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Objective. To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and... more
Objective. To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and NCPAP application (SURF-NCPAP group) demonstrate less need for mechanical ventilation (MV), compared with infants who receive MV after surfactant administration (SURF-MV group). Methods. A prospective randomized study was conducted, in which infants <30 weeks’ gestation were randomized to the SURF-NCPAP group or the SURF-MV group. Results. At 7 days of life, no patient in the SURFNCPAP group but 6 patients (43%) in the SURF-MV group still were undergoing MV. The duration of oxygen therapy, NCPAP, and MV, the need for a second dose of surfactant, and the length of stay in the intensive care unit were significantly greater in the SURF-MV group. Conclusions. The immediate reinstitution of NCPAP after surfactant administration for infants with infant respiratory distress syndrome is safe and beneficial, as indicated by the lesser need for MV and the briefer requirement for respiratory supports, compared with the institution of MV after surfactant treatment. Moreover, this strategy contributed to reducing the need for surfactant treatment and reducing the time and costs involved in keeping the infants in the neonatal intensive care unit. Pediatrics 2004;113:e560 –e563. URL: http: //www.pediatrics.org/cgi/content/full/113/6/e560; continuous positive airway pressure, mechanical ventilation, surfactant, respiratory distress syndrome, infant. ABBREVIATIONS. a/APo2, arterial/alveolar oxygen tension ratio; iRDS, infant respiratory distress syndrome; MV, mechanical ventilation; NCPAP, nasal continuous positive airway pressure; SURF-MV, mechanical ventilation after surfactant treatment; SURF-NCPAP, nasal continuous positive airway pressure after surfactant treatment; Fio2, fraction of inspired oxygen; IVH, intraventricular hemorrhage; BPD, bronchopulmonary dysplasia; ROP, retinopathy of prematurity; PDA, patent ductus arteriosus. The cornerstones of treatment of infant respiratory distress syndrome (iRDS) are artificial respiratory support and surfactant treatment. Among respiratory support techniques, nasal continuous positive airway pressure (NCPAP)1 and mechanical ventilation (MV)2 are known for their effectiveness in reducing the mortality and morbidity rates associated with iRDS. Moreover, early application of NCPAP1 and early treatment with surfactant3 are effective in decreasing the need for MV, with its related adverse effects. Unfortunately, these results are not always taken into account in neonatal intensive care units, and MV is often initiated after endotracheal intubation for surfactant administration, without consideration of the fact that many infants who are able to breathe spontaneously could be supported with NCPAP only.4–7 The present study was planned to test the hypothesis that preterm infants ( 30 weeks’ gestation) with iRDS who were treated with NCPAP and surfactant administration followed by immediate reinstitution of NCPAP could fare better than those who received MV after surfactant administration and who were weaned progressively from MV. In particular, our aim was to determine whether the first strategy could reduce the need for MV during the subsequent clinical course of our patients.
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Our aim was to evaluate whether single and multiple intubation-surfactant-extubation (INSURE) procedures have similar effects on the need of mechanical ventilation (MV) and occurrence of bronchopulmonary dysplasia (BPD) in extremely... more
Our aim was to evaluate whether single and multiple intubation-surfactant-extubation (INSURE) procedures have similar effects on the need of mechanical ventilation (MV) and occurrence of bronchopulmonary dysplasia (BPD) in extremely preterm infants. We studied infants of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30 weeks of gestation with respiratory distress syndrome (RDS) who were treated with single (FiO(2)&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.30 without need of MV) or multiple (FiO(2)&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.40 without need of MV) INSURE procedures. Seventy-five infants were studied: 53 (71%) received single INSURE and 22 (29%) received multiple INSURE procedures. Infants in the single and multiple groups had similar rates of need of MV (15 vs. 23%) and occurrence of BPD (9 vs. 9%), although the latter were more immature and affected by more severe RDS (higher FiO(2), lower a/ApO(2), and pO(2)/FiO(2)) than the former. Single and multiple INSURE procedures were followed by similar respiratory outcome in a cohort of extremely preterm infants. Further studies are warranted to evaluate whether the multiple INSURE strategy enhances the success rate of INSURE in preventing the need of MV and the occurrence of BPD.
