Backgorund Parents after Neonatal Intensive Care Unit (NICU) hospitalization of preterm infant ma... more Backgorund Parents after Neonatal Intensive Care Unit (NICU) hospitalization of preterm infant may develop psychopathological symptoms. The aim of the study was to determine how parental stress and psychophysical wellbeing affect posttraumatic symptoms (PTTS) in parents during the first year after NICU discharge. Moreover, this study aimed to explore any gender-specific difference in psychological distress among mothers and fathers. Methods Prospective study design from September 2018 to September 2019. 20 pairs of parents of preterm infants admitted to a tertiary-level NICU were enrolled. Primary outcome was evaluation of PTTS in parents of preterm infants at one year after NICU discharge through Impact of Event Scale- Revised. Secondary outcomes were: impact of parental stress, psychophysical wellbeing, anxiety and depression respectively through Parental Stressor Scale: NICU, Short Form Health Survey-36(SF-36), Self-rating Anxiety Scale and Self-rating Depression Scale. Results M...
La Pediatria medica e chirurgica: Medical and surgical pediatrics
The birth of a neonate with congenital malformation for the parents determines often a process of... more The birth of a neonate with congenital malformation for the parents determines often a process of adaptation with a phase of shock, a phase of incredibility and scare and, at last, one of adaptation and equilibration. The reactions of the parents and the difficulties they meet in the relation with the child depend mostly on the characteristics of the malformation and on the explanations and support they receive. The Health care personnel knows well that the communication of a diagnosis of a congenital malformation to the parents is frustrating. Both the Pediatrics and the Gynaecologist have to considerate seriously and consciously this relational question, considering that the communication is a interpersonal relationship and therefore flexible and changeable in every case. After this previous statement we consider it useful to report advises taken from the literature: the parents have to be informed at once the diagnosis is confirmed, possibly at the same time and in presence of the infant; the communication should be done both from the Pediatrics and the Gynaecologist, possibly at the same time; the communication should take place in a private atmosphere and with plenty of time.
An appropriate timing of hospital discharge of the healthy, term neonate represents a balance bet... more An appropriate timing of hospital discharge of the healthy, term neonate represents a balance between birth medicalization and surveillance of immediate health hazards. In the absence of European recommendations, the authors have conducted a broad national survey on the current policies of neonatal discharge. A 13-item questionnaire was sent to 136 Italian birth centers. Quantitative variables were expressed as mean+/-range. Qualitative variables were expressed as frequencies. chi squared test was used for variables comparison. Mean age at discharge for a vaginally delivered neonate was 72 hours. Twelve percent of centres would not schedule a follow-up appointment. Neonates born after a cesarean section were discharged at a mean age of 97 hours. Almost all centres (95/98) would discharge an healthy infant without risk factors for hyperbilirubinemia with a total serum bilirubin (TSB) of 13 mg/dL at 72 hours but 14.7% of these centers would not recheck TSB. The same healthy neonate wo...
We investigated if nonnutritive sucking (NNS) during heelstick procedures alleviates behavioral d... more We investigated if nonnutritive sucking (NNS) during heelstick procedures alleviates behavioral distress in neonates. In our NICU, 26 neonates without severe complications (mean Minde score 0.8, range 0-3), undergoing heelstick procedures at least twice a day, in the first 2 weeks of life, were enrolled in the trial (mean gestational age 33.9 weeks, range 26-39 weeks, mean birth weight 1, 988.5 g, range 1,200-4,010 g, mean Apgar score at the first minute 6. 7, range 4-10, at the fifth minute 8.5, range 6-10). Two heelpricks were performed in each neonate with NNS randomly assigned. Behavioral states, transcutaneous oxygen tension (TcPO(2)), heart rate, and respiratory rate were monitored before, during and after the heelstick procedures. Heelstick procedures lasted for a mean of 109 s (range 50-230 s) with NNS, and a mean of 128.8 s (range 20-420 s) without NNS. Compared with baseline, heart rate and behavioral distress increased and respiratory rate decreased during heelstick and a...
Reinfection with rubella is possible. The real risk for fetus and newborn is not known, as are th... more Reinfection with rubella is possible. The real risk for fetus and newborn is not known, as are the incidences of rubella reinfection during pregnancy and congenital rubella infection after maternal reinfection.
