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Bianco F, Ricci F, Catozzi C, Murgia X, Schlun M, Bucholski A, Hetzer U, Bonelli S, Lombardini M, Pasini E, Nutini M, Pertile M, Minocchieri S, Simonato M, Rosa B, Pieraccini G, Moneti G, Lorenzini L, Catinella S, Villetti G, Civelli M, Pioselli B, Cogo P, Carnielli V, Dani C, Salomone F. From bench to bedside: in vitro and in vivo evaluation of a neonate-focused nebulized surfactant delivery strategy. Respir Res 2019; 20:134. [PMID: 31266508 PMCID: PMC6604359 DOI: 10.1186/s12931-019-1096-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 02/24/2019] [Accepted: 06/12/2019] [Indexed: 01/17/2023] Open
Abstract
Background Non-invasive delivery of nebulized surfactant has been a neonatology long-pursued goal. Nevertheless, the clinical efficacy of nebulized surfactant remains inconclusive, in part, due to the great technical challenges of depositing nebulized drugs in the lungs of preterm infants. The aim of this study was to investigate the feasibility of delivering nebulized surfactant (poractant alfa) in vitro and in vivo with an adapted, neonate-tailored aerosol delivery strategy. Methods Particle size distribution of undiluted poractant alfa aerosols generated by a customized eFlow-Neos nebulizer system was determined by laser diffraction. The theoretical nebulized surfactant lung dose was estimated in vitro in a clinical setting replica including a neonatal continuous positive airway pressure (CPAP) circuit, a cast of the upper airways of a preterm neonate, and a breath simulator programmed with the tidal breathing pattern of an infant with mild respiratory distress syndrome (RDS). A dose-response study with nebulized surfactant covering the 100–600 mg/kg nominal dose-range was conducted in RDS-modelling, lung-lavaged spontaneously-breathing rabbits managed with nasal CPAP. The effects of nebulized poractant alfa on arterial gas exchange and lung mechanics were assessed. Exogenous alveolar disaturated-phosphatidylcholine (DSPC) in the lungs was measured as a proxy of surfactant deposition efficacy. Results Laser diffraction studies demonstrated suitable aerosol characteristics for inhalation (mass median diameter, MMD = 3 μm). The mean surfactant lung dose determined in vitro was 13.7% ± 4.0 of the 200 mg/kg nominal dose. Nebulized surfactant delivered to spontaneously-breathing rabbits during nasal CPAP significantly improved arterial oxygenation compared to animals receiving CPAP only. Particularly, the groups of animals treated with 200 mg/kg and 400 mg/kg of nebulized poractant alfa achieved an equivalent pulmonary response in terms of oxygenation and lung mechanics as the group of animals treated with instilled surfactant (200 mg/kg). Conclusions The customized eFlow-Neos vibrating-membrane nebulizer system efficiently generated respirable aerosols of undiluted poractant alfa. Nebulized surfactant delivered at doses of 200 mg/kg and 400 mg/kg elicited a pulmonary response equivalent to that observed after treatment with an intratracheal surfactant bolus of 200 mg/kg. This bench-characterized nebulized surfactant delivery strategy is now under evaluation in Phase II clinical trial (EUDRACT No.:2016–004547-36). Electronic supplementary material The online version of this article (10.1186/s12931-019-1096-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Bianco
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - F Ricci
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - C Catozzi
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - X Murgia
- Scientific Consultancy, Saarbrücken, Germany
| | - M Schlun
- PARI Pharma GmbH, Starnberg, Germany
| | | | - U Hetzer
- PARI Pharma GmbH, Starnberg, Germany
| | - S Bonelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Lombardini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - E Pasini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Nutini
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Pertile
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - S Minocchieri
- Division of Neonatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - M Simonato
- Pediatric Research Institute "Città della Speranza", Padova, Italy
| | - B Rosa
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - G Pieraccini
- Mass Spectrometry Center (CISM), Polo Biomedico, Careggi University Hospital of Florence, Florence, Italy
| | - G Moneti
- Mass Spectrometry Center (CISM), Polo Biomedico, Careggi University Hospital of Florence, Florence, Italy
| | - L Lorenzini
- Health Science and Technologies Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Bologna, Italy
| | - S Catinella
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - G Villetti
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - M Civelli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - B Pioselli
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - P Cogo
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - V Carnielli
- Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - C Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence School of Medicine, Careggi University Hospital of Florence, Viale Morgagni, 85, Florence, Italy.
