Background: acute bronchiolitis is frequently diagnosed in infants, involves small airways. It’s ... more Background: acute bronchiolitis is frequently diagnosed in infants, involves small airways. It’s often followed by recurrent wheeze. Lung Clearance Index(LCI) is a marker of VI derived from MBW test. It’s more sensible than spirometry indices to detect abnormalities inperipheral lung regions and is easy to obtain also in young children. Aims: analyze and compare MBW indices among children previously hospitalized for acute bronchiolitis (PB), age-matched healthy controls (HC) and Cystic Fibrosis (CF) children. Methods: Prospective longitudinal study including PB children hospitalized in our Emergency Department 5-6 years ago, CF with no relevant airway colonization, and HC. Anamnestic and clinical data were collected during follow-up together with LCI, indices of VI arising in the conductive (Scond) and acinar (Sacin) zones, calculated from N2-MBW. Results: 29 PB,20 CF and 15 HC were recruited. PB had higher LCI levels than HC(p Conclusion: Bronchiolitis could lead to impaired lung function at preschool age. LCI is an easy-to-use sensible marker of ventilation inhomogeneity, also in asymptomatic and non-chronic patients.
Background and aim of the work: The EXIT-to-airway procedure is aimed to provide the time require... more Background and aim of the work: The EXIT-to-airway procedure is aimed to provide the time required to secure airways when an extrinsic or intrinsic fetal mass raise concerns about airways control at delivery. Due to the rarity of the procedure, we aim to provide a summary of the appropriate prenatal planning by a multidisciplinary team. Methods: Report of a case of EXIT-to-airway procedure. Results: A 30 years-old woman, G2P1 with previous cesarean section, was referred to our Unit at 34 gestational weeks due to a fetal cervical mass of 7cm. An EXIT-to-airways procedure was performed by a multidisciplinary team after accurate preoperative planning and the practice simulations. The partial fetal extraction and the amnioinfusion of pre-heated saline were used to prevent fetal complications. The use of supplemental intravenous anesthesia with remifentanil and better control of uterine tone with nitroglycerin allowed reducing the exposure to volatile halogen for both the mother and the fetus. The accurate preoperative planning and the practice simulations allowed us to perform the treatment safely in urgency due to the onset of spontaneous labor at 37 weeks and 6 days. Conclusions: The strong cooperation among specialists, accurate prenatal planning, and adopting all the required procedures and precautions are of paramount importance to successfully perform the EXIT-to-airway procedure.
To assess reproducibility and accuracy of left ventricular output (LVO) quantifications in neonat... more To assess reproducibility and accuracy of left ventricular output (LVO) quantifications in neonates, when left ventricular outflow tract diameter (LVOTD) was measured at the hinges of the aortic valve (AV), at the aortic sinus (AS), and at the sinotubular junction (STJ).
The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcar... more The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality of care. In particular, mitigation strategies adopted to combat the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower fa...
We report herein the case of a child hospitalized for suspected seizures, with severe life-threat... more We report herein the case of a child hospitalized for suspected seizures, with severe life-threatening upper respiratory obstruction from tonsillar and adenoid hypertrophy who needed persistent intubation before surgical removal. The day after intubation, an elective extubation, was followed by the position of a sleep study device (SOMNOscreenTM PSG, SOMNOmedics GmbH, Randersacker, Germany). Measurements were interrupted after 1/2 hour because appearance of prolonged apnea and severe desaturations
Introduction: Both surgical techniques for correction of congenital heart diseases (CHD) and intr... more Introduction: Both surgical techniques for correction of congenital heart diseases (CHD) and intraoperatory neurologic protection improved during the last 20 years. Nevertheless cardiac surgery is still a risk for neurologic morbidity. Methods and patients: Analysis of the postoperative neurologic status of infants younger than 6 months who underwent cardiac surgery from January 1998 to December 1999. We reviewed the EEG tracings, cranial ultrasound reports (CUS) and CT scans of 48 patients. Diagnoses were: ventricular septal defect = 15, Fallot (TOF) = 9, patent ductus arteriosus (PDA) = 5, coarctation of aorta = 4, atrio-ventricular septal defect = 4, transposition of great arteries (TGA) = 3, hypoplastic left heart syndrome = 2, pulmonary atresia = 2, total anomalous pulmonary veins drainage = 2, double outlet right ventricle = 1, cor triatriatum = 1. Mean age (range) at intervention was 54 days (2-150), 44 infants (91.7%) survived at follow-up: 23 EEG, 22 CUS and 2 CT were performed in the recent postoperative. Among survivors 5/44 had neurologic complications. EEG was altered in 4: two of them (1 TOF, 1 TGA) had pathologic CUS and CT as well (ischemic pattern in the former, atrophy in the latter). Finally a preterm newborn with PDA had mild abnormalities at CUS. After a mean follow-up of 16 +/- 6 months 3/5 patients had mild-to-moderate psychomotor delay and 2 recovered. Conclusions: According to our preliminary data the prevalence of neurologic complications in infants who undergo cardiac surgery seems to be low. The pathological findings of the recent postoperative seem to recover up to normalization in some cases at mid-term follow-up. As expected, permanent complications effect more often complex CHD. Further follow-up studies to school age will be mandatory to check the very final results of cardiac surgery performed during early infancy.
