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Barone G, Natile M, Nigro CS, D'Andrea V, Ancora G. Prospective case series study on the use of a novel analgosedation protocol for ultrasound-guided catheterization in Neonatal Intensive Care Unit. Eur J Pediatr 2024:10.1007/s00431-024-05557-9. [PMID: 38592483 DOI: 10.1007/s00431-024-05557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
Critically ill newborns admitted to Neonatal Intensive Care Unit often require a centrally inserted central catheters (CICCs) inserted by ultrasound-guided puncture of the internal jugular or brachio-cephalic vein. Achieving an appropriate level of sedation and analgesia is paramount for procedure success and patient safety, avoiding the potential risks associated with excessive deep sedation. The aim of this study is to evaluate the feasibility of a novel protocol of sedation. Data from 46 patients were prospectively collected. The feasibility was assessed throughout the monitoring of adverse events and the incidence of spontaneous movements. The procedure was completed in 100% of cases. There were no cases of escalation of the baseline ventilatory support despite the procedure and no case of hypotension, and all spontaneous movements were controlled with additional boluses when required. CONCLUSION Our study represents the very first step towards the design of a validated protocol for analgosedation during ultrasound-guided CICC insertion in NICU. WHAT IS KNOWN • Critically ill newborns admitted to Neonatal Intensive Care Unit often require a centrally inserted central catheter. • Achieving an appropriate level of sedation and analgesia is paramount for procedure success and patient safety, avoiding the potential risks associated with excessive deep sedation. WHAT IS NEW • The use of this new protocol for analgosedation is able to achieve a good level of sedation and pain control without significant adverse event. • Ultrasound-guided CICC insertion can be performed even in non-ventilated newborns.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital Rimini, AUSL della Romagna, Viale Settembrini, n 2, Rimini, Italy.
| | - Miria Natile
- Neonatal Intensive Care Unit, Infermi Hospital Rimini, AUSL della Romagna, Viale Settembrini, n 2, Rimini, Italy
| | | | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital Rimini, AUSL della Romagna, Viale Settembrini, n 2, Rimini, Italy
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Barone G, Pittiruti M, Prontera G, Ancora G, D'Andrea V. A novel neonatal protocol for Safe Insertion of Umbilical Venous Catheters (SIUVeC): Minimizing complications in placement and management. J Vasc Access 2024:11297298241236220. [PMID: 38436297 DOI: 10.1177/11297298241236220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Insertion of umbilical venous catheters is a common procedure in neonatal intensive care. Though sometimes lifesaving, this maneuver is potentially associated with early and late complications, some of which may be severe and even life threatening (catheter malposition, hepatic lesions, venous thrombosis, pericardial effusion, etc.). The recent literature suggests several operative strategies that, if adopted systematically, may significantly reduce the incidence of both early and late catheter related complications. This paper describes a standardized protocol (Safe Insertion Umbilical Venous Catheter = SIUVeC) which incorporates such novel strategies, with the goal of minimizing the complications related to this procedure.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Emilia Romagna, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Giorgia Prontera
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Emilia Romagna, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
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Corsini I, Rodriguez-Fanjul J, Raimondi F, Boni L, Berardi A, Aldecoa-Bilbao V, Alonso-Ojembarrena A, Ancora G, Aversa S, Beghini R, Meseguer NB, Capasso L, Chesi F, Ciarcià M, Concheiro A, Corvaglia L, Ficial B, Filippi L, Carballal JF, Fusco M, Gatto S, Ginovart G, Gregorio-Hernández R, Lista G, Sánchez-Luna M, Martini S, Massenzi L, Miselli F, Mercadante D, Mosca F, Palacio MT, Perri A, Piano F, Prieto MP, Fernandez LR, Risso FM, Savoia M, Staffler A, Vento G, Dani C. Lung UltrasouNd Guided surfactant therapy in preterm infants: an international multicenter randomized control trial (LUNG study). Trials 2023; 24:706. [PMID: 37925512 PMCID: PMC10625281 DOI: 10.1186/s13063-023-07745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The management of respiratory distress syndrome (RDS) in premature newborns is based on different types of non-invasive respiratory support and on surfactant replacement therapy (SRT) to avoid mechanical ventilation as it may eventually result in lung damage. European guidelines currently recommend SRT only when the fraction of inspired oxygen (FiO2) exceeds 0.30. The literature describes that early SRT decreases the risk of bronchopulmonary dysplasia (BPD) and mortality. Lung ultrasound score (LUS) in preterm infants affected by RDS has proven to be able to predict the need for SRT and different single-center studies have shown that LUS may increase the proportion of infants that received early SRT. Therefore, the aim of this study is to determine if the use of LUS as a decision tool for SRT in preterm infants affected by RDS allows for the reduction of the incidence of BPD or death in the study group. METHODS/DESIGN In this study, 668 spontaneously-breathing preterm infants, born at 25+0 to 29+6 weeks' gestation, in nasal continuous positive airway pressure (nCPAP) will be randomized to receive SRT only when the FiO2 cut-off exceeds 0.3 (control group) or if the LUS score is higher than 8 or the FiO2 requirements exceed 0.3 (study group) (334 infants per arm). The primary outcome will be the difference in proportion of infants with BPD or death in the study group managed compared to the control group. DISCUSSION Based on previous published studies, it seems that LUS may decrease the time to administer surfactant therapy. It is known that early surfactant administration decreases BPD and mortality. Therefore, there is rationale for hypothesizing a reduction in BPD or death in the group of patients in which the decision to administer exogenous surfactant is based on lung ultrasound scores. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05198375 . Registered on 20 January 2022.
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Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | | | - Francesco Raimondi
- Division of Neonatology, Federico II University of Naples, Naples, Italy
| | - Luca Boni
- SC Epidemiologia Clinica IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Policlinico Universitario Modena, Modena, Italy
| | - Victoria Aldecoa-Bilbao
- Neonatal Intensive Care Unit, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal Fetal and Neonatal Medicine), Barcelona, Spain
| | | | - Gina Ancora
- Neonatal Intensive Care Unit, Ospedale Infermi Di Rimini, Rimini, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Renzo Beghini
- Neonatal Intensive Care Unit, AOUI Verona, Verona, Italy
| | | | - Letizia Capasso
- Division of Neonatology, Federico II University of Naples, Naples, Italy
| | - Francesca Chesi
- Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Ana Concheiro
- Neonatal Intensive Care Unit, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit IRCCS AUOBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Luca Filippi
- Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jesus Fuentes Carballal
- Neonatal Intensive Care Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Coruña, Spain
| | - Monica Fusco
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Sara Gatto
- Neonatal Intensive Care Unit, Ospedale Dei Bambini "V.Buzzi", Milan, Italy
| | - Gemma Ginovart
- Neonatal Intensive Care Unit. Hospital Germans Trias I Pujol, Badalona, Spain
| | | | - Gianluca Lista
- Neonatal Intensive Care Unit, Ospedale Dei Bambini "V.Buzzi", Milan, Italy
| | | | - Silvia Martini
- Neonatal Intensive Care Unit IRCCS AUOBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Francesca Miselli
- Neonatal Intensive Care Unit, Policlinico Universitario Modena, Modena, Italy
| | - Domenica Mercadante
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marta Teresa Palacio
- Neonatal Intensive Care Unit, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal Fetal and Neonatal Medicine), Barcelona, Spain
| | | | - Francesca Piano
- Neonatal Intensive Care Unit, Ospedale Infermi Di Rimini, Rimini, Italy
| | | | | | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | | | | | - Giovanni Vento
- Neonatal Intensive Care Unit, Policlinico Gemelli, Rome, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
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D’Andrea V, Cascini V, Russo R, Perri A, Prontera G, Ancora G, Vento G, Lisi G, Barone G. The Role of Ultrasound in Epicutaneo-Caval Catheter Insertion in Neonates: Systematic Review, Meta-Analysis and Future Perspectives. Diagnostics (Basel) 2023; 13:2850. [PMID: 37685388 PMCID: PMC10487192 DOI: 10.3390/diagnostics13172850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/09/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Chest and abdominal X-rays after the insertion of an epicutaneo-caval catheter in infants are the standard method of checking the tip location in many neonatal intensive care units. The role of ultrasound in the tip location of the epicutaneo-caval catheter in neonates has been the subject of many recent studies. This systematic review investigates the accuracy of epicutaneo-caval catheter tip location by comparing ultrasound and conventional radiology. We performed a systematic literature search in multiple databases. The selection of studies yielded nineteen articles. The systematic review and meta-analysis were performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis). The analyses showed that ultrasound is a better imaging technique for epicutaneo-caval catheter tip location in the neonatal intensive care unit than conventional radiology. By improving operator training and selecting a standardized echography protocol, ultrasound could become the gold standard for visualizing the epicutaneo-caval catheter tip in the neonatal intensive care unit. This would have some important benefits: (1) increased accuracy in tip location (2); a more rapid use of the central venous access (3); and a significant reduction in radiation exposure.
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Affiliation(s)
- Vito D’Andrea
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Valentina Cascini
- Pediatric Surgery Unit, Hospital Spirito Santo, 65124 Pescara, Italy; (V.C.); (G.L.)
| | - Rosellina Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Alessandro Perri
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Giorgia Prontera
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Gina Ancora
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, 47923 Rimini, Italy; (G.A.); (G.B.)
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Gabriele Lisi
- Pediatric Surgery Unit, Hospital Spirito Santo, 65124 Pescara, Italy; (V.C.); (G.L.)
- Pediatric Surgery Unit, Department of Medicine and Aging Science, “G. D’Annunzio University”, 66100 Chieti, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, 47923 Rimini, Italy; (G.A.); (G.B.)
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5
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D'Andrea V, Pezza L, Prontera G, Ancora G, Pittiruti M, Vento G, Barone G. The intracavitary ECG method for tip location of ultrasound-guided centrally inserted central catheter in neonates. J Vasc Access 2023; 24:1134-1139. [PMID: 35081816 DOI: 10.1177/11297298211068302] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The correct position of the tip of a central venous access device is important in all patients, and especially in neonates. The traditional method of tip location (approximated intra-procedural length estimation + post procedural chest X-ray) is currently considered inaccurate and not cost-effective by most recent guidelines, which recommend the adoption of tip location by intracavitary electrocardiography (IC-ECG) whenever possible. METHODS This study prospectively investigated the applicability, the feasibility, the accuracy, and the safety IC-ECG for tip location in neonates requiring insertion of ultrasound-guided centrally inserted central venous catheters (CICCs) with caliber 3Fr or more. All catheter tip locations were verified using simultaneously both IC-ECG and ultrasound-based tip location, using the Neo-ECHOTIP protocol. RESULTS A total of 105 neonates were enrolled. The applicability of IC-ECG was 100% since a P wave was evident on the surface ECG of all neonates recruited for the study. The feasibility was also 100% since an increase of the P-wave was detected in all cases. The accuracy was also 100%, since a perfect match between IC-ECG based tip location and ultrasound-based tip location was found. There were no adverse events directly or indirectly related to the IC-ECG technique; no arrhythmias occurred. CONCLUSIONS When applied to ultrasound guided CICCs, tip location by IC-ECG is applicable and feasible in neonates, and it is safe and accurate.
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Affiliation(s)
- Vito D'Andrea
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucilla Pezza
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital Rimini, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital Rimini, Rimini, Italy
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6
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Barone G, D'Andrea V, Ancora G, Cresi F, Maggio L, Capasso A, Mastroianni R, Pozzi N, Rodriguez-Perez C, Romitti MG, Tota F, Spagnuolo F, Raimondi F, Pittiruti M. The neonatal DAV-expert algorithm: a GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access in newborns. Eur J Pediatr 2023; 182:3385-3395. [PMID: 37195350 DOI: 10.1007/s00431-023-04984-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/18/2023]
Abstract
In most NICUs, the choice of the venous access device currently relies upon the operator's experience and preferences. However, considering the high failure rate of vascular devices in the neonatal population, such clinical choice has a critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems in line with the current scientific evidence. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in the neonatal population. After a systematic review of the available evidence, the panel of the consensus (which included Italian neonatologists specifically experts in this area) has provided structured recommendations answering four sets of questions regarding (1) umbilical venous catheters, (2) peripheral cannulas, (3) epicutaneo-cava catheters, and (4) ultrasound-guided centrally and femorally inserted central catheters. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice. Conclusion: The goal of the present consensus is to offer a systematic set of recommendations on the choice of the most appropriate vascular access device in Neonatal Intensive Care Unit.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL Della Romagna, Viale Settembrini 2, Rimini, Italy.