Several recent reports have described short-term effects of moderate hyperbilirubinemia, and have... more Several recent reports have described short-term effects of moderate hyperbilirubinemia, and have questioned the treatment protocols of neonatal jaundice. However, most of these studies were not designed to investigate the effects of hyperbilirubinemia per se and could have been influenced by phototherapy. We have evaluated with the Brazelton Neonatal Behavioral Scale 17 moderately jaundiced term 3-day-old infants (mean bilirubin level 10.6 mg/100 ml, range 8.4-14.3) not treated with phototherapy and 17 not jaundiced matched subjects; 14 jaundiced 4-day-old subjects (mean bilirubin level 10.4 mg/100 ml, range 8.4-12.9) and 14 not jaundiced matched subjects; 10 ex-jaundiced 1-month-old infants (mean bilirubin level 11.5 mg/100 ml, range 9.1-15.9) and 10 matched not jaundiced infants. No differences were found between jaundiced infants and not jaundiced infants. Our data indicate that moderate levels of hyperbilirubinemia not treated with phototherapy do not influence neonatal behavior. Hence, more aggressive treatment is not justified, at least in term infants.
This study was performed to determine whether covering the eyes with an opaque screen over the he... more This study was performed to determine whether covering the eyes with an opaque screen over the head end of the bassinet instead of the normal patch would improve the behavioral organization of jaundiced, but otherwise healthy, term infants treated with phototherapy. 38 matched infants were randomly assigned to have a patch or a screen. Serum bilirubin at the time of observation was 11.2-17.5 mg/100 ml (mean = 13.7, patch) and 9.4-16.4 mg/100 ml (mean = 13.4, screen). 19 infants, of whom 11 were jaundiced (6.2-14.3 mg/100 ml, mean = 10.3), served as control subjects. The infants were examined with the Brazelton scale on the 3rd day after birth, when the patch subjects had been under blue light from 6 to 45 h (mean = 23.9), and the screen subjects from 6 to 61.5 h (mean = 22.6). The control subjects scored better (all differences, p less than 0.05) than the patch subjects on inanimate visual, animate visual, visual and auditory, alertness. The control subjects also did better than the screen subjects on inanimate visual, animate visual, animate auditory, visual and auditory, alertness, but poorer on motor maturity and consolability. The screen subjects did poorer than the patch subjects only on skin color lability. At 1 month of age, 9 sets of matched infants were examined. The only difference was that the control subjects did better than the patch subjects on animate visual and lability of state. Our data confirm the poorer short-term orientation performance of jaundiced infants treated with phototherapy but do not indicate that covering the eyes with an opaque screen improves behavioral organization.
To investigate brain morphology and function in patients with glycogen storage disease type I (GS... more To investigate brain morphology and function in patients with glycogen storage disease type I (GSDI). Nineteen patients (13 females and 6 males, aged 0.9-22.6 years) and 38 sex- and age-matched controls entered the study. Neurological examinations, psychometric tests (IQ, tests of performance and verbal abilities), standard electroencephalogram (EEG), somatosensory (SEPs), visual (VEPs), and brain-stem auditory evoked potentials (BAEPs), and brain magnetic resonance imaging (MRI) were performed. The results of tests of performance ability were lower in patients than in controls (P <.05). The prevalence of abnormal EEG findings (26.3% versus 2.6%), VEPs (38.4% versus 7.7%), SEPs (23.0% versus 0%), and BAEPs abnormalities (15.7% versus 0%) was higher in patients than in controls (P <.05). MRI pattern was altered in 57.1% of patients and was normal in all controls (P <.05). Both results of tests of performance ability and BAEPs abnormalities significantly correlated with the frequency of admissions for hypoglycemia, whereas EEG abnormalities correlated with dietary compliance (P <.05). Brain damage, probably caused by recurrent severe hypoglycemia, may be present in patients with GSDI.
Pompe disease is a rare autosomal recessive myopathy due to the deficiency of lysosomal acid alph... more Pompe disease is a rare autosomal recessive myopathy due to the deficiency of lysosomal acid alpha-glucosidase. Clinical phenotypes range from the severe classic infantile form (hypotonia and hypertrophic cardiomyopathy), to milder late onset forms (skeletal myopathy and absence of significant heart involvement). Enzyme replacement therapy with recombinant human alpha-glucosidase derived from either rabbit milk or Chinese hamster ovary cells has been introduced and is undergoing clinical trials. Reported is a long-term follow-up of 3 Pompe patients presenting without cardiomyopathy, treated with recombinant human alpha-glucosidase derived from Chinese hamster ovary cells. This study suggests that enzyme replacement therapy can lead to significant motor and respiratory improvement in the subgroup of patients who start the therapy before extensive muscle damage has occurred. The recombinant enzyme derived from Chinese hamster ovary cells, administered at doses significantly higher than previously reported, appears to have the same safety as the drug derived from rabbit milk.
