1 year of age in infants with CDH.
    No preview · Article · Nov 1999 · European Journal of Pediatrics
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hemangiomas are the most common tumor of infancy. Most hemangiomas are harmless and follow a benign clinical course and undergo regression with time. Sometimes they can destroy vital organs and become life-threatening. We report two cases of neonatal hemangiomas which presented very different clinical aspects and course.
    No preview · Article · Jun 1999 · European Journal of Ultrasound
  • [Show abstract] [Hide abstract]
    ABSTRACT: Imaging investigations and other findings observed in a term infant with a multicentric hepatic hemangioendothelioma, admitted to the Intensive Care Unit at the age of 13 days because of non specified feeding difficulties and dyspnoea, are presented. Physical examination revealed cardiac bruit and congestive heart failure with marked hepatomegaly; in addition there were multiple small skin hemangiomas. Echocardiography was negative, abdominal sonography showed multiple round lesions of mixed echogenicity in the liver, large vascular channels, a right hepatic artery and hepatic veins enlarged, a caliber of the aorta below the level of the superior mesenteric artery reduced. The infant was additionally investigated by whole-body scintigraphy with 99mTc-labeled red blood cells to determine the possibility of coexistence of other visceral hemangiomas and by MR, in which the tumor manifested as multiple well-circumscribed space-occupying nodules of high signal intensity on T2-weighted images with evidence of fast flow. The baby underwent furosemide and steroid therapy: serial two-dimensional US scans showed change in echogenicity, responding to therapy. Doppler sonography has proven to be also very useful in the monitoring therapy determining changes in flow pattern and velocity at the level of hepatic, cerebral and renal vessels: before therapy we observed a reduction of the diastolic flow until the zero line through the internal carotid artery and renal artery with an increase of the Resistance Index. It means that this important component can be compromised in the presence of a hepatic hemangioendothelioma.
    No preview · Article · Apr 1998 · Minerva pediatrica
  • [Show abstract] [Hide abstract]
    ABSTRACT: Imaging investigations and other finding observed in a term infant with a multicentric hepatic hemangioendothelioma, admitted to the Intensive Care Unit at the age of 13 days because of non specified feeding difficulties and dyspnoea, are presented. Physical examination revealed cardiac bruit and congestive heart failure with marked hepatomegaly; in addition there were multiple small skin hemangiomas. Echocardiography was negative, abdominal sonography showed multiple round lesions of mixed echogenicity in the liver, large vascular channels, a right hepatic artery and hepatic veins enlarged, a caliber of the aorta below the level of the superior mesenteric artery reduced. The infant was additionally investigated by whole-body scintigraphy with 99mTc-labeled red blood cells to determine the possibility of coexistence of other visceral hemangiomas and by MR, in which the tumor manifested as multiple well-circumscribed space-occupying nodules of high signal intensity on T2-weighted images with evidence of fast flow. The baby underwent furosemide and steroid therapy: serial two-dimensional US scans showed change in echogenicity, responding to therapy. Doppler sonography has proven to be also very useful in the monitoring therapy determining changes in flow pattern and velocity at the level of hepatic, cerebral and renal vessels: before therapy we observed a reduction of the diastolic flow until the zero line through the internal carotid artery and renal artery with an increase of the Resistance Index. It means that this important component can be compromised in the presence of a hepatic hemangioendothelioma.
    No preview · Article · Mar 1998 · Minerva Pediatrica
  • [Show abstract] [Hide abstract]
    ABSTRACT: From October 1994 through May 1997 newborn infants with congenital diaphragmatic hernia (CDH) were treated at our hospital with high frequency oscillatory ventilation (HFOV) as a primary modality of ventilation and delayed surgery; the aim was to prevent iatrogenic lung injury and to perform operation on infants with a more stabilized pulmonary vascular bed. Results were compared with our previous experience and infants were divided into 2 chronological groups: group 1, consisting of 13 term symptomatic newborns with isolated CDH treated from November 1991 through September 1994 with conventional ventilation and operation in the first hours of life; group 2, comprising 18 similar CDH infants treated with the new management protocol. The 2 groups did not differ significantly in birth weight and gestational age. Age at repair was 17.08 ± 13.03 hours in group 1 and 55.69 ± 27.93 hours in group 2 (p = 0.0001).In the last 13 cases surgery was performed in the neonatal intensive care unit. Preoperative and postoperative pH, PaO2, SaO2, oxygenation index, AaDO2 and preoperative PaCO2 were significantly improved in infants of group 2. Extracorporeal membrane oxygenation (ECMO) was used in one infant of group 1, who died, and in 3 infants of group 2, with one survivor. Inhaled nitric oxide was used in one infant of group 1, who died, and in 2 infants of group 2, both survived. Group 2 showed a higher survival rate (83% versus 61%) and a shorter hospital stay. Management of infants with CDH is still in evolution and there is not agreement about the optimal strategy; treatment with a conservative pulmonary management using early HFOV as a primary modality of ventilation, eventually inhaled nitric oxide or ECMO and preoperative stabilization allowed us to improve the outcome of our population of CDH infants.
    No preview · Article · Jan 1998
  • Poggiani C · Auriemma A · Menghini P · Bellan C · Colombo A