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL Della Romagna, Viale Settembrini 2, Rimini, Italy
| | - Francesco Cresi
- Neonatology and Neonatal Intensive Care Unit, Sant'Anna Hospital, University of Turin, Città Della Salute E Della Scienza, Turin, Italy
| | - Luca Maggio
- Neonatology and Neonatal Intensive Care Unit, AO San Camillo Forlanini, Rome, Italy
| | - Antonella Capasso
- Neonatology and Neonatal Intensive Care Unit, A.O.U. Federico 2, Naples, Italy
| | | | - Nicola Pozzi
- Neonatal Intensive Care Unit, San Pio Hospital, Benevento, Italy
| | - Carmen Rodriguez-Perez
- Neonatology and Neonatal Intensive Care Unit, ASST Spedali Civili, Ospedale Dei Bambini, Brescia, Italy
| | | | - Francesca Tota
- Neonatal Intensive Care Unit, Ospedale S. Chiara, APSS, Trento, Italy
| | - Ferdinando Spagnuolo
- Neonatal Intensive Care Unit, AOU Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Raimondi
- Neonatology and Neonatal Intensive Care Unit, A.O.U. Federico 2, Naples, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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7
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Lamberti G, Domenichelli V, Straziuso S, Pelusi G, Natile M, Ancora G, Barone G. Use of the Dialkylcarbamoylchloride Dressing in the Care of Central Venous Access Exit Site in a Pediatric and Neonatal Population. Diagnostics (Basel) 2023; 13:diagnostics13091520. [PMID: 37174912 PMCID: PMC10177172 DOI: 10.3390/diagnostics13091520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Dialkylcarbamoylchloride dressing is a fatty acid derivative that has been shown in vitro to bind a number of pathogenic microorganisms. The purpose of this prospective study was to evaluate the safety and the efficacy of this technology in the care of the exit site of central venous catheter in a paediatric and neonatal population. METHODS The study was conducted from September 2020 to December 2022 at the Infermi Hospital in Rimini. Central venous catheters were placed using the SIC bundle for insertion. Dialkylcarbamoylchloride dressing was placed below the subcutaneous anchoring at the time of CVC placement and at each dressing change. Data about the catheters and the exit site were recorded and then compared with an historical cohort. RESULTS 118 catheters were placed during the studied period. The dialkylcarbamoylchloride dressing was well-tolerated. No case of systemic or local infection was recorded. The comparison with the historical cohort showed a reduction in the rate of exit site infection (p value 0.03). CONCLUSION Dialkylcarbamoylchloride dressing is well-tolerated in paediatric and neonatal population. It represents a promising tool as a strategy for infection prevention.
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Affiliation(s)
- Giorgio Lamberti
- Pediatric Surgery, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | | | - Simona Straziuso
- Pediatric Surgery, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Gabriella Pelusi
- Pediatric Surgery, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Miria Natile
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
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8
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Tarocco A, Morciano G, Perrone M, Cafolla C, Ferrè C, Vacca T, Pistocchi G, Meneghin F, Cocchi I, Lista G, Cetin I, Greco P, Garani G, Stella M, Natile M, Ancora G, Savarese I, Campi F, Bersani I, Dotta A, Tiberi E, Vento G, Chiodin E, Staffler A, Maranella E, Di Fabio S, Wieckowski MR, Giorgi C, Pinton P. Increase of Parkin and ATG5 plasmatic levels following perinatal hypoxic-ischemic encephalopathy. Sci Rep 2022; 12:7795. [PMID: 35551488 PMCID: PMC9098891 DOI: 10.1038/s41598-022-11870-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022] Open
Abstract
Brain injury at birth is an important cause of neurological and behavioral disorders. Hypoxic-ischemic encephalopathy (HIE) is a critical cerebral event occurring acutely or chronically at birth with high mortality and morbidity in newborns. Therapeutic strategies for the prevention of brain damage are still unknown, and the only medical intervention for newborns with moderate-to-severe HIE is therapeutic hypothermia (TH). Although the neurological outcome depends on the severity of the initial insult, emerging evidence suggests that infants with mild HIE who are not treated with TH have an increased risk for neurodevelopmental impairment; in the current clinical setting, there are no specific or validated biomarkers that can be used to both correlate the severity of the hypoxic insult at birth and monitor the trend in the insult over time. The aim of this work was to examine the presence of autophagic and mitophagic proteins in bodily fluids, to increase knowledge of what, early at birth, can inform therapeutic strategies in the first hours of life. This is a prospective multicentric study carried out from April 2019 to April 2020 in eight third-level neonatal intensive care units. All participants have been subjected to the plasma levels quantification of both Parkin (a protein involved in mitophagy) and ATG5 (involved in autophagy). These findings show that Parkin and ATG5 levels are related to hypoxic-ischemic insult and are reliable also at birth. These observations suggest a great potential diagnostic value for Parkin evaluation in the first 6 h of life.
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Affiliation(s)
- Anna Tarocco
- Neonatal Intensive Care Unit and Neonatology, University Hospital S. Anna, 44121, Ferrara, Italy.,Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Via Fossato di Mortara 70, 44121, Ferrara, Italy
| | - Giampaolo Morciano
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Via Fossato di Mortara 70, 44121, Ferrara, Italy.
| | - Mariasole Perrone
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Via Fossato di Mortara 70, 44121, Ferrara, Italy
| | - Claudia Cafolla
- Department of Medical Sciences, Pediatric Unit, University of Ferrara, 44121, Ferrara, Italy
| | - Cristina Ferrè
- Department of Medical Sciences, Pediatric Unit, University of Ferrara, 44121, Ferrara, Italy
| | - Tiziana Vacca
- Neonatal Intensive Care Unit and Neonatology, University Hospital S. Anna, 44121, Ferrara, Italy
| | - Ginevra Pistocchi
- BSC Medical Biosciences Faculty of Medicine, Imperial College, London, SW7 2AZ, UK
| | - Fabio Meneghin
- Neonatal Pathology and Neonatal Intensive Care Unit, Vittore-Buzzi Children Hospital, Milan, Italy
| | - Ilaria Cocchi
- Neonatal Pathology and Neonatal Intensive Care Unit, Vittore-Buzzi Children Hospital, Milan, Italy
| | - Gianluca Lista
- Neonatal Pathology and Neonatal Intensive Care Unit, Vittore-Buzzi Children Hospital, Milan, Italy
| | - Irene Cetin
- Obstetrics and Gynecology Unit, Vittore Buzzi Children Hospital" and University of Milan, 20154, Milan, Italy
| | - Pantaleo Greco
- Department of Medical Sciences, Section of Obstetrics and Gynecology, University Hospital S.Anna, 44121, Ferrara, Italy
| | - Giampaolo Garani
- Neonatal Intensive Care Unit and Neonatology, University Hospital S. Anna, 44121, Ferrara, Italy
| | - Marcello Stella
- Pediatrics Department and Neonatal and Pediatric Intensive Care Unit, Bufalini Hospital, 47521, Cesena, Italy
| | - Miria Natile
- Neonatal Intensive Care Unit, Infermi Hospital Rimini, 47921, Rimini, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital Rimini, 47921, Rimini, Italy
| | - Immacolata Savarese
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, 00165, Rome, Italy
| | - Francesca Campi
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, 00165, Rome, Italy
| | - Iliana Bersani
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, 00165, Rome, Italy
| | - Andrea Dotta
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, 00165, Rome, Italy
| | - Eloisa Tiberi
- Department of Woman and Child Health, Obstetric and Neonatology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health, Obstetric and Neonatology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Elisabetta Chiodin
- Division of Neonatology, Central Teaching Hospital of Bolzano, 39100, Bolzano, Italy
| | - Alex Staffler
- Division of Neonatology, Central Teaching Hospital of Bolzano, 39100, Bolzano, Italy
| | - Eugenia Maranella
- Neonatology and Neonatal Intensive Care Unit, San Salvatore Hospital, 67100, L'Aquila, Italy
| | - Sandra Di Fabio
- Neonatology and Neonatal Intensive Care Unit, San Salvatore Hospital, 67100, L'Aquila, Italy
| | - Mariusz R Wieckowski
- Laboratory of Mitochondrial Biology and Metabolism, NenckiInstituteofExperimental Biology, Polish Academy of Sciences, 02-093, Warsaw, Poland
| | - Carlotta Giorgi
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Via Fossato di Mortara 70, 44121, Ferrara, Italy
| | - Paolo Pinton
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Via Fossato di Mortara 70, 44121, Ferrara, Italy.
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9
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Baldoni F, Ancora G, Latour JM. Being the Father of a Preterm-Born Child: Contemporary Research and Recommendations for NICU Staff. Front Pediatr 2021; 9:724992. [PMID: 34552898 PMCID: PMC8450441 DOI: 10.3389/fped.2021.724992] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Most studies on parental reactions to a preterm birth and to hospitalization of the newborn in Neonatal Intensive Care Units (NICUs) have involved mothers. However, emotional responses and behaviors of fathers are equally important. Usually, the father is the first to meet the preterm newborn, to find out information about baby's condition and to communicate to the mother and other family members. In this context he is often left alone and can show psychological difficulties including affective disorders such as depression or anxiety. This paper describes the role of fathers in the NICU, the best practices to support fathers, and to explain the role of a psychologist in the NICU staff. Considerations and suggestions are provided on the difficulties encountered to support parents, with a focus on the role of fathers during the COVID-19 pandemic. Methods and Discussion: Considering contemporary research data and following an attachment perspective, we analyze the role of the father of a preterm-born child in the relation with the partner and in newborn caring. Research has shown that involving fathers in newborn care in NICU and at home is essential not only because it promotes the father/son attachment relationship and has positive effects on the psychological and somatic development of the newborn, but also for the health of the mother and whole family. Conclusion: Recommendations are provided to enhance the functions of fathers in the NICU, promote their involvement in the care of their infant, and interventions to prevent the manifestation of psychological suffering and/or perinatal affective disorders. The commitments of a psychologist in a NICU team are presented and require not only clinical skills, but also the ability to manage the emotional and relational difficulties of fathers, family and NICU staff. Considerations and suggestions are provided on the difficulties encountered by parents in the NICU during the COVID-19 pandemic.
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Affiliation(s)
- Franco Baldoni
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini, Italy
| | - Jos M Latour
- Faculty of Health, School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom.,Department of Nursing, Hunan Children's Hospital, Changsha, China
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10
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Lugli L, Bedetti L, Guidotti I, Pugliese M, Picciolini O, Roversi MF, DellaCasa Muttini E, Lucaccioni L, Bertoncelli N, Ancora G, Gargano G, Mosca F, Sandri F, Corvaglia LT, Solinas A, Perrone S, Stella M, Iughetti L, Berardi A, Ferrari F. Neuroprem 2: An Italian Study of Neurodevelopmental Outcomes of Very Low Birth Weight Infants. Front Pediatr 2021; 9:697100. [PMID: 34589450 PMCID: PMC8474877 DOI: 10.3389/fped.2021.697100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the increased survival of preterm newborns worldwide, the risk of neurodevelopmental disabilities remains high. Analyzing the outcomes of the preterm population can identify risk factors and enable specific early interventions. Aims: Neuroprem is a prospective cohort study of very low birth weight (VLBW) infants that aims to evaluate the neurodevelopmental outcomes and risk factors for severe functional disability at 2 years of corrected age. Methods: Nine Italian neonatal intensive care units participated in the network. The Griffiths Mental Developmental Scales (GMDS-R) or the Bayley Scales of Infant and Toddler Development (BSDI III) and a neuro-functional evaluation (according to the International Classification of Disability and Health and Neuro-Functional Assessment, or NFA ICF-CY) were administered to VLBW infants at 24 months of corrected age. The primary outcome measure was severe functional disability, defined as cerebral palsy, bilateral blindness, deafness, an NFA ICF-CY of >2, a BSDI III cognitive composite score of <2 SD, or a GMDS-R global quotient score of <2 SD. Perinatal risk factors for severe functional disability were assessed through multivariate logistic regression analysis. Results: Among 502 VLBW survivors who completed the 24-month follow-up, 48 (9.6%) presented severe functional disability, of whom 27 had cerebral palsy (5.4%). Rates of severe functional disability and cerebral palsy were higher in neonates with a lower gestational age (p < 0.001). Overall, 147 infants (29.3%) were referred to neuromotor intervention. In the multivariate regression model, gestational age at birth OR 0.79; 95% CI 0.67-0.90; p = 0.001) and periventricular-intraventricular hemorrhage (OR 2.51; 95% CI 1.19-5.26; p = 0.015) were significantly associated with severe functional disability. Conclusion: Neuroprem 2 provides updated information on the neurodevelopmental outcomes of VLBW infants in a large Italian cohort. The overall rate of neurodevelopmental disabilities was quite lower than reported in the previous literature. These data indicate the need for structured follow-up programs from a national neonatal network perspective.
