Lucia Marrozzini’s research while affiliated with University of Modena and Reggio Emilia and other places

Introduction Maternal pre-pregnancy overweight status might create a chronic systemic inflammatory environment for the foetus, impairing neurons development. The Motor Optimality Score-Revised (MOS-R) is an established tool to assess infant spontaneous movement at 3-5 months helping predict later neurodevelopmental outcomes in infants, including language, minor neurological dysfunction or learning difficulties at school age. The aim of our study was to investigate if maternal BMI together with other characteristics were potentially associated with MOS-R score at 3-5 months in a sample of newborns representative of physiologic full-term pregnancies. Methods 128 mother-children couples were enrolled in the Hospital of Modena, Italy. Mothers’ socio-demographic characteristics and BMI pre and during pregnancy were collected. MOS-R was assessed in infants within 9-18 weeks post term age (Median 13, IQR 12-14). Descriptive statistics, bivariate associations and multivariate analysis were performed. Results In our sample, 94.5% of infants (44% females) had a MOS-R≥25 (optimal score), 3.9% a MOS-R between 23-24 and 1.6% a MOS-R<23. In bivariate analyses pre-pregnancy BMI≥25 and weight gain higher than recommended during pregnancy were associated with MOS-R<25 (p < 0.05); being unemployed before and during pregnancy and having pregnancy during COVID lockdown were associated with reduced “age adequate movement repertoire” subcategory (p < 0.05). In multivariate analysis, pre-pregnancy BMI≥25 remained the only factor significantly associated with lower scores (p < 0.05). Discussion Our sample of healthy infants showed a typical range of spontaneous movements reflecting neural integrity. However, lower MOS-R scores were associated with pre-pregnancy overweight. This finding reinforce the importance of enhancing public health actions targeted at keeping a weight in the normal range to protect from a large number of unhealthy conditions both the mother and the offspring. Key messages • Pre-pregnancy weight appears associated with infant spontaneous movement in 3-5 months infants. • Public health actions targeted at keeping female weight in the normal range must be strengthen.

Enteroviruses (EV) are a relevant source of infection in paediatric patients. The majority of cases concerns the neonatal period and the first months of life. Due to their extreme epidemiological fluctuations, molecular epidemiology is crucial to understand the circulation of main serotypes in a specific area and period. The gold standard for the diagnosis currently relies on Polymerase Chain Reaction (PCR) assay to detect EV RNA in biological samples (usually cerebrospinal fluid and plasma, but also throat swabs and faeces). EV infections usually have a benign course and prognosis. Nevertheless, they may become life threatening, especially when the onset of symptoms occurs in the first days of life. Mortality is associated with myocarditis, hepatitis and multi-organ failure. Neurodevelopmental sequelae have been reported in cases of severe infection with central nervous system involvement (such as meningo-encephalitis). Even though the use of specific antiviral agents in severe neonatal infections has been reported in single cases or studies including few neonates, the current treatment of EV infections remains mainly supportive and further studies are needed to endorse the use of these drugs in clinical practice.

Objective: This study aims to evaluate safety and success rates of lumbar puncture (LP) and to identify factors associated with adverse events or failure of LP in infants. Methods: This two-center prospective observational study investigated infants younger than 90 days of age who underwent LP. Need for resuscitation oxygen desaturation (SpO 2 < 90%), bradycardia and intraventricular hemorrhage were considered adverse events. LP failed if cerebrospinal spinal fluid was not collected or had traces of blood. Logistic regression analysis was used to evaluate whether corrected gestational age (GA), body weight at LP, position, and any respiratory support during LP affected SpO 2 desaturation or failure of LP. Results: Among 204 LPs, 134 were performed in full-term and 70 in pre-term born infants. SpO 2 desaturations occurred during 45 (22.4%) LPs. At multivariate analysis, lower GA at LP ( p < 0.001), non-invasive respiratory support ( p 0.007) and mechanical ventilation ( p 0.004) were associated with SpO 2 desaturations. Transient, self-resolving bradycardia occurred in 7 (3.4%) infants. Two infants had intraventricular hemorrhage detected within 72 h of LP. No further adverse events were registered. Failure of LP occurred in 38.2% of cases and was not associated with any of the factors evaluated. Conclusions: LP was safe in most infants. Body weight or GA at LP did not affect LP failure. These data are useful to clinicians, providing information on the safety of the procedure.