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Objective. Ibuprofen enhances cerebral blood flow autoregulation and was shown to protect neurologic functions after oxidative stresses in an animal model. For these reasons, we hypothesized that the prophylactic use of ibuprofen would... more
Objective. Ibuprofen enhances cerebral blood flow autoregulation and was shown to protect neurologic functions after oxidative stresses in an animal model. For these reasons, we hypothesized that the prophylactic use of ibuprofen would reduce the occurrence of intraventricular hemorrhage (IVH) and its worsening toward grades 2 to 4 among preterm infants. To confirm this hypothesis, we planned the present prospective study.Methods. This was a double-blind, randomized, controlled trial in which preterm infants with gestational ages of <28 weeks received ibuprofen or placebo within the first 6 hours of life. The infants were assigned randomly, at 7 neonatal care units, to receive ibuprofen (10 mg/kg, followed by 5 mg/kg after 24 and 48 hours) or placebo. Serial echoencephalography was performed 24 and 48 hours after the initial cerebral ultrasound study, on postnatal days 7, 15, and 30, and at 40 weeks' postconceptional age. Grade 1 IVH or no IVH was considered a successful outc...
Research Interests: Medicine, Italy, Humans, Female, Male, and 15 moreAnesthesia, Animal Model, Infants, Newborn Infant, Ibuprofen, Neonatal Intensive Care Unit, Gestational Age, Cerebral Blood Flow, Ductus Arteriosus, Cerebral Hemorrhage, Intraventricular Hemorrhage, Neuroprotective Agents, Adverse effect, Medical and Health Sciences, and Infant Premature
Objectives. To evaluate the effect of 2 cord-care regimens (salicylic sugar powder vs chlorhexidine as a 4% detergent water solution) on cord separation time and other outcomes in preterm infants.Methods. A prospective, randomized,... more
Objectives. To evaluate the effect of 2 cord-care regimens (salicylic sugar powder vs chlorhexidine as a 4% detergent water solution) on cord separation time and other outcomes in preterm infants.Methods. A prospective, randomized, controlled trial was conducted on 244 preterm newborns with a gestational age of <34 weeks and a birth weight of <2500 g. All preterm newborns were enrolled, regardless of their health condition. We excluded from the study infants whose conditions during the first hours of life required the catheterization of umbilical vessels. We also excluded from the general statistical analysis all newborns who had their programmed cord-care regimen changed because of the presence or the suspicion of omphalitis. On arrival at our neonatal intensive care unit or neonatal special care unit, infants were bathed thoroughly with a soap solution (Saugella, Guieu, Italy), and the umbilical cord (UC) was treated with 1 of the 2 antiseptic products chosen for the study. ...
Research Interests: Pediatrics, Medicine, Prospective studies, Humans, Female, and 15 moreMale, Sucrose, Time Factors, Chlorhexidine, Neonatal Intensive Care Unit, Gestational Age, Antisepsis, Salicylic Acid, Bandages, Psychology and Cognitive Sciences, Infant Care, Premature infant, Medical and Health Sciences, Cord, and Infant Premature
Objective. To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and... more
Objective. To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and NCPAP application (SURF-NCPAP group) demonstrate less need for mechanical ventilation (MV), compared with infants who receive MV after surfactant administration (SURF-MV group).Methods. A prospective randomized study was conducted, in which infants <30 weeks’ gestation were randomized to the SURF-NCPAP group or the SURF-MV group.Results. At 7 days of life, no patient in the SURF-NCPAP group but 6 patients (43%) in the SURF-MV group still were undergoing MV. The duration of oxygen therapy, NCPAP, and MV, the need for a second dose of surfactant, and the length of stay in the intensive care unit were significantly greater in the SURF-MV group.Conclusions. The immediate reinstitution of NCPAP after surfactant administration for infants with infant resp...