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Affiliation(s)
- Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Luca Bedetti
- Neonatal Intensive Care Unit, University Hospital of Modena, Modena, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Isotta Guidotti
- Neonatal Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Marisa Pugliese
- Neonatal Intensive Care Unit, University Hospital of Modena, Modena, Italy.,Psychology Unit, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Odoardo Picciolini
- Physical and Rehabilitation Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital of Rimini, Rimini, Italy
| | - Giancarlo Gargano
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Maggiore Hospital of Bologna, Bologna, Italy
| | - Luigi Tommaso Corvaglia
- Neonatal Intensive Care Unit, Sant'Orsola Malpighi University Hospital of Bologna, Bologna, Italy
| | - Agostina Solinas
- Neonatal Intensive Care Unit, Sant'Anna Hospital of Ferrara, Ferrara, Italy
| | - Serafina Perrone
- Neonatal Intensive Care Unit, University Hospital of Parma, Parma, Italy
| | - Marcello Stella
- Neonatal Intensive Care Unit, Bufalini Hospital of Cesena, Cesena, Italy
| | | | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.,Department of Medical and Surgical Sciences of Mothers, Children and Adults, Pediatric Postgraduate School, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, University Hospital of Modena, Modena, Italy
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11
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Lugli L, Bedetti L, Lucaccioni L, Gennari W, Leone C, Ancora G, Berardi A. An Uninfected Preterm Newborn Inadvertently Fed SARS-CoV-2-Positive Breast Milk. Pediatrics 2020; 146:peds.2020-004960. [PMID: 32843439 DOI: 10.1542/peds.2020-004960] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 11/24/2022] Open
Abstract
There are increasing concerns regarding coronavirus disease, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approaches to breastfeeding and the management of neonates born to pauci-symptomatic mothers with coronavirus disease vary worldwide, although some scientific societies across Europe and the United States have emphasized the benefits of breastfeeding, even with expressed breast milk. Because SARS-CoV-2 has been, thus far, only exceptionally detected in breast milk, the risk of disease transmission has remained hypothetical.We herein report the case of a healthy preterm newborn who was inadvertently fed SARS-CoV-2-positive breast milk. Two different samples, collected with and without strict hygiene precautions, were both confirmed to be SARS-CoV-2 positive. However, the newborn was not infected, supporting the protective role of breast milk. Furthermore, in this report, we highlight the difficulties in the practical management of a neonate whose breastfeeding mother was confirmed as positive for SARS-CoV-2 after delivery.
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Affiliation(s)
| | | | | | | | - Chiara Leone
- Obstetrics and Gynecology, University Hospital of Modena and Reggio Emilia, Modena, Italy; and
| | - Gina Ancora
- Neonatal Intensive Care, Infermi Hospital of Rimini, Rimini, Italy
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12
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Benini F, Corsini I, Castagno E, Silvagni D, Lucarelli A, Giacomelli L, Amigoni A, Ancora G, Astuto M, Borrometi F, Casilli RM, Chiappini E, Cutrera R, De Matteis A, di Mauro G, Musolino A, Fabbri A, Ferrero F, Fornaro M, Gangemi M, Lago P, Macrì F, Manfredini L, Memo L, Minicucci A, Petralia P, Pinelli N, Antonucci R, Tajè S, Tizi E, Venturelli L, Zampogna S, Urbino AF. COnsensus on Pediatric Pain in the Emergency Room: the COPPER project, issued by 17 Italian scientific societies. Ital J Pediatr 2020; 46:101. [PMID: 32703304 PMCID: PMC7376910 DOI: 10.1186/s13052-020-00858-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/23/2020] [Indexed: 12/03/2022] Open
Abstract
In the pediatric setting, management of pain in the emergency department – and even in common care – is a challenging exercise, due to the complexity of the pediatric patient, poor specific training of many physicians, and scant resources. A joint effort of several Italian societies involved in pediatrics or in pain management has led to the definition of the PIPER group and the COPPER project. By applying a modified Delphi method, the COPPER project resulted in the definition of 10 fundamental statements. These may represent the basis for improving the correct management of children pain in the emergency department.
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Affiliation(s)
- Franca Benini
- Paediatric Pain and Palliative Care Service, Department of Women's and Children's Health, University Hospital Padua, Via Giustiniani 3, 35126, Padua, Italy.
| | - Ilaria Corsini
- Department of Medical and Surgical Sciences, Unit of Paediatric Emergency, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Emanuele Castagno
- Department of Paediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Davide Silvagni
- Department of Paediatric Emergency and Critical Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Annunziata Lucarelli
- Department of Paediatrics and Emergency, Giovanni XXIII Children's Hospital, A.O.U. Consorziale Policlinico - Giovanni XXIII, Bari, Italy
| | - Luca Giacomelli
- Polistudium SRL, Milan, Italy and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Angela Amigoni
- Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica (AMIETIP), Bologna, Italy
| | - Gina Ancora
- Società Italiana di Neonatologia (SIN), Milan, Italy
| | - Marinella Astuto
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Roma, Italy
| | - Fabio Borrometi
- Società di Anestesia e Rianimazione Neonatale e Pediatrica Italiana (SARNePI), Roma, Italy
| | - Rosa Maria Casilli
- Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica (AMIETIP), Bologna, Italy
| | - Elena Chiappini
- Società Italiana di Pediatria Preventiva e Sociale (SIPPS), Roma, Italy
| | - Renato Cutrera
- Federazione Italiana delle Associazioni e Società Scientifiche dell'Area Pediatrica (FIARPED), Rome, Italy
| | | | - Giuseppe di Mauro
- Società Italiana di Pediatria Preventiva e Sociale (SIPPS), Roma, Italy
| | - Anna Musolino
- Società Italiana di Medicina Emergenza Urgenza Pediatrica (SIMEUP), Milan, Italy
| | - Andrea Fabbri
- Società Italiana di Medicina di Emergenza ed Urgenza (SIMEU), Turin, Italy
| | - Federica Ferrero
- Società Italiana di Pediatria Preventiva e Sociale (SIPPS), Roma, Italy
| | | | | | - Paola Lago
- Società Italiana di Neonatologia (SIN), Milan, Italy
| | - Francesco Macrì
- Federazione delle Società Medico-Scientifiche Italiane (FISM), Milan, Italy
| | - Luca Manfredini
- Associazione Italiana di Ematologia e Oncologia Pediatrica (AIEOP), Milan, Italy
| | - Luigi Memo
- Società Italiana di Pediatria (SIP), Milan, Italy
| | | | - Paolo Petralia
- Associazione Ospedali Pediatrici Italiani (AOPI), Genova, Italy
| | - Nicola Pinelli
- Federazione Italiana Aziende Sanitarie e Ospedaliere (FIASO), Rome, Italy
| | | | - Silvia Tajè
- Società Italiana Malattie Genetiche Pediatriche e Disabilità (SIMGePed), Milan, Italy
| | - Emiliano Tizi
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Roma, Italy
| | - Leo Venturelli
- Società Italiana di Pediatria Preventiva e Sociale (SIPPS), Roma, Italy
| | - Stefania Zampogna
- Società Italiana di Medicina Emergenza Urgenza Pediatrica (SIMEUP), Milan, Italy
| | - Antonio F Urbino
- Department of Paediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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13
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Barone G, Pittiruti M, Ancora G, Vento G, Tota F, D'Andrea V. Centrally inserted central catheters in preterm neonates with weight below 1500 g by ultrasound-guided access to the brachio-cephalic vein. J Vasc Access 2020. [PMID: 32648811 DOI: 10.1177/1129729820940174.] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Central venous access in critically ill newborns can be challenging. Ultrasound-guided brachio-cephalic vein catheterization is a relatively new procedure, recently introduced in several neonatal intensive care units. The aim of this study is to evaluate the safety and feasibility of such a technique in preterm babies. DESIGN Retrospective analysis of prospectively collected data on ultrasound-guided central venous catheter insertion in preterm neonates. SETTING Neonatal intensive care unit. PATIENTS Critically ill preterm neonates with weight below 1500 g requiring a central access. INTERVENTIONS Ultrasound-guided brachio-cephalic vein catheterization. MAIN RESULTS Thirty centrally inserted catheters were placed in 30 neonates. The success rate of the procedure was 100%. No case of accidental arterial or pleural puncture was registered during the study period. CONCLUSION The brachio-cephalic vein can be safely catheterized in preterm newborns requiring intensive care after appropriate training.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Ospedale Infermi, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Ospedale Infermi, Rimini, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Francesca Tota
- Neonatal Intensive Care Unit, Ospedale S. Chiara, APSS, Trento, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Catholic University Hospital "A.Gemelli," Rome, Italy
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14
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Barone G, Pittiruti M, Ancora G, Vento G, Tota F, D'Andrea V. Centrally inserted central catheters in preterm neonates with weight below 1500 g by ultrasound-guided access to the brachio-cephalic vein. J Vasc Access 2020; 22:344-352. [PMID: 32648811 DOI: 10.1177/1129729820940174] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Central venous access in critically ill newborns can be challenging. Ultrasound-guided brachio-cephalic vein catheterization is a relatively new procedure, recently introduced in several neonatal intensive care units. The aim of this study is to evaluate the safety and feasibility of such a technique in preterm babies. DESIGN Retrospective analysis of prospectively collected data on ultrasound-guided central venous catheter insertion in preterm neonates. SETTING Neonatal intensive care unit. PATIENTS Critically ill preterm neonates with weight below 1500 g requiring a central access. INTERVENTIONS Ultrasound-guided brachio-cephalic vein catheterization. MAIN RESULTS Thirty centrally inserted catheters were placed in 30 neonates. The success rate of the procedure was 100%. No case of accidental arterial or pleural puncture was registered during the study period. CONCLUSION The brachio-cephalic vein can be safely catheterized in preterm newborns requiring intensive care after appropriate training.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Ospedale Infermi, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Ospedale Infermi, Rimini, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Francesca Tota
- Neonatal Intensive Care Unit, Ospedale S. Chiara, APSS, Trento, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Catholic University Hospital "A.Gemelli," Rome, Italy
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15
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Ancora G, Faldella G, Chiereghin A, Marsico C, Nigro CS, Lazzarotto T, Sambri V, Brusa G, Capretti MG. Parechovirus infection causing sepsis-like illness in newborns: a NICU approach. New Microbiol 2020; 43:144-147. [PMID: 32656569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
Human parechovirus (HpeV) is an important emerging infection in young infants, able to cause sepsis-like disease and meningoencephalitis, especially in newborns. Among the 19 identified genotypes, HPeV1, 3 and 6 are the most common types involved in human infections; HPeV3 is the type mainly responsible for neonatal infections and for infections involving the central nervous system. Signs and symptoms overlap with those of a bacterial infection and patients are usually treated with broad spectrum antibiotics. In the majority of cases lumbar puncture shows absence of pleocytosis, even in the presence of signs of meningitis. In these cases, cerebrospinal fluid cultures are negative for bacteria but, in the absence of diagnosis of viral infection, a full and unnecessary antibiotic cycle is often continued. Moreover, high sensitivity neuroimaging, i.e., magnetic resonance, and follow-up are often missed, thus resulting in substandard care. Availability of a real time PCR assay for HPeV RNA allows rapid and sensitive diagnosis as long as the disease is suspected. In this case study, we present cases of HPeV infections in newborns requiring neonatal intensive care admission, discuss their optimal management, and highlight the most relevant findings in the literature.