| | - F Salomone
- Department of Preclinical Pharmacology, R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
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Zangari A, Noviello C, Nobile S, Cobellis G, Gulia C, Piergentili R, Gigli S, Carnielli V. Surgical management of Necrotizing Enterocolitis in an Incredibly Low Birth Weight infant and review of the Literature. Clin Ter 2017; 168:e297-e299. [PMID: 29044351 DOI: 10.7417/t.2017.2024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Survival of preterm infants have dramatically improved over the last decades. Nonetheless, infants born preterm remain vulnerable to many complications, including necrotizing enterocolitis (NEC). The severity of the disease and the mortality rate are directly correlated with decreasing gestational age and birth weight. Despite surgical treatment mortality rate remains very high in extremely premature infants, especially in newborns at the lowest limit of viability. Survival of infants of birth weight (BW) below 750 g has been increasingly reported in recent years, however the overall mortality in extremely low "BW" infants (ELBW) requiring surgery for NEC has not decreased over the past years. We describe our experience with a male preterm infant who survived after an ileostomy procedure for Bell stage II NEC, with improving neuromotor skills at 2 years follow up. Although standard indication to surgery is Bell stage III, in our case the choice of minimal laparotomy, exploration of the bowel and ileostomy at Bell stage II was safe and effective. Our experience suggest that surgery has not a negative impact on survival and ileostomy could prevent further damage of the bowel in NEC. We hypothesize that indication to surgery at an earlier stage may prevent further progression of the disease without a significantly negative impact on survival. Further studies are needed to confirm the appropriateness of this approach in ELBW infants.
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Affiliation(s)
- A Zangari
- Azienda Ospedaliera San Camillo Forlanini, Roma
| | - C Noviello
- Azienda Ospedali Riuniti Umberto Primo Lancisi Salesi, Ancona
| | - S Nobile
- Azienda Ospedali Riuniti Umberto Primo Lancisi Salesi, Ancona
| | - G Cobellis
- Azienda Ospedali Riuniti Umberto Primo Lancisi Salesi, Ancona
| | - C Gulia
- Università degli Studi di Roma Sapienza, Dipartimento di Urologia, Roma
| | - R Piergentili
- Italian National Research Council, Institute of Molecular Biology and Pathology (IBPM), Roma
| | - S Gigli
- Department of Radiology, Anatomo-pathology and Oncology, Sapienza University of Rome, Italy
| | - V Carnielli
- Azienda Ospedali Riuniti Umberto Primo Lancisi Salesi, Ancona
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De Meo MS, Polidori C, Pompilio A, Carnielli V, Savini S, Ciuccarelli F, Andresciani E, Garzone A, Carloni L, Moretti V. CP-069 Quality of antibiotic treatment in preterm neonates: a ready-to-use formulation of gentamicin sulphate. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sweet D, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Halliday HL. [European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants--2013 update]. Zhonghua Er Ke Za Zhi 2014; 52:749-755. [PMID: 25537540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- D Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Queen's University Belfast, Belfast, UK
| | - V Carnielli
- Dipartimento di Neonatologia, Ospedale Universitario di Ancona, Universtà Politecnica delle Marche, Ancona, Italy
| | - G Greisen
- Department of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - M Hallman
- Department of Pediatrics, Institute of Clinical Medicine, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - E Ozek
- Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
| | - R Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - O D Saugstad
- Department of Pediatric Research, Rikshospitalet Medical Center, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - U Simeoni
- Sevice de Néonatologie, Hospital de la Conception, Assistance Publique-Hopitaux de Marseille, Marseille, France
| | - C P Speer
- Department of Pediatrics, University Children's Hospital, Würzburg, Germany
| | - H L Halliday
- Department of Child Health, Queen's University Belfast and Royal Maternity Hospital, Belfast, UK
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Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Halliday HL. [European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2010 update]. Zhonghua Er Ke Za Zhi 2011; 49:27-33. [PMID: 21429308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- D G Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK
