Isotta Guidotti

Università degli Studi di Modena e Reggio Emilia, Modène, Emilia-Romagna, Italy

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Publications (12)21.44 Total impact

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    ABSTRACT: Abstract Neonatal Herpes simplex virus (HSV) pneumonia without apparent accompanying disseminated infection is a rare condition. We describe a case of neonatal pneumonia following maternal HSV type-1 viraemia in late pregnancy. A review of the literature shows that cases of HSV presenting as pneumonia in the first week of life are the most severe form of neonatal HSV.
    No preview · Article · Sep 2014 · Journal of Maternal-Fetal and Neonatal Medicine
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    ABSTRACT: Background: Data regarding the minimum duration of intrapartum antibiotic prophylaxis (IAP) required for preventing group B Streptococcus (GBS) early-onset sepsis are conflicting. Understanding factors that influence neonatal colonization (NC) might help us understand factors associated with failure of prophylaxis. Methods: This is a 14-month prospective cohort study conducted at a single tertiary care center with a screening-based strategy. Women were enrolled if they had ≥ 35 weeks' gestation and were GBS-positive at the vaginal site on admission. Their neonates were cultured from the throat and rectum at 24-48 h after birth. Colony growth was graded semiquantitatively (from 1+ to 4+). Uni- and multivariate logistic regression analyses were performed to evaluate risk factors for NC. Results: There were 502 neonates, 458 of whom were exposed to IAP. All cases of NC were associated with a lack of IAP exposure (P < 0.01), intrapartum fever ≥ 37.5°C (P < 0.01) and African ethnicity (P < 0.01). In the 458 IAP-exposed neonates, the rates of NC were low and did not vary significantly in the range of less than 1-12 h before delivery (score test for trend of odds, P = 0.13). The only independent factors associated with NC were intrapartum fever ≥ 37.5°C and heavy maternal colonization (P < 0.01 and P = 0.03, respectively). Conclusions: Heavy maternal colonization, intrapartum fever, African ethnicity and lack of IAP exposure were associated with GBS transmission in neonates born to women who were tested positive on admission. Low rates of NC were found among IAP-exposed neonates irrespective of IAP duration.
    No preview · Article · Jul 2014 · The Pediatric Infectious Disease Journal
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    ABSTRACT: Fetal hydrops is a condition resulting from interstitial fluid accumulation in fetal compartments secondary to increased capillary permeability and characterized by high rates of perinatal mortality and morbidity. Clinical features include skin edema, hydrothorax, pericardial effusion, ascites with or without polyhydramnios, and placental edema. While it may occur as associated feature in multiple disorders, it has been documented to recur in Noonan syndrome, the most common disorder among RASopathies, but also in cardiofaciocutaneous and Costello syndromes. Here, we report on the occurrence of severe hydrops in a newborn heterozygous for the invariant c.4A>G missense change in SHOC2 which underlies Noonan-like syndrome with loose anagen hair, documenting that it represents a clinically relevant complication in this condition, shared by RASopathies. © 2014 Wiley Periodicals, Inc.
    No preview · Article · Apr 2014 · American Journal of Medical Genetics Part A
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    ABSTRACT: Notwithstanding progress in perinatal-neonatal medicine, perinatal asphyxia has not disappeared. Nowadays, it can be observed in 0.5-2‰ of term-born infants; it is associated with a high rate of mortality and a wide range of disabilities. The link among perinatal asphyxia, hypoxic ischemic encephalopathy (HIE) and neuromotor outcome is complex. In the recent years, progress in cerebral magnetic resonance imaging (MRI) and in the spontaneous movement of the newborn led to a better comprehension of the pathogenesis and evolution of this event. Three major novelties were recently defined: first, the possibility of neuroprotection through hypothermia; second, the definition of the structure and the function of the brain through different MRI techniques; third, general movements (GMs) as an early marker of cerebral injury and predictors of later cerebral palsy (CP). Term-born infants present 2 typical patterns of cerebral injury: the most common affects basal ganglia and thalami (BGT), sometimes with cortical and white matter (WM) involvement; the other is limited to WM with or without cortical injury. The outcome depends on the extension, site and severity of the damage. Lesions other than these should cast doubt on the diagnosis of perinatal asphyxia, MRI in the neonatal period is therefore of relevance for medico-legal purposes. As for the prognosis, it is important to evaluate the severity of the HIE according to the three stages of Sarnat, the severity of abnormal electroencephalogram and the type of GMs abnormalities. MRI and sequential observation of GMs (abnormal developmental trajectories) are complementary tools for predicting motor outcome and for selecting infants who require early rehabilitation.