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Affiliation(s)
- Gina Ancora
- Neonatal Intensive Care Unit, AUSL Romagna, Infermi Hospital, Rimini, Italy
| | - Giacomo Faldella
- Neonatal Intensive Care Unit, AUSL Romagna, Infermi Hospital, Rimini, Italy
| | - Angela Chiereghin
- Department of Specialized, Experimental and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St. Orsola Hospital, Bologna, Italy
| | - Concetta Marsico
- Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, University of Bologna, Italy
| | | | - Tiziana Lazzarotto
- Department of Specialized, Experimental and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St. Orsola Hospital, Bologna, Italy
| | | | - Giacomo Brusa
- Neonatal Intensive Care Unit, AUSL Romagna, Infermi Hospital, Rimini, Italy
| | - Maria Grazia Capretti
- Neonatal Intensive Care Unit, St. Orsola-Malpighi Hospital, University of Bologna, Italy
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16
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Morciano G, Patergnani S, Bonora M, Pedriali G, Tarocco A, Bouhamida E, Marchi S, Ancora G, Anania G, Wieckowski MR, Giorgi C, Pinton P. Mitophagy in Cardiovascular Diseases. J Clin Med 2020; 9:jcm9030892. [PMID: 32214047 PMCID: PMC7141512 DOI: 10.3390/jcm9030892] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular diseases are one of the leading causes of death. Increasing evidence has shown that pharmacological or genetic targeting of mitochondria can ameliorate each stage of these pathologies, which are strongly associated with mitochondrial dysfunction. Removal of inefficient and dysfunctional mitochondria through the process of mitophagy has been reported to be essential for meeting the energetic requirements and maintaining the biochemical homeostasis of cells. This process is useful for counteracting the negative phenotypic changes that occur during cardiovascular diseases, and understanding the molecular players involved might be crucial for the development of potential therapies. Here, we summarize the current knowledge on mitophagy (and autophagy) mechanisms in the context of heart disease with an important focus on atherosclerosis, ischemic heart disease, cardiomyopathies, heart failure, hypertension, arrhythmia, congenital heart disease and peripheral vascular disease. We aim to provide a complete background on the mechanisms of action of this mitochondrial quality control process in cardiology and in cardiac surgery by also reviewing studies on the use of known compounds able to modulate mitophagy for cardioprotective purposes.
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Affiliation(s)
- Giampaolo Morciano
- Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, 48033 Ravenna, Italy; (G.M.); (S.P.); (G.P.)
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (M.B.); (A.T.); (E.B.); (C.G.)
| | - Simone Patergnani
- Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, 48033 Ravenna, Italy; (G.M.); (S.P.); (G.P.)
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (M.B.); (A.T.); (E.B.); (C.G.)
| | - Massimo Bonora
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (M.B.); (A.T.); (E.B.); (C.G.)
| | - Gaia Pedriali
- Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, 48033 Ravenna, Italy; (G.M.); (S.P.); (G.P.)
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (M.B.); (A.T.); (E.B.); (C.G.)
| | - Anna Tarocco
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (M.B.); (A.T.); (E.B.); (C.G.)
- Neonatal Intensive Care Unit, University Hospital S. Anna Ferrara, 44121 Ferrara, Italy
| | - Esmaa Bouhamida
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (M.B.); (A.T.); (E.B.); (C.G.)
| | - Saverio Marchi
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy;
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital Rimini, 47923 Rimini, Italy;
| | - Gabriele Anania
- Department of Medical Sciences, Section of General and Thoracic Surgery, University of Ferrara, 44121 Ferrara, Italy;
| | - Mariusz R. Wieckowski
- Laboratory of Mitochondrial Biology and Metabolism, Nencki Institute of Experimental Biology of the Polish Academy of Sciences, 3 Pasteur Str., 02-093 Warsaw, Poland;
| | - Carlotta Giorgi
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (M.B.); (A.T.); (E.B.); (C.G.)
| | - Paolo Pinton
- Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, 48033 Ravenna, Italy; (G.M.); (S.P.); (G.P.)
- Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy; (M.B.); (A.T.); (E.B.); (C.G.)
- Correspondence:
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Lago P, Spada C, Lugli L, Garetti E, Pirelli A, Savant Levet P, Ancora G, Merazzi D. Pain management during therapeutic hypothermia in newborn infants with hypoxic-ischaemic encephalopathy. Acta Paediatr 2020; 109:628-629. [PMID: 31637755 DOI: 10.1111/apa.15071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/09/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Paola Lago
- Neonatal Intensive Care Unit, Women's and Children's Department Ca’ Foncello Hospital Treviso Italy
| | - Caterina Spada
- Neonatal Intensive Care Unit Women's and Children's Health Department Azienda Ospedaliera University of Modena and Reggio Emilia Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit Women's and Children's Health Department Azienda Ospedaliera University of Modena and Reggio Emilia Italy
| | - Elisabetta Garetti
- Neonatal Intensive Care Unit Women's and Children's Health Department Azienda Ospedaliera University of Modena and Reggio Emilia Italy
| | - Anna Pirelli
- Neonatal Intensive Care Unit Presidio Ospedaliero di Rho ASST Rhodense Rho, Milano Italy
| | - Patrizia Savant Levet
- Neonatal Intensive Care Unit Maria Vittoria Hospital ASL Citta' di Torino Torino Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit Azienda Sanitaria Romagna Infermi Hospital Rimini Rimini Italy
| | - Daniele Merazzi
- Neonatal Intensive Care Unit, Mother's and Infant's Department Valduce Hospital Como Italy
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Ancora G, Meloni C, Soffritti S, Sandri F, Ferretti E. Intrapartum Asphyxiated Newborns Without Fetal Heart Rate and Cord Blood Gases Abnormalities: Two Case Reports of Shoulder Dystocia to Reflect Upon. Front Pediatr 2020; 8:570332. [PMID: 33194898 PMCID: PMC7652761 DOI: 10.3389/fped.2020.570332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022] Open
Abstract
Our report covers two cases of severe hypoxic-ischemic encephalopathy in newborns whose birth was complicated by shoulder dystocia. In both cases, there were inconsistencies observed among cardiotocographic traces, baby's clinical conditions at birth, and umbilical cord blood gases. Namely, normal cardiotocographic monitoring and cord pH > 7, in spite of the fact that the newborns were severely depressed at birth and their blood gases evaluated within 1 h from birth showed a severe metabolic acidosis. Moreover, one of the two newborns displayed moderately low hemoglobin levels. Metabolic and infectious causes were ruled out. Both newborns developed severe hypoxic-ischemic encephalopathy and received therapeutic hypothermia for 72 h. Both survived, one with a severe dystonic cerebral palsy whereas the other developed only a mild developmental delay in language. Cardiac asystole theory could explain these two cases, reinforcing the need for specific resuscitation guidelines for infants experiencing a birth complicated by shoulder dystocia.
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Affiliation(s)
- Gina Ancora
- Neonatal Intensive Care Unit, Department of Maternal, Infant and Adolescent Health, Infermi Hospital, Azienda Unità Sanitaria Locale Romagna, Rimini, Italy
| | - Claudio Meloni
- Obstetrics and Gynecology Unit, Department of Maternal, Infant and Adolescent Health, Infermi Hospital, Azienda Unità Sanitaria Locale Romagna, Rimini, Italy
| | - Silvia Soffritti
- Neonatal Intensive Care Unit, Department of Maternal and Infant Health, Maggiore Hospital, Bologna, Italy
| | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Department of Maternal and Infant Health, Maggiore Hospital, Bologna, Italy
| | - Emanuela Ferretti
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, The Ottawa General Hospital, University of Ottawa, Ottawa, ON, Canada
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19
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Pirelli A, Savant Levet P, Garetti E, Ancora G, Merazzi D, Bellieni CV, Lago P. Literature review informs clinical guidelines for pain management during screening and laser photocoagulation for retinopathy of prematurity. Acta Paediatr 2019; 108:593-599. [PMID: 30054933 DOI: 10.1111/apa.14523] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/29/2018] [Accepted: 07/25/2018] [Indexed: 01/12/2023]
Abstract
AIM The aim of this study was to carry out a literature review and develop clinical guidelines for pain prevention and control during screening and laser photocoagulation for retinopathy of prematurity (ROP) in neonatal intensive care units (NICUs). METHODS The Italian Society of Neonatology assessed papers published between 1986 and June 2017 and used the Grading of Recommendations, Assessment, Development and Evaluation approach, to develop new guidelines on pain and ROP. RESULTS The Society's pain experts assessed the full texts of 47 papers, including randomised or quasi-randomised controlled trials and case-control studies on nonpharmacological and pharmacological measures used in NICUs during the screening and laser photocoagulation of neonates for ROP. The literature suggested methods for reducing the stress and pain associated with ROP screening procedures. The panel concluded that the literature showed that it was feasible to provide laser photocoagulation for ROP in spontaneously breathing patients with adequate analgesia. CONCLUSION This literature review on managing pain in infants with ROP in NICUs led to the development of national guidelines, which will help physicians and nurses to reduce the stress and pain experienced by premature newborn infants during unavoidable screening and treatment for ROP.
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Affiliation(s)
- Anna Pirelli
- NICU; Women's and Children's Health Department; ASST Rhodense; Ospedale of Rho; Rho Italy
| | | | - Elisabetta Garetti
- NICU; Women's and Children's Health Department; Azienda Ospedaliera-University of Modena; Modena Italy
| | - Gina Ancora
- Women's and Children's Health Department; Infermi Hospital; Azienda Ospedaliera of Rimini; Rimini Italy
| | - Daniele Merazzi
- NICU; Mother's and Infant's Department; Valduce Hospital; Como Italy
| | | | - Paola Lago
- NICU; Women's and Children's Health Department; Azienda Ospedaliera-University of Padova; Padova Italy
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20
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Ancora G, Lago P, Garetti E, Merazzi D, Savant Levet P, Bellieni CV, Pieragostini L, Pirelli A. Evidence-based clinical guidelines on analgesia and sedation in newborn infants undergoing assisted ventilation and endotracheal intubation. Acta Paediatr 2019; 108:208-217. [PMID: 30290021 DOI: 10.1111/apa.14606] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/31/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
Abstract
AIM This review informed pain control guidelines for clinicians performing mechanical ventilation, nasal continuous positive airway pressure and endotracheal intubation on term and preterm newborn infants. METHODS We reviewed literature published between 1986 and June 2017 on analgesia and sedation during assisted ventilation and before endotracheal intubation in newborn infants admitted to neonatal intensive care units. The subsequent guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Our review produced five strong standard of care recommendations. One, reduce neonatal stress and use nonpharmacological analgesia during invasive ventilation. Two, favour intermittent boluses of opioids, administered after pain scores and before invasive procedures, during short expected periods of mechanical ventilation, mainly in preterm infants affected by respiratory distress syndrome. Three, do not use morphine infusion in preterm infants under 27 gestational weeks. Four, always use algometric scores to titrate analgesic drugs doses. Five, use premedication before endotracheal intubation for a more rapid, less painful, less traumatic and safer manoeuvre. We also developed 30 conditional recommendations on therapeutic options. CONCLUSION Our review produced 35 recommendations on standard care and therapeutic options relating to the analgesia and sedation of newborn infants during ventilation and before endotracheal intubation.