Research Interests: Pediatrics, Medicine, Prospective studies, Humans, Female, and 14 moreMale, Anesthesia, Length of Stay, Newborn Infant, Mechanical Ventilation, Neonatal Intensive Care Unit, Ventilator Weaning, Respiratory distress, Continuous Positive Airway Pressure, Psychology and Cognitive Sciences, Respiratory distress syndrome, Medical and Health Sciences, Infant Premature, and Respiration Artificial
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Objectives: To compare the ultrasound examination with pH-metry in order to evaluate the diagnostic accuracy of sonography for diagnosis of gastro-oesophageal reflux (GOR) in preterm infants. Methods: A prospective study was conducted on... more
Objectives: To compare the ultrasound examination with pH-metry in order to evaluate the diagnostic accuracy of sonography for diagnosis of gastro-oesophageal reflux (GOR) in preterm infants. Methods: A prospective study was conducted on 31 premature infants <34 weeks with clinically diagnosed GOR. First, they underwent 24-hour pH-monitoring; successively, the sonographic assessment was performed within 12 h after pH-monitoring. The two operators who performed the pH-monitoring and sonography respectively, were unaware of each other’s results. Results: Twenty-one patients (67.7%) had significant GOR with a reflux index >5 (GOR group). The median (range) reflux index in this group was 9.19% (6.04–20.1). Ten newborns (32.3%) did not have significant GOR with a reflux index <5. Sonography was positive for GOR in 8 patients (25.8%); all 8 infants with sonographic diagnosis of GOR had a reflux index >5. Therefore, sonographic diagnosis did not produce false positives. Sonogra...
Research Interests: Neonatology, Medicine, Humans, Female, Male, and 15 moreEsophageal pH monitoring, Clinical Sciences, Newborn Infant, Gastro, Diagnostic Accuracy, Indexation, Gastroesophageal Reflux, Predictive value of tests, Positive predictive value, False Negative, False Positive, Fetal Monitoring, Negative predictive value, Paediatrics and reproductive medicine, and Infant Premature
Background: Doxapram is a respiratory stimulant widely used for the treatment of idiopathic apnea of prematurity, although it has been demonstrated that it can induce a transient decrease of cerebral blood flow and that isolated mental... more
Background: Doxapram is a respiratory stimulant widely used for the treatment of idiopathic apnea of prematurity, although it has been demonstrated that it can induce a transient decrease of cerebral blood flow and that isolated mental delay in infants weighing <1,250 g is associated with the total dosage and duration of doxapram therapy. Objectives: To evaluate the effects of doxapram on cerebral hemodynamics in preterm infants using cerebral Doppler ultrasonography and near-infrared spectroscopy. Methods: Preterm infants who required treatment with doxapram for apnea of prematurity unresponsive to caffeine were treated with doxapram at an hourly dose of 0.5 mg·kg–1·h–1, followed by 1.5 and 2.5 mg·kg–1·h–1. Results: 20 preterm infants were studied. Doxapram induced a significant decrease of oxygenated hemoglobin (O2Hb) and cerebral intravascular oxygenation (HbD = O2Hb – HHb) and an increase of HHb and CtOx concentrations, while cerebral blood volume and cerebral blood flow velo...
Research Interests: Neonatology, Medicine, Birth Weight, Brain, Prospective studies, and 15 moreHumans, Near Infrared Spectroscopy, Anesthesia, Clinical Sciences, Newborn Infant, Oxygen, Gestational Age, Apnea, Cerebral Blood Flow, Blood Flow Velocity, Oxygen Consumption, Case Control Studies, Cerebral Blood Volume, Paediatrics and reproductive medicine, and Infant Premature
Inborn metabolic diseases, such as disorders in pyruvate metabolism, in gluconeogenesis or in the respiratory chain, may present with lactic acidosis in newborn infants. A simple tool to screen for the efficacy of mitochondrial oxidation... more
Inborn metabolic diseases, such as disorders in pyruvate metabolism, in gluconeogenesis or in the respiratory chain, may present with lactic acidosis in newborn infants. A simple tool to screen for the efficacy of mitochondrial oxidation reduction activity is the detection of the redox status through simultaneous measurements of plasma lactate, pyruvate and ketone bodies, which are strongly influenced by feeding and stress. We present the redox status values of 55 very-low birth-weight infants under different nutritional conditions. We were able to demonstrate that the redox status values are not dependent on the type of nutrition (oral feeding or continuous enteral nutrition). Instead we observed a strong difference between newborns with intrauterine growth retardation and newborns with appropriate growth. Newborns with intrauterine growth retardation show lower preprandial values of glucose and ketone bodies than newborns with appropriate weight, but higher levels of lactate and p...
