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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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Bertaso A, Gottardo R, Murari M, Mazzola M, Porpiglia NM, Taus F, Beghini R, Gandini F, Bortolotti F. Hair testing applied to the assessment of in utero exposure to drugs: Critical analysis of 51 cases of the University Hospital of Verona. Drug Test Anal 2023; 15:980-986. [PMID: 37154073 DOI: 10.1002/dta.3515] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
The work discusses the results of hair and urine testing performed in 51 cases of suspected in utero drug exposure handled at the University Hospital of Verona from 2016 to 2022. On the day of birth or the day after birth, urine from mother and newborn (UM and UN) and hair from mother (HM), newborn (HN) and father (HF), if possible, were collected. Urine underwent immunoassay and GC-MS analysis, whereas hair underwent LC-MS/MS and GC-MS/MS analysis. In 50 out of 51 cases, HM and/or HN were available. In 92% of them, hair testing resulted in a positive, often (>50% cases) for more than one class of substance. The most detected substances were cocaine, opiates, methadone and cannabinoids. Maternal segmental analysis showed a prevalent decreasing concentration trend during pregnancy in case of positivity for one class of substances, whereas, as expected, a neatly prevalent increasing trend in the case of positivity for more than one class of substances. In nine cases, HF was also available, resulting in all being positive, usually for the same classes of substances identified in HM, thus questioning parental responsibility. In 33 cases, urine samples from the mother or newborn were also collected. Of them, 27 cases (82%) tested positive, showing peri-partum drug consumption and then confirming the severity of the addiction. Hair testing showed to be a reliable diagnostic tool to investigate in utero drug exposure because of the possibility of obtaining a complete picture of maternal addictive behaviour and family background, thanks to segmental maternal hair analysis and father hair testing.
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Affiliation(s)
- Anna Bertaso
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Rossella Gottardo
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Matilde Murari
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Mara Mazzola
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Nadia Maria Porpiglia
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - Francesco Taus
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
- Department of Diagnostic and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Renzo Beghini
- Department of Pediatrics, Verona University Hospital, Verona, Italy
| | - Fabio Gandini
- Social Services, Verona University Hospital, Verona, Italy
| | - Federica Bortolotti
- Department of Diagnostic and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
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Rugolotto S, Errico G, Beghini R, Ilic S, Richelli C, Padovani EM. Weaning of epoprostenol in a small infant receiving concomitant bosentan for severe pulmonary arterial hypertension secondary to bronchopulmonary dysplasia. Minerva Pediatr 2006; 58:491-4. [PMID: 17008861] [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: 05/12/2023]
Abstract
Endothelin receptor antagonism is an important therapeutic tool of pulmonary arterial hypertension (PAH). Bosentan was the first orally active, dual antagonist of endothelin receptors in human adults, and has been recently considered for children as well. However, little is known about bosentan treatment in children weighing less than 10 kg. We describe the use of bosentan concomitantly to epoprostenol in an infant weighing 3.5 kg and affected with severe bronchopulmonary dysplasia (BPD) and PAH. At 5 months old, when she presented subsystemic PAH secondary to severe BPD, she was treated with oxygen, digoxin and diuretics. At 8 months old, due to severe PAH not responsive to 100% oxygen, high frequency oscillatory ventilation (HFOV) and nitric oxide (NO), we started epoprostenol and bosentan. Bosentan dose was doubled at 9 months old, when HFOV and NO were slowly discontinued due to improved oxygenation index. Regular echocardiographic measurements of systolic right ventricular pressure were recorded by the method of tricuspidal atrio-ventricular gradient. A four-month combined epoprostenol and bosentan treatment decreased systolic right ventricular pressure from 68% to 40% of the systemic level, till its normalization at 11 months old. Later, when bosentan and epoprostenol were discontinued and sildenafil was started, severe PAH was reported again. Our patient died due to septic shock and refractory hypoxia at 14 months old.
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Affiliation(s)
- S Rugolotto
- Neonatal Intensive Care Unit, Department of Pediatrics, Ospedale Policlinico, Via delle Menegone, 37134 Verona, Italy.
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