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Affiliation(s)
- Gina Ancora
- NICU; Azienda Sanitaria Romagna; Infermi Hospital Rimini; Rimini Italy
| | - Paola Lago
- NICU; Azienda ULSS 2 MarcaTrevigiana; CàFoncello Hospital; Treviso Italy
| | - Elisabetta Garetti
- NICU; Women's and Children's Health Department; Azienda Ospedaliera; University of Modena; Modena Italy
| | - Daniele Merazzi
- NICU; Mother's and Infant's Department; Valduce Hospital; Como Italy
| | - Patrizia Savant Levet
- NICU; Maria Vittoria Hospital; Mother's and Infant's Department; ASL Città di Torino Italy
| | | | | | - Anna Pirelli
- NICU; Rho Hospital; ASST Rhodense; Garbagnate Milanese; Milano Italy
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Fabi M, Corinaldesi E, Pierantoni L, Mazzoni E, Landini C, Bigucci B, Ancora G, Malaigia L, Bodnar T, Di Fazzio G, Lami F, Valletta E, Cicero C, Biasucci G, Iughetti L, Marchetti F, Sogno Valin P, Amarri S, Brusa S, Sprocati M, Maggiore G, Dormi A, Lanzoni P, Donti A, Lanari M. Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease? PLoS One 2018; 13:e0202658. [PMID: 30180185 PMCID: PMC6122791 DOI: 10.1371/journal.pone.0202658] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/07/2018] [Indexed: 12/22/2022] Open
Abstract
Background Kawasaki disease (KD) is a febrile systemic vasculitis of unknown etiology and the main cause of acquired heart disease among children in the developed world. To date, abdominal involvement at presentation is not recognized as a risk factor for a more severe form of the disease. Objective To evaluate whether presenting abdominal manifestations identify a group at major risk for Intravenous immunoglobulin (IVIG)-resistance and coronary lesions. Methods Retrospective study of KD patients diagnosed between 2000 and 2015 in 13 pediatric units in Italy. Patients were divided into 2 groups according to the presence or absence of abdominal manifestations at onset. We compared their demographic and clinical data, IVIG-responsiveness, coronary ectasia/aneurysms, laboratory findings from the acute and subacute phases. Results 302 patients (181 boys) were enrolled: 106 patients with, and 196 patients without presenting abdominal features. Seasonality was different between the groups (p = 0.034). Patients with abdominal manifestations were younger (p = 0.006) and more frequently underwent delayed treatment (p = 0.014). In the acute phase, patients with abdominal presentation had higher platelet counts (PLT) (p = 0.042) and lower albuminemia (p = 0.009), while, in the subacute phase, they had higher white blood cell counts (WBC) and PLT (p = 0.002 and p < 0.005, respectively) and lower red blood cell counts (RBC) and hemoglobin (Hb) (p = 0.031 and p 0.009). Moreover, the above mentioned group was more likely to be IVIG-resistant (p < 0.005) and have coronary aneurysms (p = 0.007). In the multivariate analysis, presenting abdominal manifestations, age younger than 6 months, IVIG- resistance, delayed treatment and albumin concentration in the acute phase were independent risk factors for coronary aneurysms (respectively p<0.005, <0.005, = 0.005 and 0.009). Conclusions This is the first multicenter report demonstrating that presenting gastrointestinal features in KD identify patients at higher risk for IVIG-resistance and for the development of coronary aneurysms in a predominantly Caucasian population. Clinical trial registration 8/20014/O/OssN.
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Affiliation(s)
- Marianna Fabi
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- * E-mail:
| | | | - Luca Pierantoni
- Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisa Mazzoni
- Department of Pediatrics, Maggiore Hospital, Bologna, Italy
| | - Chiara Landini
- Department of Pediatrics, Maggiore Hospital, Bologna, Italy
| | | | - Gina Ancora
- Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Laura Malaigia
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Tetyana Bodnar
- Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Giorgia Di Fazzio
- Department of Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Francesca Lami
- Department of Pediatric, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Valletta
- Department of Pediatrics, G.B.Morgagni–L. Pierantoni Hospital, AUSL della Romagna, Forlì, Italy
| | - Cristina Cicero
- Department of Pediatrics, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Giacomo Biasucci
- Department of Pediatrics, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Lorenzo Iughetti
- Department of Pediatric, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Federico Marchetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
| | - Paola Sogno Valin
- Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Sergio Amarri
- Department of Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Sandra Brusa
- Department of Pediatrics, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Monica Sprocati
- Department of Pediatrics, Arcispedale Sant’Anna, Ferrara, Italy
| | | | - Ada Dormi
- Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy
| | - Paolo Lanzoni
- Department of Pediatrics, Ramazzini Hospital, Carpi, Italy
| | - Andrea Donti
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Marcello Lanari
- Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
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22
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Lago P, Garetti E, Bellieni CV, Merazzi D, Savant Levet P, Ancora G, Pirelli A. Systematic review of nonpharmacological analgesic interventions for common needle-related procedure in newborn infants and development of evidence-based clinical guidelines. Acta Paediatr 2017; 106:864-870. [PMID: 28295585 DOI: 10.1111/apa.13827] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/24/2016] [Accepted: 03/07/2017] [Indexed: 11/28/2022]
Abstract
The aim of this literature review was to develop clinical guidelines for the prevention and control of needle-related pain in newborn infants. The guidelines were developed by the Italian Society of Neonatology, using the Grading of Recommendations, Assessment, Development and Evaluation approach, based on the assessment of 232 papers published between 1986 and 2015. The quality of the evidence was high or moderate for some behavioural and nonpharmacological interventions. CONCLUSION There was sufficient evidence to strongly support the use of nonpharmacological interventions for common needle-related procedures in newborn infants. Combined interventions seemed to be more effective in relieving procedural pain.
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Affiliation(s)
- Paola Lago
- Neonatal Intensive Care Unit; Women's and Children's Health Department; Azienda Ospedaliera-University of Padova; Padova Italy
| | - Elisabetta Garetti
- NICU; Women's and Children's Health Department; Azienda Ospedaliera-University of Modena; Modena Italy
| | | | - Daniele Merazzi
- NICU; Mother's and Infant's Department; Valduce Hospital; Como Italy
| | | | - Gina Ancora
- Women's and Children's Health Department; Infermi Hospital; Azienda Ospedaliera of Rimini; Rimini Italy
| | - Anna Pirelli
- NICU; MBBM Foundation; San Gerardo Hospital; Monza Italy
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Zucchelli M, Lefosse M, Corvaglia L, Martini S, Sandri F, Soffritti S, Ancora G, Mammoliti P, Gargano G, Galassi E. Introduction of percutaneous-tunneled transfontanellar external ventricular drainage in the management of hydrocephalus in extremely low-birth-weight infants. J Neurosurg Pediatr 2016; 18:1-6. [PMID: 27015520 DOI: 10.3171/2016.1.peds15563] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hydrocephalus treatment in extremely low-birth-weight (ELBW) infants still represents a challenge for the pediatric neurosurgeon, particularly when the patient weighs far less than 1000 g. In such cases, the benefits in terms of neurological outcome following early treatment do not always outweigh the surgical risks, especially considering the great difference in the surgical risk before patient weight increases. To assess the efficacy and reliability of a percutaneous-tunneled, transfontanellar external ventricular drain (PTTEVD) in ELBW infants, the authors started a new protocol for the early surgical treatment of hydrocephalus. METHODS Ten cases of posthemorrhagic hydrocephalus (PHH) in ELBW infants (5 cases < 700 g, range for all cases 550-1000 g) were treated with a PTTEVD that was implanted at bedside as the first measure in a stepwise approach. RESULTS The average duration of the procedure was 7 minutes, and there was no blood loss. The drain remained in place for an average of 24 days (range 8-45 days). In all cases early control of the hydrocephalus was achieved. One patient had a single episode of CSF leakage (due to insufficient CSF removal). In another patient Enterococcus in the CSF sample was detected the day after abdominal surgery with ileostomy (infection resolved with intrathecal vancomycin). One patient died of Streptococcus sepsis, a systemic infection existing prior to drain placement that never resolved. One patient had Pseudomonas aeruginosa sepsis prior to drain insertion; a PTTEVD was implanted, the infection resolved, and the hydrocephalus was treated in the same way as with a traditional EVD, while the advantages of a quick, minimally invasive, bedside procedure were maintained. Once a patient reached 1 kg in weight, when necessary, a ventriculoperitoneal shunt was implanted and the PTTEVD was removed. CONCLUSIONS The introduction of PTTEVD placement in our standard protocol for the management of PHH has proved to be a wise option for small patients.
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Affiliation(s)
- Mino Zucchelli
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital
| | - Mariella Lefosse
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital
| | - Silvia Martini
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital
| | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Maternal and Pediatrics Department, Maggiore Hospital, Bologna
| | - Silvia Soffritti
- Neonatal Intensive Care Unit, Maternal and Pediatrics Department, Maggiore Hospital, Bologna
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini
| | | | - Giancarlo Gargano
- Neonatal Intensive Care Unit, Obstetrics, Gynecology and Pediatrics Department, Arcispedale Santa Maria Nuova Hospital, IRCCS, Reggio Emilia, Italy
| | - Ercole Galassi
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital
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Vergine G, Sorci M, Rosafio C, Bigucci B, Filippini B, Ancora G. "Cyrano nose" associated with hepatic hemangiomas successfully treated with propranolol. Dermatol Online J 2015; 21:13030/qt8ft0005b. [PMID: 26436973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 06/05/2023] Open
Abstract
Hemangioma of the nasal tip is commonly described as "Cyrano nose" and his treatment is extremely difficult because of its location and possible severe aesthetic complications like definitive nasal deformation. We describe a patient who presented at two months of age with a "Cyrano nose" associated with multiple hepatic and cutaneous hemangiomas, which completely resolved after therapy with propranolol. Treatment was well tolerated and aesthetic result was excellent.
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Vergine G, Sorci M, Rosafio C, Bigucci B, Filippini B, Ancora G. “Cyrano nose” associated with hepatic hemangiomas successfully treated with propranolol. Dermatol Online J 2015. [DOI: 10.5070/d3217028118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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26
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Capretti MG, Lanari M, Tani G, Ancora G, Sciutti R, Marsico C, Lazzarotto T, Gabrielli L, Guerra B, Corvaglia L, Faldella G. Role of cerebral ultrasound and magnetic resonance imaging in newborns with congenital cytomegalovirus infection. Brain Dev 2014; 36:203-11. [PMID: 23647916 DOI: 10.1016/j.braindev.2013.04.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the diagnostic and prognostic value of cerebral magnetic resonance imaging (cMRI) in comparison with that of cerebral ultrasound (cUS) in predicting neurodevelopmental outcome in newborns with congenital cytomegalovirus (CMV) infection. METHODS Forty CMV-congenitally infected newborns underwent cUS and cMRI within the first month of life. Clinical course, laboratory findings, visual/hearing function and neurodevelopmental outcome were documented. RESULTS Thirty newborns showed normal cMRI, cUS and hearing/visual function in the first month of life; none showed CMV-related abnormalities at follow-up. Six newborns showed pathological cMRI and cUS findings (pseudocystis, ventriculomegaly, calcifications, cerebellar hypoplasia) but cMRI provided additional information (white matter abnormalities in three cases, lissencephaly/polymicrogyria in one and a cyst of the temporal lobe in another one); cerebral calcifications were detected in 3/6 infants by cUS but only in 2/6 by cMRI. Four of these 6 infants showed severe neurodevelopmental impairment and five showed deafness during follow-up. Three newborns had a normal cUS, but cMRI documented white matter abnormalities and in one case also cerebellar hypoplasia; all showed neurodevelopmental impairment and two were deaf at follow-up. One more newborn showed normal cUS and cMRI, but brainstem auditory evoked responses were abnormal; psychomotor development was normal at follow-up. CONCLUSIONS Compared with cUS, cMRI disclosed additional pathological findings in CMV-congenitally infected newborns. cUS is a readily available screening tool useful in the identification of infected newborns with major cerebral involvement. Further studies with a larger sample size are needed to determine the prognostic role of MRI, particularly regarding isolated white matter lesions.