Backgorund Parents after Neonatal Intensive Care Unit (NICU) hospitalization of preterm infant ma... more Backgorund Parents after Neonatal Intensive Care Unit (NICU) hospitalization of preterm infant may develop psychopathological symptoms. The aim of the study was to determine how parental stress and psychophysical wellbeing affect posttraumatic symptoms (PTTS) in parents during the first year after NICU discharge. Moreover, this study aimed to explore any gender-specific difference in psychological distress among mothers and fathers. Methods Prospective study design from September 2018 to September 2019. 20 pairs of parents of preterm infants admitted to a tertiary-level NICU were enrolled. Primary outcome was evaluation of PTTS in parents of preterm infants at one year after NICU discharge through Impact of Event Scale- Revised. Secondary outcomes were: impact of parental stress, psychophysical wellbeing, anxiety and depression respectively through Parental Stressor Scale: NICU, Short Form Health Survey-36(SF-36), Self-rating Anxiety Scale and Self-rating Depression Scale. Results M...
La Pediatria medica e chirurgica: Medical and surgical pediatrics
The birth of a neonate with congenital malformation for the parents determines often a process of... more The birth of a neonate with congenital malformation for the parents determines often a process of adaptation with a phase of shock, a phase of incredibility and scare and, at last, one of adaptation and equilibration. The reactions of the parents and the difficulties they meet in the relation with the child depend mostly on the characteristics of the malformation and on the explanations and support they receive. The Health care personnel knows well that the communication of a diagnosis of a congenital malformation to the parents is frustrating. Both the Pediatrics and the Gynaecologist have to considerate seriously and consciously this relational question, considering that the communication is a interpersonal relationship and therefore flexible and changeable in every case. After this previous statement we consider it useful to report advises taken from the literature: the parents have to be informed at once the diagnosis is confirmed, possibly at the same time and in presence of the infant; the communication should be done both from the Pediatrics and the Gynaecologist, possibly at the same time; the communication should take place in a private atmosphere and with plenty of time.
An appropriate timing of hospital discharge of the healthy, term neonate represents a balance bet... more An appropriate timing of hospital discharge of the healthy, term neonate represents a balance between birth medicalization and surveillance of immediate health hazards. In the absence of European recommendations, the authors have conducted a broad national survey on the current policies of neonatal discharge. A 13-item questionnaire was sent to 136 Italian birth centers. Quantitative variables were expressed as mean+/-range. Qualitative variables were expressed as frequencies. chi squared test was used for variables comparison. Mean age at discharge for a vaginally delivered neonate was 72 hours. Twelve percent of centres would not schedule a follow-up appointment. Neonates born after a cesarean section were discharged at a mean age of 97 hours. Almost all centres (95/98) would discharge an healthy infant without risk factors for hyperbilirubinemia with a total serum bilirubin (TSB) of 13 mg/dL at 72 hours but 14.7% of these centers would not recheck TSB. The same healthy neonate wo...
We investigated if nonnutritive sucking (NNS) during heelstick procedures alleviates behavioral d... more We investigated if nonnutritive sucking (NNS) during heelstick procedures alleviates behavioral distress in neonates. In our NICU, 26 neonates without severe complications (mean Minde score 0.8, range 0-3), undergoing heelstick procedures at least twice a day, in the first 2 weeks of life, were enrolled in the trial (mean gestational age 33.9 weeks, range 26-39 weeks, mean birth weight 1, 988.5 g, range 1,200-4,010 g, mean Apgar score at the first minute 6. 7, range 4-10, at the fifth minute 8.5, range 6-10). Two heelpricks were performed in each neonate with NNS randomly assigned. Behavioral states, transcutaneous oxygen tension (TcPO(2)), heart rate, and respiratory rate were monitored before, during and after the heelstick procedures. Heelstick procedures lasted for a mean of 109 s (range 50-230 s) with NNS, and a mean of 128.8 s (range 20-420 s) without NNS. Compared with baseline, heart rate and behavioral distress increased and respiratory rate decreased during heelstick and a...
Reinfection with rubella is possible. The real risk for fetus and newborn is not known, as are th... more Reinfection with rubella is possible. The real risk for fetus and newborn is not known, as are the incidences of rubella reinfection during pregnancy and congenital rubella infection after maternal reinfection.