    No preview · Article · Jan 2014 · Medico e Bambino

  • No preview · Article · Nov 2013 · Archives of Disease in Childhood
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    ABSTRACT: The management of neonates at risk of early-onset sepsis is a challenge. In the last years, the approach has been based on laboratory tests that have been proven to be low predictive. Recent Italian data suggest that a less invasive approach, based on careful physical examination, may replace testing. Starting from 2009 in Emilia Romagna (Italy) asymptomatic neonates at risk of early-onset sepsis do not undergo sepsis workup. Clinicians and nurses in turn fill in and sign a standardized form (detailing general wellbeing, skin colour including perfusion, and the presence of respiratory signs) at close intervals. At-risk neonates are diagnosed in a timely manner through this strategy.
    No preview · Article · Oct 2013 · Medico e Bambino
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    ABSTRACT: Abstract Few studies focus on the neuropsychological and behavioural outcomes of preterm children at preschool age. This paper reviews the most recent and relevant contributions on cognitive, neuropsychological and behavioural outcomes and the neuroradiological findings in extremely and very preterm infants. In the first 2 years of life, cognitive impairment is common: it has an incidence of 30-40% and a higher prevalence than neuromotor and neurosensorial impairments. Recent studies report that even preterm infants with no major disabilities at preschool age perform more poorly than term peers in multiple neuropsychological domains such as language, attention, memory, visuomotor and visuospatial processing and executive functions. The incidence and severity of problems increase with decreasing gestational age. A delayed acquisition of neuropsychological functions and/or the occurrence of behavioural problems at preschool age are likely to be predictive of the high rate of cognitive deficits at school age and in adolescence. Neuropsychological functions across multiple developmental domains should be assessed longitudinally during routine follow-up checks.
    No preview · Article · Apr 2013 · 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
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    ABSTRACT: Background: Prevention of residual cases of neonatal group B streptococcus (GBS) early-onset disease (EOGBS) has become a goal in the past decade. This study is aimed at evaluating changes in the incidence of EOGBS over a 9-year period after the implementation of a screening-based approach and comparing 2 different protocols for managing healthy-appearing at-risk newborns (ARNs). Methods: A screening-based strategy was introduced in Emilia-Romagna (Italy) in 2003. A prospective, cohort study was conducted from 2003 to 2011; culture-proven EOGBS cases were analyzed in 2 periods: period 1 (2003 to 2008) and period 2 (2009 to 2011). ARNs (≥35 weeks' gestation) were managed according to 2 different protocols: laboratory testing plus observation (period 1) was replaced with expectant observation alone (period 2). Results: Ninety-one EOGBS cases were observed (incidence rate: 0.26/1000 live births). The incidence in full-term babies declined from 0.30 (period 1) to 0.14/1000 live births (period 2, P = 0.04). Recto-vaginal screening cultures in full-term mothers increased significantly from 10/45 (period 1) to 10/14 (period 2, P = 0.002). EOGBS was diagnosed earlier in ARNs than in not-at-risk newborns (mean age 5.5 versus 14.5 hours, P = 0.007). There were no differences in age at diagnosis irrespective of whether ARNs were managed with laboratory testing plus observation (mean 3.5 hours, period 1) or with expectant observation alone (mean 2.4 hours, period 2). Conclusions: When screening cultures were handled according to standard protocols, cases of EOGBS in full-term newborns simultaneously decreased. ARNs were diagnosed in a timely manner through both strategies. The clinical yield of laboratory testing was negligible.