Research Interests: Neonatology, Medicine, Prospective studies, Humans, Glucose, and 15 moreFemale, Male, Clinical Sciences, Newborn Infant, Gluconeogenesis, Metabolic Acidosis, Lactic Acid, Ketone Bodies, Oxidation-Reduction, Enteral Nutrition, Lactic acidosis, Paediatrics and reproductive medicine, Fetal Growth Retardation, Infant nutritional physiological phenomena, and very low birth weight
Research Interests: Magnetic Resonance Imaging, Medicine, Syphilis, Perinatal Medicine, Pregnancy, and 15 moreHumans, Male, Brain Ischemia, Clinical Sciences, Newborn Infant, Lesion, Gestational Age, Neonatal Intrahepatic Cholestasis, Clinical Presentation, Cerebral Hemorrhage, Congenital syphilis, endarteritis, Paediatrics and reproductive medicine, Fatal outcome, and Infant Premature
Research Interests: Pediatrics, Medicine, Humans, Hyperglycemia, Insulin, and 13 moreDiabetes mellitus, Female, Differential Diagnosis, Pediatric, Newborn Infant, Oral Hypoglycemic Agents, Type 2 Diabetes Mellitus, Exocrine Pancreatic Insufficiency, Syndrome, Bone and Bones, neutropenia, Medical and Health Sciences, and Fatal outcome
Research Interests: Nutrition, Incidence Geometry, Medicine, Breastfeeding, Birth Weight, and 15 morePopulation, Humans, Mothers, Incidence, Pediatric, Newborn Infant, Analysis of Variance, Breast feeding, Maternal Behavior, Educational Status, Parity, Gestational Age, Gestation, Occupations, and Medical and Health Sciences
Linear branching echogenicities in the thalamus or basal ganglia have been reported in infants with several genetic and nongenetic disorders. In this article, we report 2 cases of newborns with a neurosonographic diagnosis of... more
Linear branching echogenicities in the thalamus or basal ganglia have been reported in infants with several genetic and nongenetic disorders. In this article, we report 2 cases of newborns with a neurosonographic diagnosis of thalamic/basal ganglia vasculopathy and karyotype analysis showing pericentric inversion of chromosome 2. To our knowledge, there has been no previous mention of an association between these entities. © 2005 Wiley Periodicals, Inc. J Clin Ultrasound 33:146–148, 2005
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Research Interests: Medicine, Humans, Ultrasonography, INTENSIVE CARE, Female, and 15 moreResuscitation, Male, Clinical Sciences, Newborn Infant, Public health systems and services research, Retrospective Studies, Intensive Care Medicine, Neonatal Intensive Care Unit, Central Venous Catheter, Clinical Presentation, Equipment Design, cardiac tamponade, Peripherally Inserted Central Catheter, Pericardiocentesis, and Infant Premature
Research Interests: Stratification, Medicine, Birth Weight, Dopamine, Prospective studies, and 15 moreHumans, Female, Male, Hypothyroidism, Newborn Infant, European, Public health systems and services research, Gestational Age, Observational Study, Congenital Hypothyroidism, Thyroid Stimulating Hormone, Paediatrics and reproductive medicine, Neonatal screening, Infant Premature, and Thyrotropin
Research Interests: Cognitive Science, Pediatrics, Incidence Geometry, Medicine, Birth Weight, and 15 moreErythropoietin, Prospective studies, Humans, Iron, Logistic Regression Analysis, Clinical Sciences, Newborn Infant, Early human dispersal, Blood Transfusion, Gestational Age, Observational Study, Logistic Models, Ophthalmoscopy, Respiratory distress syndrome, and Infant Premature
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Research Interests: Cardiology, Medicine, Birth Weight, Brain, Humans, and 13 moreFemale, Male, Newborn Infant, Gestational Age, Cerebral Blood Flow, Reference Values, Blood Flow Velocity, Middle Cerebral Artery, Vascular Resistance, Medical and Health Sciences, cerebral arteries, Infant Premature, and anterior cerebral artery
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The purpose of this study is to determine the changes in skin temperature of hyperbilirubinemic term newborns under conventional and fiberoptic phototherapy. The study included a group of 41 hyperbilirubinemic, but otherwise healthy, term... more