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Tessari P, Cosma A, Vettore M, Millioni R, Puricelli L, Cogo P, Cecchet D, Carnielli V, Kiwanuka E. Fibrinogen kinetics and protein turnover in obese non-diabetic males: effects of insulin. Diabetes Metab Res Rev 2010; 26:50-8. [PMID: 19943326 DOI: 10.1002/dmrr.1055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/11/2022]
Abstract
BACKGROUND Although hyperfibrinogenemia and insulin resistance are common in obesity and diabetes mellitus, the impact of obesity per se on fibrinogen turnover and the insulin effects on fibrinogen and protein kinetics is unknown. METHODS We measured fibrinogen and albumin fractional (FSR) and absolute (ASR) synthesis rates, as well as protein turnover, in non-diabetic, obese and in control male subjects both before and following an euglycemic, euaminoacidemic, hyperinsulinemic clamp, using L-[(2)H(3)]-Leucine isotope infusion. RESULTS In the obese, basal fibrinogen concentrations was approximately 25% greater (p < 0.035), and fibrinogen pool approximately 45% greater (p < 0.005), than in controls. Both FSR and ASR of fibrinogen were similar to control values. With hyperinsulinemia, although fibrinogen FSR and ASR were not significantly modified with respect to baseline in either group, fibrinogen ASR resulted to be approximately 50% greater in the obese than in controls (p < 0.015). Hyperinsulinemia equally stimulated albumin synthesis and suppressed leucine appearance from endogenous proteolysis in both groups. Amino acid clearance was also similar. In the obese, the insulin-mediated glucose disposal was approximately 50% lower (p < 0.03) than in controls, and it was inversely correlated with fibrinogen ASR during the clamp in both groups (r = - 0.58). CONCLUSIONS In obese, non-diabetic males, post absorptive fibrinogen production is normal. Whole-body amino acid disposal, basal and insulin-responsive protein degradation, and albumin synthesis are also normal. However, the greater fibrinogen ASR in the obese with hyperinsulinemia, and the inverse relationship between insulin sensitivity and clamp fibrinogen production, suggest a role for hyperinsulinemia and/or insulin resistance on fibrinogen production in obesity.
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Affiliation(s)
- P Tessari
- Department of Clinical and Experimental Medicine, Chair of Metabolism, Policlinico Universitario, via Giustiniani 2, Padua, Italy.
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Hummler HD, Hallman M, Jonsson B, Sanchez-Luna M, Carnielli V, Mercier JC. The EU Nitric Oxide Trial: Inhaled Nitric Oxide for the Prevention of Bronchopulmonary Dysplasia in Preterm Infants. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Valls-I-Soler A, Carnielli V, Claris O, de la Cruz Bértolo J, Halliday HL, Hallman M, Hummler H, Weindling M. [EuroNeoStat: a European information system on the outcomes of care for very-low-birth-weight infants (< 1500 g)]. Z Geburtshilfe Neonatol 2008; 212:116-8. [PMID: 18709632 DOI: 10.1055/s-2008-1076802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prematurity rates are increasing throughout the world. Despite an overall rather small percentage of very low birth weight infants (VLBWI), which is approx. 1-2 % in most countries, these infants contribute significantly to morbidity and neonatal and infant mortality rates. METHODS EuroNeoStat was initiated as an European information system on the outcomes of VLBWI to monitor and improve the care of these infants throughout Europe. EuroNeoStat includes an initiative, called EuroNeoSafe, to promote the safety of these high risk preterm infants. Perinatal and neonatal data from VLBWI is collected without using data that identify individuals or institutions. These data is analyzed at the coordination center in Bilbao. All institutions taking care on VLBWI in Europe can participate in this network and will be able to compare their own outcome data with other institutions from the network. Information on EuroNeoStat and the current data set is available on www.euroneostat.org. CONCLUSION Successful initiatives aiming at improving outcomes in perinatal and neonatal care require collaborative networking, an attitude of constructive criticism and thorough comparative analysis of the outcomes and incidents in the health-care process.