Hypothalamic-pituitary-gonadal (HPG) axis activation occurs three times in life: the first is during fetal life, and has a crucial role in sex determination, the second time is during the first postnatal months of life, and the third is with the onset of puberty. These windows of activation recall the three windows of the “Developmental Origin of Health and Disease” (DOHaD) paradigm and may play a substantial role in several aspects of human development, such as growth, behavior, and neurodevelopment. From the second trimester of pregnancy there is a peak in gonadotropin levels, followed by a decrease toward term and complete suppression at birth. This is due to the negative feedback of placental estrogens. Studies have shown that in this prenatal HPG axis activation, gonadotropin levels display a sex-related pattern which plays a crucial role in sex differentiation of internal and external genitalia. Soon after birth, there is a new increase in LH, FSH, and sex hormone concentrations, both in males and females, due to HPG re-activation. This postnatal activation is known as “minipuberty.” The HPG axis activity in infancy demonstrates a pulsatile pattern with hormone levels similar to those of true puberty. We review the studies on the changes of these hormones in infancy and their influence on several aspects of future development, from linear growth to fertility and neurobehavior.

Puberty is the process of physical changes between childhood and adulthood during which adolescents reach sexual maturity and become capable of reproduction. It is considered one of the main temporal windows of susceptibility for the influence of the endocrine-disrupting chemicals (EDCs). EDCs may act as single chemical agents or as chemical mixtures; they can be pubertal influencers, accelerating and anticipating the processing of maturation of secondary sexual characteristics. Moreover, recent studies have started to point out how exposure to EDCs during puberty may predispose to breast cancer later in life. In fact, the estrogen-mimicking endocrine disruptors (EEDs) may influence breast tissue development during puberty in two main ways: the first is the action on the proliferation of the breast stromal cells, the second concerns epigenetic mechanisms. The aim of this mini-review was to better highlight what is new and what is not completely known regarding the role of EDCs during puberty.

Meningitis occurs frequently in neonates and can lead to a number of acute, severe complications and long-term disabilities. An early diagnosis of neonatal meningitis is essential to reduce mortality and to improve outcomes. Initial clinical signs of meningitis are often subtle and frequently overlap with those of sepsis, and current haematologic tests do not distinguish sepsis from meningitis. Thus, lumbar puncture remains the gold standard for the diagnosis of meningitis in infants, and this procedure is recommended in clinical guidelines. Nevertheless, in clinical practice, lumbar puncture is frequently deferred or omitted due to concerns regarding hypothetical adverse events or limited experience of the performer. Future studies should assess whether a combination of clinical findings and select haematological tests at disease onset can identify those neonates with the highest risk of meningitis who should undergo lumbar puncture. Furthermore, clinicians should be convinced that the actual benefits of an early diagnosis of meningitis far outweigh the hypothetical risks associated with lumbar puncture.

Bacterial meningitis may cause long term disabilities or death, particularly at younger ages. Early diagnosis and prompt antibiotic therapy are essential for improving outcome. The diagnosis of meningitis in newborns and young infants is a challenge because symptoms and signs are frequently vague and non-specific, in particular at the onset of the disease. Cerebrospinal fluid culture and analysis remain nowadays the gold standard for diagnosis. Clinicians often defer lumbar puncture because of concerns of complications, although data concerning the risks of lumbar puncture at younger ages are poorly defined. Perhaps a combination of laboratory markers and selected clinical symptoms at the onset of meningitis would identify neonates with higher risk of meningitis who should necessarily undergo lumbar puncture. Currently, clinicians should be aware that the advantage of an early diagnosis of meningitis through lumbar puncture overcomes the risks related to the procedure.