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Affiliation(s)
- Maria Grazia Capretti
- Department of Obstetrical, Gynaecological and Paediatric Sciences, Operative Unit of Neonatology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy.
| | - Marcello Lanari
- Paediatric Department, S. Maria della Scaletta Hospital, Imola, Italy
| | - Giovanni Tani
- Department of Obstetrical, Gynaecological and Paediatric Sciences, Operative Unit of Paediatric Radiology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy
| | - Gina Ancora
- Department of Obstetrical, Gynaecological and Paediatric Sciences, Operative Unit of Neonatology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy
| | - Rita Sciutti
- Department of Obstetrical, Gynaecological and Paediatric Sciences, Operative Unit of Paediatric Radiology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy
| | - Concetta Marsico
- Department of Obstetrical, Gynaecological and Paediatric Sciences, Operative Unit of Neonatology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy
| | - Tiziana Lazzarotto
- Department of Haematology, Oncology and Laboratory Medicine, Operative Unit of Microbiology and Virology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy
| | - Liliana Gabrielli
- Department of Haematology, Oncology and Laboratory Medicine, Operative Unit of Microbiology and Virology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy
| | - Brunella Guerra
- Department of Obstetrical, Gynaecological and Paediatric Sciences, Operative Unit of Obstetrics and Gynaecology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy
| | - Luigi Corvaglia
- Department of Obstetrical, Gynaecological and Paediatric Sciences, Operative Unit of Neonatology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy
| | - Giacomo Faldella
- Department of Obstetrical, Gynaecological and Paediatric Sciences, Operative Unit of Neonatology, St. Orsola-Malpighi General Hospital, University of Bologna, Italy
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27
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Lago P, Garetti E, Pirelli A, Merazzi D, Bellieni CV, Savant Levet P, Pieragostini L, Ancora G. Sucrose for procedural pain control in infants: should we change our practice? Acta Paediatr 2014; 103:e88-90. [PMID: 24117709 DOI: 10.1111/apa.12459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 11/29/2022]
Affiliation(s)
- P Lago
- Neonatal Intensive Care Unit; Department of Women's and Children's Health; Azienda Ospedaliera - University of Padova; Padova Italy
| | - E Garetti
- Neonatal Intensive Care Unit; Azienda Ospedaliero -Universitaria; Policlinico di Modena; Modena Italy
| | - A Pirelli
- Neonatal Intensive Care Unit; MBBM Foundation-San Gerardo Hospital; Monza Italy
| | - D Merazzi
- Neonatal Intensive Care Unit; Valduce Hospital; Como Italy
| | - CV Bellieni
- Neonatology; Department of Pediatrics; Obstetrics and Reproductive Medicine; Policlinico Le Scotte-University of Siena; Siena Italy
| | - P Savant Levet
- Neonatal Intensive Care Unit; Maria Vittoria Hospital; Turin Italy
| | - L Pieragostini
- Neonatal Intensive Care Unit; San Filippo Neri Hospital; Roma Italy
| | - G Ancora
- Neonatal Intensive Care Unit; Infermi Hospital; Rimini Italy
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Ancora G, Lago P, Garetti E, Pirelli A, Merazzi D, Mastrocola M, Pierantoni L, Faldella G. Efficacy and safety of continuous infusion of fentanyl for pain control in preterm newborns on mechanical ventilation. J Pediatr 2013; 163:645-51.e1. [PMID: 23582138 DOI: 10.1016/j.jpeds.2013.02.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 01/24/2013] [Accepted: 02/18/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the analgesic superiority and the safety equivalence of continuous fentanyl infusions versus fentanyl boluses in preterm infants on mechanical ventilation. STUDY DESIGN In this multicenter, double-blind, randomized controlled trial, mechanically ventilated newborns (≤ 32(+6) weeks gestational age) were randomized to fentanyl (continuous infusion of fentanyl plus open-label boluses of fentanyl) or placebo (continuous infusion of placebo plus open-label boluses of fentanyl). The primary endpoint was analgesic efficacy, as evaluated by the Echelle Douleur Inconfort Nouveau-Né (EDIN) and Premature Infant Pain Profile scales. Safety variables were evaluated as well. RESULTS Sixty-four infants were allocated to the fentanyl group, and 67 were allocated to the placebo group. The need for open-label boluses of fentanyl was similar in the 2 groups (P = .949). EDIN scores were comparable in the 2 groups; 65 of 961 (6.8%) EDIN scores were >6 in the fentanyl group and 91 of 857 (10.6%) in the placebo group (P = .003). The median Premature Infant Pain Profile score was clinically and statistically higher in the placebo group compared with the fentanyl group on days 1, 2, and 3 of treatment (P < .05). Mechanical ventilation at age 1 week was required in 27 of 64 infants in the fentanyl group (42.2%), compared with 17 of 67 infants in the placebo group (25.4%) (P = .042). The first cycle of mechanical ventilation was longer and the first meconium passage occurred later in the fentanyl group (P = .019 and .027, respectively). CONCLUSION In very preterm infants on mechanical ventilation, continuous fentanyl infusion plus open-label boluses of fentanyl does not reduce prolonged pain, but does reduce acute pain and increase side effects compared with open-label boluses of fentanyl alone.
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Affiliation(s)
- Gina Ancora
- Neonatology and Neonatal Intensive Care Unit, Department of Women's, Child's and Adolescent's Health, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
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Lago P, Garetti E, Boccuzzo G, Merazzi D, Pirelli A, Pieragostini L, Piga S, Cuttini M, Ancora G. Procedural pain in neonates: the state of the art in the implementation of national guidelines in Italy. Paediatr Anaesth 2013; 23:407-14. [PMID: 23301982 DOI: 10.1111/pan.12107] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND National and international guidelines have been published on pain control and prevention in the newborn, but data on compliance with these guidelines are lacking. AIM To document current hospital practices for analgesia at neonatal intensive care units (NICUs) 5 years after national guidelines were published in Italy. METHODS A computer-based questionnaire was sent to all registered Italian level II and level III NICUs to investigate their routine pain control practices. MAIN OUTCOME MEASURES The analgesia and sedation currently used for invasive procedures as compared with best practices. RESULTS The questionnaire was returned by 103 of the 118 NICUs (87.3%), most of which (85.4%) knew of the national guidelines on procedural pain control and prevention, and used some analgesic measures during invasive procedures. One or more nonpharmacological interventions were only used routinely by 64.1% of the NICUs for heel pricks and venipuncture, 56.0% for percutaneous insertion of central catheters, 69.7% for nasal CPAP, and 62.4% for eye tests to screen for retinopathy of prematurity. Pain medication was routinely administered at 34.3% NICUs for tracheal intubation, 46.6% for mechanical ventilation (MV), 12.9% for tracheal aspiration, 71.4% for chest tube insertion, 33.0% for lumbar puncture, and 64.0% for postoperative pain. Pain was routinely monitored at only 22.7% of the units during MV, 12.1% for nCPAP, and 21.8% postoperatively. CONCLUSION This survey showed that most Italian NICUs provide some form of analgesia and sedation for invasive procedures in accordance with national guidelines, but their routine adherence to best practices for pain control and monitoring is still suboptimal.
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Affiliation(s)
- Paola Lago
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Azienda Ospedaliera-University of Padova, Padova, Italy.
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Lago P, Boccuzzo G, Garetti E, Pirelli A, Pieragostini L, Merazzi D, Ancora G. Pain management during invasive procedures at Italian NICUs: has anything changed in the last 5 years? J Matern Fetal Neonatal Med 2013; 25 Suppl 4:148-50. [PMID: 22958050 DOI: 10.3109/14767058.2012.725973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To ascertain the extent to which neonatal analgesia for invasive procedures has changed in the last 5 years since the publication of Italian guidelines. METHODS We compared survey data for the years 2004 and 2010 on analgesia policy and practices for common invasive procedures at Italian Neonatal Intensive Care Units (NICUs); 75 NICUs answered questionnaires for both years and formed the object of this analysis. RESULTS By 2010, analgesia practices for procedural pain had improved significantly for almost all invasive procedures (p < 0.05), with both non-pharmacological and pharmacological methods being adopted by the majority of NICUs (unlike the situation in 2004). The routine use of medication for major invasive procedures was still limited, however (35% of lumbar punctures, 40% of tracheal intubations, 46% during mechanical ventilation). Postoperative pain treatment was still inadequate, and 41% of facilities caring for patients after surgery did not treat pain routinely. Pain monitoring had definitely improved since 2004 (p < 0.05), but not enough: only 21 and 17% of NICUs routinely assess pain during mechanical ventilation and after surgery, respectively. CONCLUSION There have been improvements in neonatal analgesia practices in Italy since national guidelines were published, but pain is still undertreated and underscored, especially during major invasive procedures. It is mandatory to address the gap between the recommendations in the guidelines and clinical practice must be addressed through with effective quality improvement initiatives.
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Affiliation(s)
- Paola Lago
- Neonatal Intensive Care and Pathology, Azienda Ospedaliera di Padova, Padua, Italy.
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Ancora G, Maranella E, Grandi S, Sbravati F, Coccolini E, Savini S, Faldella G. Early predictors of short term neurodevelopmental outcome in asphyxiated cooled infants. A combined brain amplitude integrated electroencephalography and near infrared spectroscopy study. Brain Dev 2013; 35:26-31. [PMID: 22082686 DOI: 10.1016/j.braindev.2011.09.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 09/15/2011] [Accepted: 09/16/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Brain Cooling (BC) represents the elective treatment in asphyxiated newborns. Amplitude Integrated Electroencephalography (aEEG) and Near Infrared Spectroscopy (NIRS) monitoring may help to evaluate changes in cerebral electrical activity and cerebral hemodynamics during hypothermia. OBJECTIVES To evaluate the prognostic value of aEEG time course and NIRS data in asphyxiated cooled infants. METHODS Twelve term neonates admitted to our NICU with moderate-severe Hypoxic-Ischemic Encephalopathy (HIE) underwent selective BC. aEEG and NIRS monitoring were started as soon as possible and maintained during the whole hypothermic treatment. Follow-up was scheduled at regular intervals; adverse outcome was defined as death, cerebral palsy (CP) or global quotient <88.7 at Griffiths' Scale. RESULTS 2/12 Infants died, 2 developed CP, 1 was normal at 6 months of age and then lost at follow-up and 7 showed a normal outcome at least at 1 year of age. The aEEG background pattern at 24 h of life was abnormal in 10 newborns; only 4 of them developed an adverse outcome, whereas the 2 infants with a normal aEEG developed normally. In infants with adverse outcome NIRS showed a higher Tissue Oxygenation Index (TOI) than those with normal outcome (80.0±10.5% vs 66.9±7.0%, p=0.057; 79.7±9.4% vs 67.1±7.9%, p=0.034; 80.2±8.8% vs 71.6±5.9%, p=0.069 at 6, 12 and 24 h of life, respectively). CONCLUSIONS The aEEG background pattern at 24h of life loses its positive predictive value after BC implementation; TOI could be useful to predict early on infants that may benefit from other innovative therapies.
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Affiliation(s)
- Gina Ancora
- Neonatology Unit, Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
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Lago P, Boccuzzo G, Garetti E, Pirelli A, Pieragostini L, Merazzi D, Ancora G. Pain management during invasive procedures at Italian NICUs: has anything changed in the last five years? J Matern Fetal Neonatal Med 2012; 26:303-5. [PMID: 23039224 DOI: 10.3109/14767058.2012.733783] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To ascertain the extent to which neonatal analgesia for invasive procedures has changed in the last 5 years since the publication of Italian guidelines. METHODS We compared survey data for the years 2004 and 2010 on analgesia policy and practices for common invasive procedures at Italian Neonatal Intensive Care Units (NICUs); 75 NICUs answered questionnaires for both years and formed the object of this analysis. RESULTS By 2010 analgesia practices for procedural pain had improved significantly for almost all invasive procedures (p < 0.05), both non-pharmacological and pharmacological methods being adopted by the majority of NICUs (unlike the situation in 2004). The routine use of medication for major invasive procedures was still limited, however (35% of lumbar punctures, 40% of tracheal intubations, 46% during mechanical ventilation). Postoperative pain treatment was still inadequate, and 41% of facilities caring for patients after surgery did not treat pain routinely. Pain monitoring had definitely improved since 2004 (p < 0.05), but not enough: only 21% and 17% of NICUs routinely assess pain during mechanical ventilation and after surgery, respectively. CONCLUSION There have been improvements in neonatal analgesia practices in Italy since national guidelines were published, but pain is still undertreated and underscored, especially during major invasive procedures. It is mandatory to address the gap between the recommendations in the guidelines and clinical practice must be addressed through with effective quality improvement initiatives.
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Affiliation(s)
- P Lago
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Azienda Ospedaliera-University of Padova, Padova, Italy.
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Ancora G, Garetti E, Pirelli A, Merazzi D, Mastrocola M, Pierantoni L, Faldella G, Lago P. Analgesic and sedative drugs in newborns requiring respiratory support. J Matern Fetal Neonatal Med 2012; 25 Suppl 4:88-90. [PMID: 22958030 DOI: 10.3109/14767058.2012.715036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Infants receiving respiratory assistance may feel pain due to underlying disease or ventilation itself. Pain control during neonatal respiratory care reduces morbidity. This article summarizes the main scientific evidence about the use of drugs during ventilatory assistance, and provides some practical suggestions on pain management in neonates with respiratory support.
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Affiliation(s)
- Gina Ancora
- UO Neonatal Intensive Care, Ospedale Infermi Rimini, Italy.