    No preview · Article · Feb 2013 · The Pediatric Infectious Disease Journal
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    ABSTRACT: We read with interest the report by Lombard and co-workers (1). The authors describe four cases of invasive neonatal group B streptococcus (GBS) disease that may have been related to contaminated breast milk. Three newborns presented with late-onset disease (LOD) and one with both early-onset disease and LOD. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.
    No preview · Article · Dec 2012 · Acta Paediatrica
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    ABSTRACT: Nearly half of very preterm (VP) and extremely preterm (EP) infants suffers from minor disabilities. The paper overviews the literature dealing with motor problems other than cerebral palsy (CP) during infancy and preschool age. The term "minor motor problems" indicates a wide spectrum of motor disorders other than CP; "minor" does not mean "minimal", as a relevant proportion of the preterm infants will develop academic and behavioural problems at school age. Early onset disorders consist of abnormal general movements (GMs), transient dystonia and postural instability; these conditions usually fade during the first months. They were underestimated in the past; recently, qualitative assessment of GMs using Prechtl's method has become a major item of the neurological examination. Late onset disorders include developmental coordination disorder (DCD) and/or minor neurological dysfunction (MND): both terms cover partly overlapping problems. Simple MND (MND-1) and complex MND (MND-2) can be identified and MND-2 gives a higher risk for learning and behavioural disorders. A relationship between the quality of GMs and MND in childhood has been recently described. The Touwen infant neurological examination (TINE) can reliably detect neurological signs of MND even in infancy. However, the prognostic value of these disorders requires further investigations.
    Full-text · Article · May 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
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    ABSTRACT: Herpes simplex virus is an important cause of neonatal infection, which can lead to death or long-term disabilities. Rarely in utero, the transmission frequently occurs during delivery. The disease may be disseminated, localized to the central nervous system, or involving skin, eye and/or mouth. Mortality rates markedly decreased with high-dose antiviral treatment. Diagnosis of neonatal infection is based on viral isolation from ulcerated vesicles or by scarifying mucocutaneous lesions. Recently polymerase chain reaction plays a central role for both viral detection (skin, mucosal, cerebrospinal fluid samples) and response to therapy. Vertical transmission may be decreased by prophylactic antiviral treatment.
    No preview · Article · Oct 2011 · 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
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    ABSTRACT: To correlate the site and severity of brain lesions seen on magnetic resonance imaging (MRI) with the quality of general movements in term infants with hypoxic-ischemic encephalopathy (HIE) and compare the prognostic value of general movements and MRI for motor outcome. Early brain MRI scans in 34 term infants with HIE not treated with hypothermia were reviewed and scored for site of injury and lesion pattern by an experienced neuroradiologist. General movement quality and trajectories at 1 and 3 postnatal months were evaluated. Motor outcome was assessed at 24 months. MRI scores for the basal ganglia and thalami, posterior limb of the internal capsule, white matter, and cortex and lesion patterns were correlated with 1-month and 3-month general movements and general movement trajectories; central gray matter scores were correlated most strongly with cramped-synchronized general movements and abnormal motor outcome. MRI scores were 100% sensitive and 72.2% specific for motor outcome, and cramped-synchronized general movements were 100% specific and 68.7% sensitive for motor outcome. In term infants with HIE, the site and severity of brain lesions seen on early MRI are highly correlated with general movements. Central gray matter damage leads to cramped-synchronized general movements and poor motor outcome. Early MRI scans and general movements are complementary tools for predicting motor outcome.
    No preview · Article · Jun 2011 · The Journal of pediatrics