Several recent reports have described short-term effects of moderate hyperbilirubinemia, and have... more Several recent reports have described short-term effects of moderate hyperbilirubinemia, and have questioned the treatment protocols of neonatal jaundice. However, most of these studies were not designed to investigate the effects of hyperbilirubinemia per se and could have been influenced by phototherapy. We have evaluated with the Brazelton Neonatal Behavioral Scale 17 moderately jaundiced term 3-day-old infants (mean bilirubin level 10.6 mg/100 ml, range 8.4-14.3) not treated with phototherapy and 17 not jaundiced matched subjects; 14 jaundiced 4-day-old subjects (mean bilirubin level 10.4 mg/100 ml, range 8.4-12.9) and 14 not jaundiced matched subjects; 10 ex-jaundiced 1-month-old infants (mean bilirubin level 11.5 mg/100 ml, range 9.1-15.9) and 10 matched not jaundiced infants. No differences were found between jaundiced infants and not jaundiced infants. Our data indicate that moderate levels of hyperbilirubinemia not treated with phototherapy do not influence neonatal behavior. Hence, more aggressive treatment is not justified, at least in term infants.
This study was performed to determine whether covering the eyes with an opaque screen over the he... more This study was performed to determine whether covering the eyes with an opaque screen over the head end of the bassinet instead of the normal patch would improve the behavioral organization of jaundiced, but otherwise healthy, term infants treated with phototherapy. 38 matched infants were randomly assigned to have a patch or a screen. Serum bilirubin at the time of observation was 11.2-17.5 mg/100 ml (mean = 13.7, patch) and 9.4-16.4 mg/100 ml (mean = 13.4, screen). 19 infants, of whom 11 were jaundiced (6.2-14.3 mg/100 ml, mean = 10.3), served as control subjects. The infants were examined with the Brazelton scale on the 3rd day after birth, when the patch subjects had been under blue light from 6 to 45 h (mean = 23.9), and the screen subjects from 6 to 61.5 h (mean = 22.6). The control subjects scored better (all differences, p less than 0.05) than the patch subjects on inanimate visual, animate visual, visual and auditory, alertness. The control subjects also did better than the screen subjects on inanimate visual, animate visual, animate auditory, visual and auditory, alertness, but poorer on motor maturity and consolability. The screen subjects did poorer than the patch subjects only on skin color lability. At 1 month of age, 9 sets of matched infants were examined. The only difference was that the control subjects did better than the patch subjects on animate visual and lability of state. Our data confirm the poorer short-term orientation performance of jaundiced infants treated with phototherapy but do not indicate that covering the eyes with an opaque screen improves behavioral organization.
To investigate brain morphology and function in patients with glycogen storage disease type I (GS... more To investigate brain morphology and function in patients with glycogen storage disease type I (GSDI). Nineteen patients (13 females and 6 males, aged 0.9-22.6 years) and 38 sex- and age-matched controls entered the study. Neurological examinations, psychometric tests (IQ, tests of performance and verbal abilities), standard electroencephalogram (EEG), somatosensory (SEPs), visual (VEPs), and brain-stem auditory evoked potentials (BAEPs), and brain magnetic resonance imaging (MRI) were performed. The results of tests of performance ability were lower in patients than in controls (P <.05). The prevalence of abnormal EEG findings (26.3% versus 2.6%), VEPs (38.4% versus 7.7%), SEPs (23.0% versus 0%), and BAEPs abnormalities (15.7% versus 0%) was higher in patients than in controls (P <.05). MRI pattern was altered in 57.1% of patients and was normal in all controls (P <.05). Both results of tests of performance ability and BAEPs abnormalities significantly correlated with the frequency of admissions for hypoglycemia, whereas EEG abnormalities correlated with dietary compliance (P <.05). Brain damage, probably caused by recurrent severe hypoglycemia, may be present in patients with GSDI.
Pompe disease is a rare autosomal recessive myopathy due to the deficiency of lysosomal acid alph... more Pompe disease is a rare autosomal recessive myopathy due to the deficiency of lysosomal acid alpha-glucosidase. Clinical phenotypes range from the severe classic infantile form (hypotonia and hypertrophic cardiomyopathy), to milder late onset forms (skeletal myopathy and absence of significant heart involvement). Enzyme replacement therapy with recombinant human alpha-glucosidase derived from either rabbit milk or Chinese hamster ovary cells has been introduced and is undergoing clinical trials. Reported is a long-term follow-up of 3 Pompe patients presenting without cardiomyopathy, treated with recombinant human alpha-glucosidase derived from Chinese hamster ovary cells. This study suggests that enzyme replacement therapy can lead to significant motor and respiratory improvement in the subgroup of patients who start the therapy before extensive muscle damage has occurred. The recombinant enzyme derived from Chinese hamster ovary cells, administered at doses significantly higher than previously reported, appears to have the same safety as the drug derived from rabbit milk.
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