The purpose of this study is to determine the changes in skin temperature of hyperbilirubinemic term newborns under conventional and fiberoptic phototherapy. The study included a group of 41 hyperbilirubinemic, but otherwise healthy, term infants, all of appropriate size for gestational age. The study was devised to include two separate groups: group 1 of 21 infants (51.2%) received conventional phototherapy, and group 2 of 20 infants (48.8%) received fiberoptic phototherapy. In both groups the surface temperature on the forehead, abdomen, left leg and back was calculated by infrared radiation thermometer (Cyclops Compac 3, Minolta, Land, England). A &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Photo-Therapie 800 Heraeus&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; unit (Drager, Lübeck, Germany) was used for conventional phototherapy (CPT). A &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Biliblanket PT system&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (Ohmeda, Louisville, KY) was used for fiberoptic phototherapy (FO-PT). In our study we did not find significant differences of skin temperature in the four areas examined in the two groups prior to phototherapy. During conventional phototherapy, mean values of skin temperature were found to be significantly higher than those found before phototherapy. During fibreoptic phototherapy no statistically significant temperature differences were found on the forehead, abdomen, leg, and back before and during phototherapy. Furthermore, a statistically significant increase in skin temperature was found during phototherapy on the forehead, abdomen, leg, and back in patients of group 1 with respect to patients of group 2. We demonstrated that fibreoptic phototherapy, in contrast to conventional phototherapy, does not induce a significant increase in skin temperature.
Research Interests: Nonparametric Statistics, Comparative Study, Medicine, Probability, Phototherapy, and 15 moreProspective studies, Complication, Humans, Female, Male, American, Forehead, Clinical Sciences, Newborn Infant, Optical fiber, Neonatal Jaundice, Fiber Optic Technology, Abdomen, Cohort Studies, and Paediatrics and reproductive medicine
Research Interests: Medicine, Prospective studies, Humans, Hemodynamics, Female, and 15 moreMale, Small for Gestational Age, Newborn Infant, Blood Flow, Internal medicine Doppler ultrasonography, Enteral Feeding, Gestational Age, Blood Flow Velocity, Parenteral Nutrition, Predictive value of tests, Enteral Nutrition, Vascular Resistance, Postprandial Lipemia, Superior mesenteric artery, and Paediatrics and reproductive medicine
Some extremely preterm infants experience spontaneous closure of the ductus arteriosus. On the other side, a high percentage (22-30%) of preterm infants born at the lower gestational age fail to respond to a single course of ibuprofen. To... more
Some extremely preterm infants experience spontaneous closure of the ductus arteriosus. On the other side, a high percentage (22-30%) of preterm infants born at the lower gestational age fail to respond to a single course of ibuprofen. To assess if there are clinical characteristics effective as predictive factors for spontaneous closure of the ductus arteriosus, development of patent ductus arteriosus (PDA) and ibuprofen-resistant PDA. A cohort of inborn infants less than 28 weeks of gestation were prospectively studied. We distinguished infants who had spontaneous closure of ductus arteriosus, who developed PDA and who developed ibuprofen-resistant PDA. We studied 34 infants. Eight infants (24%) had spontaneous closure of PDA, 17 infants (50%) had a closure of PDA following the first ibuprofen course, while 9 infants (26%) failed to respond to the first ibuprofen course. Infants born at 23-25 weeks of gestation were found to have lower likelihood of PDA spontaneous closure, and higher risk of developing PDA refractory to ibuprofen therapy. Sepsis was found to increase significantly the risk of ibuprofen failure in closing PDA. An important percentage of extremely preterm infants exhibited spontaneous closure of PDA. Among clinical characteristics lowest gestational ages predict PDA and ibuprofen-resistant PDA, while sepsis predicts only ibuprofen-resistant PDA.