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Ancora G, Maranella E, Grandi S, Pierantoni L, Guglielmi M, Faldella G. Role of bilevel positive airway pressure in the management of preterm newborns who have received surfactant. Acta Paediatr 2010; 99:1807-11. [PMID: 20545934 DOI: 10.1111/j.1651-2227.2010.01910.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Surfactant given during brief intubation followed by immediate extubation on nasal continuous positive airway pressure [Intubation-Surfactant-Extubation (InSurE) approach] is used to treat respiratory distress syndrome in newborns. Our aim was to evaluate whether bilevel positive airway pressure (BiPAP) after InSurE failure is able to prevent the need for mechanical ventilation (MV). METHODS Chart data of infants with a birth weight <1500 gr or GA <32weeks undergoing InSurE in the period 2002-2008 in an Italian Tertiary Neonatal Intensive Care Unit were reviewed retrospectively. InSurE failure was defined as follows: FiO(2) >0.4, respiratory acidosis or intractable apnoea within 1 week. After InSurE failure, newborns born before the implementation of BiPAP (historical control group) received MV, whereas those born after BiPAP implementation (BiPAP group) received BiPAP and underwent MV only if failure criteria persisted. The two groups were compared to evaluate whether BiPAP reduced the need for MV in the 7 days after InSurE failure. RESULTS Six of twenty-two (27%) and 14 of the 38 (37%) infants failed InSurE in the two groups, respectively (p > 0.05). Need for MV was 27% in the historical control group versus 0% in the BiPAP group (risk estimate, 3.38; 95% CI, 2.24, 5.09; p = 0.001). CONCLUSIONS BiPAP reduced the need for MV after InSurE failure.
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Affiliation(s)
- Gina Ancora
- Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
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Ancora G, Soffritti S, Lodi R, Tonon C, Grandi S, Locatelli C, Nardi L, Bisacchi N, Testa C, Tani G, Ambrosetto P, Faldella G. A combined a-EEG and MR spectroscopy study in term newborns with hypoxic-ischemic encephalopathy. Brain Dev 2010; 32:835-42. [PMID: 20060251 DOI: 10.1016/j.braindev.2009.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 11/02/2009] [Accepted: 11/18/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Brain damage following a perinatal hypoxic-ischemic (HI) insult has been documented by different diagnostic techniques. The aim of the present study was to relate a-EEG time course during the first 24h of life to brain metabolic changes detected by proton MR spectroscopy ((1)H-MRS) at 7-10days of life and to evaluate their correlation with outcome. METHODS Thirty-two patients with any grade HI encephalopathy were studied. Thirty-one out of 32 patients survived and underwent (1)H-MRS examination at 7-10days of life; a-EEG was recorded during the first 24h of life in 27/32 newborns; 26 patients underwent both examinations. Griffiths test, evaluation of motor skills, visual and hearing function were performed at regular intervals until the age of 2years. RESULTS a-EEG at 6, 12 and 24h of life showed a significant correlation with outcome. N-acetyl-aspartate/creatine (Cr), Lactate/Cr and myo-inositol differed significantly between patients with normal or poor outcome. a-EEG time course during the first 24h of life showed improvement in newborns with normal (1)H-MRS and good outcome and a deterioration in those with abnormal (1)H-MRS and poor outcome. CONCLUSIONS a-EEG time course may be able to document the severity and the evolution of the cerebral damage following an HI event. a-EEG is related to the severity of cerebral injury as defined by (1)H-MRS and both examinations showed a good correlation with outcome. These data, obtained in non-cooled infants, may represent reference data for future investigations in cooled infants.
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Affiliation(s)
- Gina Ancora
- Neonatology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Italy.
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Sandri F, Plavka R, Ancora G, Simeoni U, Stranak Z, Martinelli S, Mosca F, Nona J, Thomson M, Verder H, Fabbri L, Halliday H. Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics 2010; 125:e1402-9. [PMID: 20439601 DOI: 10.1542/peds.2009-2131] [Citation(s) in RCA: 207] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Early surfactant followed by extubation to nasal continuous positive airway pressure (nCPAP) compared with later surfactant and mechanical ventilation (MV) reduce the need for MV, air leaks, and bronchopulmonary dysplasia. This randomized, controlled trial investigated whether prophylactic surfactant followed by nCPAP compared with early nCPAP application with early selective surfactant would reduce the need for MV in the first 5 days of life. METHODS A total of 208 inborn infants who were born at 25 to 28 weeks' gestation and were not intubated at birth were randomly assigned to prophylactic surfactant or nCPAP within 30 minutes of birth. Outcomes were assessed within the first 5 days of life and until death or discharge of the infants from hospital. RESULTS Thirty-three (31.4%) infants in the prophylactic surfactant group needed MV in the first 5 days of life compared with 34 (33.0%) in the nCPAP group (risk ratio: 0.95 [95% confidence interval: 0.64-1.41]; P = .80). Death and type of survival at 28 days of life and 36 weeks' postmenstrual age and incidence of main morbidities of prematurity (secondary outcomes) were similar in the 2 groups. A total of 78.1% of infants in the prophylactic surfactant group and 78.6% in the nCPAP group survived in room air at 36 weeks' postmenstrual age. CONCLUSIONS Prophylactic surfactant was not superior to nCPAP and early selective surfactant in decreasing the need for MV in the first 5 days of life and the incidence of main morbidities of prematurity in spontaneously breathing very preterm infants on nCPAP.
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Affiliation(s)
- Fabrizio Sandri
- Dipartimento Materno-Infantile, Ospedale Maggiore, Bologna, Italy.
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Ancora G. [The well-being of the newborn infant in neonatal intensive care]. Minerva Pediatr 2010; 62:55-58. [PMID: 21090074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Patients referred to Neonatal Intensive Care Units are particularly vulnerable because they are in a critical or sensitive period of development. When physicians were first able to really save preemies 40 years ago, not much thought was given to their brain development. The babies we care for are so early that the brain cells are still migrating to where they will finally rest in developed brain. We are shaped, to an extent, by our environment. In early life, the environment takes on a particularly important role. So treatments may over-stimulate areas of the brain with unknown consequences. For this reason minimally invasive treatments together with attention to the environment will favour a care developmentally appropriate for pre-term babies. Use of nasalCPAP, early rescue surfactant, synchronized mechanical ventilation, together with temperature, light and noise control could help to obtain these results. Pain control, music therapy, massage, kangaroo care and a family centred care are essential to optimize results obtained from the intensive care.
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Affiliation(s)
- G Ancora
- UO Neonatologia, AOU Policlinico Sant'Orsola-Malpighi, Bologna
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Ghi T, Giunchi S, Pilu G, Youssef A, Morselli-Labate AM, Arcangeli T, Meriggiola MC, Pelusi C, Ancora G, Cocchi G, Faldella G, Pelusi G. Neonatal hypoxic-ischemic encephalopathy in apparently low risk pregnancies: Retrospective analysis of the last five years at the University of Bologna. J Matern Fetal Neonatal Med 2010; 23:516-21. [DOI: 10.3109/14767050903186293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Corvaglia L, Aceti A, Paoletti V, Mariani E, Patrono D, Ancora G, Capretti MG, Faldella G. Standard fortification of preterm human milk fails to meet recommended protein intake: Bedside evaluation by Near-Infrared-Reflectance-Analysis. Early Hum Dev 2010; 86:237-40. [PMID: 20447779 DOI: 10.1016/j.earlhumdev.2010.04.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 03/26/2010] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Protein content of preterm human milk (HM) is relatively low and extremely variable among mothers: thus, recommended protein intake is rarely met. OBJECTIVES To evaluate in a NICU setting if HM protein content after standard fortification meets the recommended intake, and also to check the effect of fortification on the osmolality of HM, as an index of feeding intolerance. METHODS Protein content of 34 preterm HM samples was evaluated by a bedside technique (Near-Infrared-Reflectance-Analysis - NIRA); osmolality was also checked. Seventeen samples were fortified with Aptamil BMF, Milupa (Group A) and 17 with FM85, Nestlé (Group B). Fortification was performed as recommended by the manufacturer ("full fortification [FF]") and also with a lower amount of fortifier ("low-dose fortification [LF]"). After fortification, actual protein content was calculated and compared to that needed to meet recommended intake (2.33-3g/dl), and osmolality was measured. RESULTS After FF, protein content was above 3g/dl in none of the samples, and below 2.33 g/dl in 16/34 samples (11 in Group A, 5 in Group B). After LF, protein content was above 3g/dl in none of the samples and below 2.33 g/dl in 32/34 samples (15 in Group A, 17 in Group B). Osmolality exceeded 400 mOsm/kg in 19 samples after FF (10 in Group A, 9 in Group B) and in 2/34 samples after LF (1 in each group). CONCLUSION HM protein content after standard fortification fails to meet the recommended intake for preterm infants in approximately half of the cases.
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Ancora G, Maranella E, Aceti A, Pierantoni L, Grandi S, Corvaglia L, Faldella G. Effect of posture on brain hemodynamics in preterm newborns not mechanically ventilated. Neonatology 2010; 97:212-7. [PMID: 19887848 DOI: 10.1159/000253149] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 03/18/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Changes in head posture influence brain hemodynamics. Optimal positioning has been recommended as 1 of 10 potentially better practices to reduce the incidence of brain injury in preterm newborns. OBJECTIVES The aim of this study was to evaluate by near-infrared spectroscopy (NIRS) the effect of different head and body positions and the influence of gestational age (GA) and nasal continuous positive airway pressure on brain hemodynamics in very preterm newborns. METHODS 24 stable preterm newborns were studied by NIRS in 6 different postures including head rotation and head inclination in both supine and prone positions. Changes in normalized tissue hemoglobin index (nTHI) and tissue oxygenation index (TOI) were measured after posture variations. RESULTS No statistically significant changes in nTHI and in TOI were found in the 6 postures. nTHI variations, expression of cerebral blood volume variations, were influenced by GA. A reduction in nTHI, with a stable TOI, in the less mature infants (with GA < or = 26 weeks), occurred on head rotation; nTHI increased again when the head was derotated. CONCLUSIONS Hemodynamic changes after posture variations depend on GA. Head rotation in newborns with GA < or = 26 weeks produced a reduction in nTHI with stable TOI. Possible physiopathological mechanisms are discussed.
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Affiliation(s)
- Gina Ancora
- Neonatology Unit, Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
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Corvaglia L, Mariani E, Aceti A, Capretti MG, Ancora G, Faldella G. Combined oesophageal impedance-pH monitoring in preterm newborn: comparison of two options for layout analysis. Neurogastroenterol Motil 2009; 21:1027-e81. [PMID: 19368657 DOI: 10.1111/j.1365-2982.2009.01301.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Gastro-oesophageal reflux (GOR) is common in preterm infants. Combined multichannel intraluminal impedance and pH monitoring (pH-MII) is emerging as an useful tool to study both acid and non-acid GOR in this population. We aimed to highlight main advantages and limits of pH-MII in preterm infants and to test whether the inclusion of GOR episodes detected only by pH monitoring details better the features of GOR. Fifty-two symptomatic preterm infants underwent a 24-hour, continuous and simultaneous measurement of pH-MII. Each layout was analyzed using two different options: option 1 included GOR episodes detected by MII and then classified as acid or non-acid according to the associated pH change; option 2 included GOR episodes detected by MII and also GOR episodes detected only by pH sensor. By adopting option 1, a total number of 2834 GOR episodes was detected by MII: 2162 of them were characterized as non-acid and 672 were characterized as acid. The median (range) number of acid MII-GOR episodes was 10 (1-52); the median (range) number of non-acid MII-GOR episodes was 36.5 (2-119). Median (range) acid MII-GOR-bolus exposure index was 0.28% (0.02-2.73%); median (range) non-acid MII-GOR-bolus exposure index was 1.03% (0.06-38.15%). By adopting option 2, an average of 53.2 acid GOR episodes and an average of 11% oesophageal exposure to acid GOR more than by option 1 was detected. An accurate and detailed description of GOR in preterm infants can be obtained only by including in the analysis all acid GOR episodes detected by pH sensor.
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Affiliation(s)
- L Corvaglia
- Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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Abstract
UNLABELLED Despite accumulating evidence that procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behaviour and neurological outcome, pain control and prevention remain controversial issues. Our aim was to develop guidelines based on evidence and clinical practice for preventing and controlling neonatal procedural pain in the light of the evidence-based recommendations contained in the SIGN classification. A panel of expert neonatologists used systematic review, data synthesis and open discussion to reach a consensus on the level of evidence supported by the literature or customs in clinical practice and to describe a global analgesic management, considering pharmacological, non-pharmacological, behavioural and environmental measures for each invasive procedure. There is strong evidence to support some analgesic measures, e.g. sucrose or breast milk for minor invasive procedures, and combinations of drugs for tracheal intubation. Many other pain control measures used during chest tube placement and removal, screening and treatment for ROP, or for postoperative pain, are still based not on evidence, but on good practice or expert opinions. CONCLUSION These guidelines should help improving the health care professional's awareness of the need to adequately manage procedural pain in neonates, based on the strongest evidence currently available.