    No preview · Article · May 1997 · European Journal of Ultrasound

  • No preview · Article · Jan 1996
  • M. Somaschini · M. Giozani · C. Bellan · A. Colombo
    [Show abstract] [Hide abstract]
    ABSTRACT: ECMO (Extracorporeal membrane oxygenation) is rarely used in Italy compared to other Northamerican or Northeuropean countries. To evaluate the need for neonatal ECMO in our region we sent a questionnaire to the main neonatal intensive care centers asking to identify those newboms who would have had indication to ECMO in 1994. 21 new borns infants had indication to ECMO in 13 NICU in Lombardia. Among them, 3 have been transferred to the ECMO center: 2 survived and 1 died because of a hypoxic cerebral death. 18 new borns have not been considered for ECMO: 5 survived and 13 died. This survey shows that ECMO is indicated in 1:3567 live births in our region (similarly to other european countries) and the small number of treated infants is due to the lack of referral of infants having indication to ECMO.
    No preview · Article · Jan 1996
  • [Show abstract] [Hide abstract]
    ABSTRACT: Seven newborn infants with life-threatening respiratory failure were treated with veno-venous (V-V) extracorporeal lung support and apneic oxygenation after maximal ventilatory and pharmacological treatment failed. Diagnosis were meconium aspiration syndrome in 3 cases, respiratory distress syndrome in 2, sepsis in 1, congenital diaphragmatic hernia in 1. Before ECMO 6 infants received tolazoline, 4 surfactant, 3 high frequency ventilation, 1 prostaglandin E, 1 epoprostenol, 2 nitric oxide. Newborns were highly hypoxemic at admission and all but one underwent rescue cannulation. V-V bypass was performed with a single lumen single cannula and tidal flow was generated by an alternating clamp using a non-occlusive roller pump. The mean duration of bypass was 162.4 +/- 162.3 hours and infants were extubated 94.5 +/- 74.8 hours after decannulation. Five newborns survived and two died. Growth and neurologic development of the older children is normal. The extracorporeal lung support with V-V bypass associated with apneic oxygenation was effective in reversing severe neonatal respiratory failure unresponsive to maximal ventilatory and pharmacological support. An early referral, prior to meeting ECMO criteria, is important in order to avoid hypoxic complications preceding ECMO.
    No preview · Article · Nov 1995 · The International journal of artificial organs
  • A Auriemma · C Poggiani · P Menghini · C Bellan · A Colombo
    [Show abstract] [Hide abstract]
    ABSTRACT: Lipomas of the corpus callosum are benign neoplasms which are rarely diagnosed in pediatric patients. In infants they are congenital lesions consisting of collections of adipose tissue; their etiology is unclear. We describe a case of callosal lipoma discovered by sonography in a 2-day-old neonate.
    No preview · Article · Feb 1993 · Pediatric Radiology
  • A Auriemma · C Bellan · P Menghini · C Mora

    No preview · Article · · La Pediatria medica e chirurgica: Medical and surgical pediatrics

Publication Stats

155 Citations
11.06 Total Impact Points

Institutions

  • 1993-2007
    • Ospedali Riuniti di Bergamo
      • Department of Hematology
      Bérgamo, Lombardy, Italy