Research Interests: Treatment Outcome, Medicine, Prospective studies, Humans, Kidney, and 13 moreDrug Resistance, Sepsis, Blood Coagulation, Newborn Infant, Ibuprofen, ACTA, Gestational Age, Gestation, Ductus Arteriosus, Logistic Models, Paediatrics and reproductive medicine, Infant Premature, and Respiration Artificial
Aim: To test the hypothesis that inhaled nitric oxide therapy can decrease the incidence of bronchopulmonary dysplasia and death in preterm infants with severe respiratory distress syndrome; to evaluate the possible predictive factors for... more
Aim: To test the hypothesis that inhaled nitric oxide therapy can decrease the incidence of bronchopulmonary dysplasia and death in preterm infants with severe respiratory distress syndrome; to evaluate the possible predictive factors for the response to inhaled nitric oxide therapy. Methods: Preterm infants (less than 30 weeks’ gestation) were randomized to receive during the first week of life inhaled nitric oxide, or nothing, if they presented severe respiratory distress syndrome. Then, the treated infants were classified as non responders and responders. Results: Twenty infants were enrolled in the inhaled nitric oxide therapy group and 20 in the control group. Bronchopulmonary dysplasia and death were less frequent in the inhaled nitric oxide group than in the control group (50 vs. 90%, p=0.016). Moreover, nitric oxide treatment was found to decrease as independent factor the combined incidence of death and BPD (OR=0.111; 95% C.I. 0.02–0.610). A birth weight lower than 750 gram...
Research Interests: Incidence Geometry, Treatment Outcome, Medicine, Birth Weight, Humans, and 11 moreNitric oxide, Anesthesia, Newborn Infant, ACTA, Bronchopulmonary Dysplasia, Respiratory distress, Inhaled Nitric Oxide, Respiratory distress syndrome, Paediatrics and reproductive medicine, Bronchodilator agents, and Infant Premature
Aim: To assess the possible cerebral haemodynamic changes occurring in preterm infants after blood transfusions. Methods: Preterm infants who had undergone blood transfusions were prospectively studied using both near infrared... more
Aim: To assess the possible cerebral haemodynamic changes occurring in preterm infants after blood transfusions. Methods: Preterm infants who had undergone blood transfusions were prospectively studied using both near infrared spectroscopy and cerebral Doppler ultrasonography. Results: Fourteen infants (mean gestational age 29.6 wk, SD 2.6; mean birthweight 1430 g, SD 332) were studied at the mean age of 29 (SD 14) d. A significant increase in oxygenated haemoglobin (O2Hb), deoxygenated haemoglobin (HHb), mixed cerebral oxygen saturation (SmO2) and change in cerebral blood volume occurred after transfusion. Between ultrasound parameters, we found a decrease in diastolic velocity and an increase in resistance index. Conclusion: Blood transfusions improve cerebral oxygen supply and induce a decrease in cerebral blood volume, probably due to an increase in cerebral vessel resistance.
Research Interests: Treatment Outcome, Medicine, Probability, Prospective studies, Humans, and 15 moreHemodynamics, Near Infrared Spectroscopy, Female, Male, Confidence intervals, Anemia, Newborn Infant, Doppler, Internal medicine Doppler ultrasonography, Blood Transfusion, Sensitivity and Specificity, Cerebral Blood Flow, Blood Flow Velocity, Paediatrics and reproductive medicine, and Infant Premature
Aim: To evaluate the hypothesis that increasing levels of nasal continuous positive airway pressure (NCPAP) may decrease cerebral blood volume (CBV) and cerebral oxygenation in infants with gestational age (GA) less than 30 weeks.Methods:... more
Aim: To evaluate the hypothesis that increasing levels of nasal continuous positive airway pressure (NCPAP) may decrease cerebral blood volume (CBV) and cerebral oxygenation in infants with gestational age (GA) less than 30 weeks.Methods: We prospectively studied a cohort of preterm infants treated with NCPAP using near‐infrared spectroscopy (NIRS). The pressure limit of NCPAP was set at 2, 4, 6 and again 2 cm H2O for 30 min.Results: Changes of pressure levels were not followed by significant changes of oxygenated haemoglobin (O2Hb), deoxygenated haemoglobin (HHb), cerebral intravascular oxygenation (HbD), oxidized‐reduced cytochrome aa3 (CtOx), tissue oxygenation index (TOI), tissue haemoglobin index (THI) and cerebral blood volume (ΔCBV).Conclusion: NCPAP at 2–6 cm H2O pressure levels did not affect cerebral oxygenation and CBV. These findings are reassuring and confirm the safety of NCPAP in preterm infants with GA less than 30 weeks.