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Affiliation(s)
- Paola Lago
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Padova, Via Giustiniani 3, Padua, Italy.
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Ancora G, Maranella E, Locatelli C, Pierantoni L, Faldella G. Changes in cerebral hemodynamics and amplitude integrated EEG in an asphyxiated newborn during and after cool cap treatment. Brain Dev 2009; 31:442-4. [PMID: 18650042 DOI: 10.1016/j.braindev.2008.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 05/09/2008] [Accepted: 06/10/2008] [Indexed: 11/26/2022]
Abstract
Amplitude integrated EEG (aEEG) and Near Infrared Spectroscopy (NIRS) were applied in a newborn with a moderate hypoxic-ischemic encephalopathy before, during and after brain cooling. At 2h of life a selective head cooling with mild systemic hypothermia was started and maintained for 72h. aEEG background pattern improved from severely abnormal to normal during the first 17h of life. NIRS revealed a reduction in cerebral blood volume (CBV) during hypothermia that recovered during the rewarming period, whereas brain oxygenation remained stable. As brain cooling is supposed to reduce delayed hyperemia and help to maintain neuronal metabolism following cerebral insults, aEEG and NIRS monitoring may be useful during hypothermic treatment in order to document changes in CBV and brain oxygenation possibly reflecting the efficacy of hypothermia.
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Affiliation(s)
- Gina Ancora
- Institute of Neonatology, University of Bologna, Via Massarenti 11, Bologna, Italy.
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Ancora G, Mastrocola M, Bagnara C, Zola D, Pierantoni L, Rossi G, Corvaglia L, Faldella G. Influence of gestational age on the EDIN score: an observational study. Arch Dis Child Fetal Neonatal Ed 2009; 94:F35-8. [PMID: 18499770 DOI: 10.1136/adc.2007.133777] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIM Hospitalised neonates, particularly if preterm, may be exposed to prolonged pain. At present the only validated scale to assess prolonged pain in preterms is the EDIN (Echelle Douleur Inconfort Nouveau-Né) scale. Gestational age has been shown to influence the response of infants to acute pain but its potential effect in the setting of prolonged pain has not been investigated. The aim of the present study was to evaluate whether neonatal maturity as expressed by gestational age and/or postnatal age influences their expression of prolonged pain. METHODS In a 1 year period, 84 neonates (gestational age 25-41 weeks), referred to the authors' neonatal intensive care unit were evaluated using the EDIN scale two to three times a day (1571 scores). The EDIN scores were categorised as indicative (>6) or not indicative (< or =6) of pain. Gestational age and postnatal age were included in a logistic regression analysis along with some painful situations and analgesic treatment to identify the impact on the EDIN scores. RESULTS Logistic regression analysis showed that the EDIN scores were positively associated with gestational age (odds ratio 1.166; 95% CI 1.123 to 1.211). Postnatal age, sepsis and presence of respiratory support also influenced the EDIN score. CONCLUSIONS Gestational age influences expression of prolonged pain. Content validity of the EDIN scale could be improved by adding categories for gestational age and attributing higher basal scores to less mature newborns.
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Affiliation(s)
- G Ancora
- Institute of Neonatology, Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Italy.
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Corvaglia L, Rotatori R, Ferlini M, Aceti A, Ancora G, Faldella G. The effect of body positioning on gastroesophageal reflux in premature infants: evaluation by combined impedance and pH monitoring. J Pediatr 2007; 151:591-6, 596.e1. [PMID: 18035136 DOI: 10.1016/j.jpeds.2007.06.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 04/27/2007] [Accepted: 06/06/2007] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the pattern of acid and nonacid gastroesophageal reflux (GER) in different body positions in preterm infants with reflux symptoms by a combined multichannel intraluminal impedance (MII)-pH monitoring, which identifies both acid and nonacid GER. STUDY DESIGN Premature infants with frequent regurgitation and postprandial desaturation (n = 22) underwent a 24-hour recording of MII-pH. In a within-subjects design, reflux indexes were analyzed with the infants in 4 different positions: supine (S), prone (P), on the right side (RS), and on the left side (LS). RESULTS All infants were analyzed for 20 hours. The mean number of recorded GER episodes was 109.7. The mean esophageal exposure to acid and nonacid GER was lower in positions P (4.4% and 0.3%, respectively) and LS (7.5% and 0.7%, respectively) than in positions RS (21.4% and 1.2%, respectively) and S (17.6% and 1.3%, respectively). The number of postprandial nonacid GER episodes decreased but the number of acid GER episodes increased over time. The LS position showed the lowest esophageal acid exposure (0.8%) in the early postprandial period, and the P position showed the lowest esophageal acid exposure (5.1%) in the late postprandial period. CONCLUSION Placing premature infants in the prone or left lateral position in the postprandial period is a simple intervention to limit GER.
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Affiliation(s)
- Luigi Corvaglia
- Institute of Preventive Pediatrics and Neonatology, St. Orsola Malpighi General Hospital, University of Bologna, Bologna, Italy.
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Guala A, Carrera P, Pastore G, Somaschini M, Ancora G, Faldella G, De Filippi P, Ferrero F, Guarino R, Danesino C. Familial clustering of unexplained transient respiratory distress in 12 newborns from three unrelated families suggests an autosomal-recessive inheritance. ScientificWorldJournal 2007; 7:1611-6. [PMID: 17906824 PMCID: PMC5901276 DOI: 10.1100/tsw.2007.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report on 12 near-term babies from three families in which an unexplained transient respiratory distress was observed. No known risk factor was present in any family and no sequelae were recorded at follow-up. The most common causes of respiratory distress at birth are Neonatal Respiratory Distress Syndrome (NRD) and Transient Tachypnea of the Newborn (TTN), and their cumulative incidence is estimated to be about 2%. Genetic factors have been identified in NRD (surfactant genes) or suggested for TTN (genes affecting lung liquid clearance). Survivors from NRD may develop clinically relevant sequelae, while TTN does not cause any problem later in life. Our cases do not immediately fit NRD or TTN, while familial recurrence suggests the existence of a previously unreported subgroup on patients with respiratory distress for which autosomal-recessive inheritance is likely.
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MESH Headings
- Female
- Genetic Predisposition to Disease/genetics
- Heterozygote
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/classification
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/genetics
- Italy
- Male
- Pedigree
- Respiratory Distress Syndrome, Newborn/classification
- Respiratory Distress Syndrome, Newborn/diagnosis
- Respiratory Distress Syndrome, Newborn/genetics
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Abstract
AIM We recently developed the ABC scale to assess pain in term newborns. The aim of the present study was to assess the reliability of the scale in preterm babies. MATERIAL AND METHODS The scale consists of three cry parameters: (a) pitch of the first cry, (b) rhythmicity of the bout of crying and (c) cry constancy. Changes in these parameters were previously found to distinguish medium and high levels of pain as evaluated by spectral analysis of crying. We enrolled 72 babies to perform the steps usually requested to validate a scale, namely the study of the concurrent validity, specificity and sensibility. Moreover, we assessed the interjudge reliability and the clinical utility and ease of the scale. RESULTS A good correlation (r = 0.68; r(2)= 0.45; p < 0.0001) was found between scores obtained with the ABC scale and the premature infant pain profile (PIPP) scale, demonstrating a good concurrent validity. The scale also showed good sensitivity and specificity (we found statistically significant differences between mean values of scores obtained in babies who underwent pain and babies who underwent non-painful stimulus.) Interobserver reliability was good: Cohen's kappa = 0.7. CONCLUSION The good correlation between the two scales shows that the ABC scale is also reliable for premature babies.
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Affiliation(s)
- Cv Bellieni
- Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Siena, Italy.
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Ancora G, Lanari M, Lazzarotto T, Venturi V, Tridapalli E, Sandri F, Menarini M, Ferretti E, Faldella G. Cranial ultrasound scanning and prediction of outcome in newborns with congenital cytomegalovirus infection. J Pediatr 2007; 150:157-61. [PMID: 17236893 DOI: 10.1016/j.jpeds.2006.11.032] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 09/16/2006] [Accepted: 11/03/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report the accuracy of ultrasound scanning (US) in predicting neurodevelopmental and sensorineural outcome in patients with congenital cytomegalovirus (CMV) infection. STUDY DESIGN Fifty-seven neonates with congenital CMV infection underwent brain US and were observed prospectively for motor skills, developmental quotient, and hearing function. RESULTS Abnormal results on US were found in 12 of 57 neonates. US lesions were more frequent in newborns with clinical and laboratory signs of congenital CMV infection at birth (10/18) than in newborns who had no symptoms at birth (2/39; P < .001). At least 1 sequela developed in all neonates with symptoms who had abnormal US results, whereas none of the neonates with symptoms who had normal US results had long-term sequelae (P < .001). In the population without symptoms, sensorineural hearing loss developed in 3 of 37 (8.1%) neonates with normal US results, whereas severe sequelae developed in 1 of 2 neonates with abnormal US results. CONCLUSIONS A good correlation was found between cerebral US abnormalities and the prediction of outcome in newborns who were congenitally infected with CMV and had symptoms at birth. US could be performed as the first neuroimaging study in these newborns. Data are insufficient to permit any suggestions for the population without symptoms.
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Affiliation(s)
- Gina Ancora
- Institute of Neonatology, Department of Gynecological, Obstetrical, and Pediatric Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
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Faldella G, Galletti S, Corvaglia L, Ancora G, Alessandroni R. Safety of DTaP–IPV–HIb–HBV hexavalent vaccine in very premature infants. Vaccine 2007; 25:1036-42. [PMID: 17088013 DOI: 10.1016/j.vaccine.2006.09.065] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 09/05/2006] [Accepted: 09/21/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the clinical safety of DTaP-IPV-HIb-HBV hexavalent immunization in very premature infants and to verify if the first administration of vaccine is by itself a reason for close monitoring hospitalized VLBW infants born at less than 31 weeks' gestation. PATIENTS AND METHODS Eighty-one preterm newborns less than 31 weeks' gestational age, admitted in the NICU, were eligible to be immunized with hexavalent vaccine under close monitoring, including pre-and post-immunization continuous monitoring of heart rate, oxygen saturation, respiratory rate, resistance index at the anterior cerebral artery and ECG cQT interval. RESULTS Of the 81 eligible premature newborns, 36 were graduated from the NICU before the least date for immunization, at 7 weeks of age. The other 45 were vaccinated in the NICU and entered the study. Twenty-three of them were under medical treatment for chronic disease at the time of the immunization while 22 were healthy and stable. Five infants (11%) had apnoea/bradycardia/desaturation, related to vaccine administration and required medical support. All five infants were in the group of newborns with chronic disease (21.7% prevalence of adverse reactions in this group). No significant variation of cQT or RI before and after the immunization was observed either in the whole groups of patients or in the five infants who showed cardio-respiratory events related to vaccination. CONCLUSIONS Hexavalent DTaP-IPV-HIb-HBV immunization is not associated with cardiac electric activity and cerebral blood flow variations in both stable and unstable very premature infants. However, it can cause apnoea/bradycardia/desaturation in premature babies with chronic disease. Therefore, if the baby is in the NICU for chronic diseases at 2 months post-birth, it should be monitored for apnoea, bradycardia and desaturation in association with vaccination. Hospitalized healthy preterm infants without chronic disease and therapy seem to be less vulnerable to cardio-respiratory adverse reactions. Nevertheless, it is advisable to immunize and monitor them at 8 weeks before discharge instead of possibly delaying immunization for several weeks and not monitor them.
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Affiliation(s)
- Giacomo Faldella
- Istituto di Pediatria Preventiva e Neonatologia, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy.
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Abstract
We report a case of severe, peripheral, and diffuse tissue ischemia after umbilical vein catheterization (UVC) in a preterm newborn born to a preeclamptic mother. Nitroglycerin ointment was used to treat lesions. The recovery was good but partial loss of the distal phalange of one finger and one toe occurred. This is the first report of peripheral vasospasm occurring after UVC. Topical nitroglycerin, traditionally used to treat peripheral artery catheter-induced ischemic injury, may be useful to treat the same lesions occurring after UVC.
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Affiliation(s)
- Gina Ancora
- Institute of Neonatology, University of Bologna, Bologna, Italy
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