Background: acute bronchiolitis is frequently diagnosed in infants, involves small airways. It’s ... more Background: acute bronchiolitis is frequently diagnosed in infants, involves small airways. It’s often followed by recurrent wheeze. Lung Clearance Index(LCI) is a marker of VI derived from MBW test. It’s more sensible than spirometry indices to detect abnormalities inperipheral lung regions and is easy to obtain also in young children. Aims: analyze and compare MBW indices among children previously hospitalized for acute bronchiolitis (PB), age-matched healthy controls (HC) and Cystic Fibrosis (CF) children. Methods: Prospective longitudinal study including PB children hospitalized in our Emergency Department 5-6 years ago, CF with no relevant airway colonization, and HC. Anamnestic and clinical data were collected during follow-up together with LCI, indices of VI arising in the conductive (Scond) and acinar (Sacin) zones, calculated from N2-MBW. Results: 29 PB,20 CF and 15 HC were recruited. PB had higher LCI levels than HC(p Conclusion: Bronchiolitis could lead to impaired lung function at preschool age. LCI is an easy-to-use sensible marker of ventilation inhomogeneity, also in asymptomatic and non-chronic patients.
Background and aim of the work: The EXIT-to-airway procedure is aimed to provide the time require... more Background and aim of the work: The EXIT-to-airway procedure is aimed to provide the time required to secure airways when an extrinsic or intrinsic fetal mass raise concerns about airways control at delivery. Due to the rarity of the procedure, we aim to provide a summary of the appropriate prenatal planning by a multidisciplinary team. Methods: Report of a case of EXIT-to-airway procedure. Results: A 30 years-old woman, G2P1 with previous cesarean section, was referred to our Unit at 34 gestational weeks due to a fetal cervical mass of 7cm. An EXIT-to-airways procedure was performed by a multidisciplinary team after accurate preoperative planning and the practice simulations. The partial fetal extraction and the amnioinfusion of pre-heated saline were used to prevent fetal complications. The use of supplemental intravenous anesthesia with remifentanil and better control of uterine tone with nitroglycerin allowed reducing the exposure to volatile halogen for both the mother and the fetus. The accurate preoperative planning and the practice simulations allowed us to perform the treatment safely in urgency due to the onset of spontaneous labor at 37 weeks and 6 days. Conclusions: The strong cooperation among specialists, accurate prenatal planning, and adopting all the required procedures and precautions are of paramount importance to successfully perform the EXIT-to-airway procedure.
To assess reproducibility and accuracy of left ventricular output (LVO) quantifications in neonat... more To assess reproducibility and accuracy of left ventricular output (LVO) quantifications in neonates, when left ventricular outflow tract diameter (LVOTD) was measured at the hinges of the aortic valve (AV), at the aortic sinus (AS), and at the sinotubular junction (STJ).
The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcar... more The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality of care. In particular, mitigation strategies adopted to combat the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower fa...
We report herein the case of a child hospitalized for suspected seizures, with severe life-threat... more We report herein the case of a child hospitalized for suspected seizures, with severe life-threatening upper respiratory obstruction from tonsillar and adenoid hypertrophy who needed persistent intubation before surgical removal. The day after intubation, an elective extubation, was followed by the position of a sleep study device (SOMNOscreenTM PSG, SOMNOmedics GmbH, Randersacker, Germany). Measurements were interrupted after 1/2 hour because appearance of prolonged apnea and severe desaturations
Introduction: Both surgical techniques for correction of congenital heart diseases (CHD) and intr... more Introduction: Both surgical techniques for correction of congenital heart diseases (CHD) and intraoperatory neurologic protection improved during the last 20 years. Nevertheless cardiac surgery is still a risk for neurologic morbidity. Methods and patients: Analysis of the postoperative neurologic status of infants younger than 6 months who underwent cardiac surgery from January 1998 to December 1999. We reviewed the EEG tracings, cranial ultrasound reports (CUS) and CT scans of 48 patients. Diagnoses were: ventricular septal defect = 15, Fallot (TOF) = 9, patent ductus arteriosus (PDA) = 5, coarctation of aorta = 4, atrio-ventricular septal defect = 4, transposition of great arteries (TGA) = 3, hypoplastic left heart syndrome = 2, pulmonary atresia = 2, total anomalous pulmonary veins drainage = 2, double outlet right ventricle = 1, cor triatriatum = 1. Mean age (range) at intervention was 54 days (2-150), 44 infants (91.7%) survived at follow-up: 23 EEG, 22 CUS and 2 CT were performed in the recent postoperative. Among survivors 5/44 had neurologic complications. EEG was altered in 4: two of them (1 TOF, 1 TGA) had pathologic CUS and CT as well (ischemic pattern in the former, atrophy in the latter). Finally a preterm newborn with PDA had mild abnormalities at CUS. After a mean follow-up of 16 +/- 6 months 3/5 patients had mild-to-moderate psychomotor delay and 2 recovered. Conclusions: According to our preliminary data the prevalence of neurologic complications in infants who undergo cardiac surgery seems to be low. The pathological findings of the recent postoperative seem to recover up to normalization in some cases at mid-term follow-up. As expected, permanent complications effect more often complex CHD. Further follow-up studies to school age will be mandatory to check the very final results of cardiac surgery performed during early infancy.
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Papers by Paolo Biban