Research Interests: Functional Near Infrared Spectroscopy, Medicine, Brain, Humans, Hemodynamics, and 15 moreNear Infrared Spectroscopy, Female, Male, Anesthesia, Newborn Infant, Gestational Age, Cerebro, Hemoglobins, Oxygenation, Continuous Positive Airway Pressure, Continuo, health status indicators, Paediatrics and reproductive medicine, Continuous, and Infant Premature
Research Interests: Medicine, Humans, Magnesium, Female, Anesthesia, and 13 moreNewborn Infant, Public health systems and services research, Blood Flow, Internal medicine Doppler ultrasonography, Cerebral Blood Flow, Gestation, Blood Flow Velocity, Magnesium Sulfate, Middle Cerebral Artery, Vascular Resistance, Paediatrics and reproductive medicine, cerebral arteries, and Infant Premature
Research Interests: Medicine, Phototherapy, Brain, Prospective studies, Humans, and 13 moreHemodynamics, Female, Male, Anesthesia, Newborn Infant, Blood Flow, Internal medicine Doppler ultrasonography, Gestational Age, Fiber Optic Technology, Cerebral Blood Flow, Diastole, Medical and Health Sciences, and Infant Premature
Objective. The purpose of this study was to evaluate the development of significant hyperbilirubinemia in a large unselected newborn population in a metropolitan area with particular attention to the relationship between type of feeding... more
Objective. The purpose of this study was to evaluate the development of significant hyperbilirubinemia in a large unselected newborn population in a metropolitan area with particular attention to the relationship between type of feeding and incidence of neonatal jaundice in the first week of life. Study Design. A population of 2174 infants with gestational age ≥37 weeks was prospectively investigated during the first days of life. Total serum bilirubin determinations were performed on infants with jaundice. The following variables were studied: type of feeding, method of delivery, weight loss after birth in relationship to the type of feeding, and maternal and neonatal risk factors for jaundice. Statistical analyses were performed using thez test for parametric variables and the ttest for nonparametric variables. In addition, the multiple logistic regression allows for the estimation of the role of the individual characteristics in the development of hyperbilirubinemia. Data concern...
Research Interests: Pediatrics, Medicine, Logistic Regression, Breastfeeding, Birth Weight, and 15 morePopulation, Humans, Fasting, Blood groups, Jaundice, Bilirubin, Logistic Regression Analysis, Newborn Infant, Breast feeding, Cesarean Section, Gestational Age, Neonatal Jaundice, Logistic Models, Infant food, and Medical and Health Sciences
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The aim of the present study was to evaluate if high-frequency oscillatory ventilation (HFOV) might reduce lung inflammation in preterm infants with infant respiratory distress syndrome (RDS) in comparison with the early application of... more
The aim of the present study was to evaluate if high-frequency oscillatory ventilation (HFOV) might reduce lung inflammation in preterm infants with infant respiratory distress syndrome (RDS) in comparison with the early application of another potentially lung-protective ventilation strategy, such as pressure support ventilation plus volume guarantee (PSV + VG). Infants at less than 30 weeks of gestation with RDS were enrolled consecutively in the study if they required mechanical ventilation, and were randomly allocated to receive HFOV or PSV + VG. Bronchial aspirate samples for the measurement of interleukin (IL)-1beta, IL-8, and IL-10 were obtained before surfactant treatment (T1), after 6-18 hr of ventilation (T2), after 24-48 hr of ventilation (T3), and before extubation (T4). Thirteen patients were enrolled in the HFOV group, and 12 in the PSV + VG group. The mean values of IL-1beta, IL-8, and IL-10 at T4 were lower in the HFOV group than in the PSV + VG group. The present study demonstrates that early treatment with HFOV is associated with a reduction of lung inflammation in comparison with PSV + VG in preterm infants with RDS.
Research Interests: Cytokines, Inflammation, Treatment Outcome, Risk assessment, Lung Inflammation, and 15 moreProbability, Prospective studies, Humans, Female, Male, Follow-up studies, Pediatric, Pediatric Pulmonology, Newborn Infant, Survival Rate, Risk Assessment, Bronchopulmonary Dysplasia, Severity of Illness Index, Respiratory function tests, and Paediatrics and reproductive medicine
Prevention of bilirubin encephalopathy is based on the detection of infants at risk of developing a significant hyperbilirubinemia. This task can be accomplished by performing a simple umbilical cord blood test, such as blood group, Rh,... more
Prevention of bilirubin encephalopathy is based on the detection of infants at risk of developing a significant hyperbilirubinemia. This task can be accomplished by performing a simple umbilical cord blood test, such as blood group, Rh, Coombs&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; test and glucose-6-phosphate dehydrogenase, in order to detect hemolytic diseases. In preterm infants, the prevention of hyperbilirubinemia with phototherapy is a relatively simple task, since these infants are cared for in hospital. Early hospital discharge of full-term neonates represents a major concern. The management of neonatal jaundice requires that therapy begins when total serum bilirubin levels are significantly below the levels at which kernicterus is considered an immediate threat. Unfortunately, determination of serum bilirubin is a painful procedure, and is not very accurate since there is a high variability in laboratory measurements. The accuracy and precision of a new transcutaneous bilirubin measurement, comparable to the standard of care laboratory test, makes the daily evaluation of transcutaneous bilirubin measurement a useful tool in distinguishing physiological from nonphysiological hyperbilirubinemia, and determining the bilirubin increment in the first days of life. Full-term neonates who lose a significant amount of weight are especially at risk of significant hyperbilirubinemia and must be treated with ad libitum feeding and intensive phototherapy.
Research Interests:
Hemolysis may contribute to hyperbilirubinemia in Gilbert's syndrome. The authors examined blood carboxyhemoglobin corrected for inspired CO (COHbc) to index heme catabolism and serum conjugated bilirubin fractions to reflect... more
Hemolysis may contribute to hyperbilirubinemia in Gilbert's syndrome. The authors examined blood carboxyhemoglobin corrected for inspired CO (COHbc) to index heme catabolism and serum conjugated bilirubin fractions to reflect bilirubin conjugation. Both parameters were related to UDP-glucuronosyltransferase 1A1 (UGT) promoter polymorphism, associated with Gilbert's syndrome, in term male newborns. COHbc was expressed as percentage of total hemoglobin, and total conjugated
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Despite the role of reactive oxygen species in the development of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) in preterm infants, the anti-oxidant properties of commercial surfactants have never been studied.... more
Despite the role of reactive oxygen species in the development of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) in preterm infants, the anti-oxidant properties of commercial surfactants have never been studied. We measured the superoxide dismutase (SOD) and catalase (CAT) activity, the scavenger activity against hydrogen peroxide (H(2)O(2)), and its changes after the addition of SOD and CAT in four natural surfactants, namely Infasurf, Curosurf, Survanta, and Alveofact. We found that they contain measurable amount of SOD and CAT. Curosurf and Survanta seem to have higher antioxidant effect than Infasurf and Alveofact. Moreover, the highest phospholipid concentration and recommended dose of Curosurf imply that its scavenger activity for each treatment dose in preterm infants is likely higher than that of Survanta. Finally, the supplementation with SOD and CAT induced a remarkable increase of antioxidant action in all studied surfactants.