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Valls-i-Soler A, Carnielli V, Claris O, de la Cruz Bértolo J, Halliday HL, Hallman M, Hummler H, Weindling M. EuroNeoStat: a European information system on the outcomes of care for very-low-birth-weight infants. Neonatology 2008; 93:7-9. [PMID: 17630492 DOI: 10.1159/000105519] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- A Valls-i-Soler
- Neonatal and Clinical Epidemiology Unit, Department of Paediatrics, Hospital de Cruces, University of the Basque Country, Barakaldo-Bilbao, Spain.
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10
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Sweet D, Bevilacqua G, Carnielli V, Greisen G, Plavka R, Didrik SO, Simeoni U, Speer CP, Soler A, Valls I, Halliday H. [European consensus guidelines on the management of neonatal respiratory distress syndrome]. Zhonghua Er Ke Za Zhi 2008; 46:30-34. [PMID: 18353235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Stiris TA, Carnielli V. European Society for Neonatology: training program for the neonatologist in Europe. Acta Paediatr 2003; 91:604-5. [PMID: 12113333 DOI: 10.1080/080352502753711768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- T A Stiris
- Department of Paediatrics, Ullevål University Hospital, Norway.
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Stiris TA, Carnielli V. [European society for neonatology. Training program for neonatologists in Europe]. An Esp Pediatr 2002; 56:397-8. [PMID: 12042165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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Stiris T, Carnielli V. European Society for Neonatology Programa de Formación del neonatólogo en Europa. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)77834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Caliari S, Vantini I, Sembenini C, Gregori B, Carnielli V, Benini L. Fecal fat measurement in the presence of long- and medium-chain triglycerides and fatty acids. Comparison of three methods. Scand J Gastroenterol 1996; 31:863-7. [PMID: 8888432 DOI: 10.3109/00365529609051993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 02/04/2023]
Abstract
BACKGROUND It has been suggested that some of the limitations of the Van de Kamer method for fecal fat measurement could be overcome with the Jeejeebhoy method or the near-infrared reflectance assay. METHODS To test this hypothesis, a fecal fat test was carried out with the three methods, adding butter or MCT oil to the diet of four steatorrhoic patients. An in vitro recovery study of long- and medium-chain triglycerides was also performed. RESULTS The Jeejeebhoy method measured long- and medium-chain fats more accurately than the Van de Kamer method. It found consistently higher steatorrhea values. Mean results of the near-infrared reflectance analysis resembled those of the Van de Kamer method, but with wide discordance of individual data. CONCLUSION The Jeejeebhoy method is more accurate than the Van de Kamer method for fecal fat measurement. The difference may be clinically relevant when most fecal fatty acids derive from medium-chain triglycerides. Near-infrared reflectance may be a viable proposition only when a greater degree of approximation is acceptable.
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Affiliation(s)
- S Caliari
- Division of Gastroenterologic Rehabilitation, University of Verona, Italy
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15
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Ferrarese P, Pettenazzo A, Trevisanuto D, Verlato G, Biban P, Benini F, Carnielli V, Cogo P, Corner P, Orzali A, Zaramella P, Chiandetti L. [Transportation of the critical newborn infant and child]. Pediatr Med Chir 1996; 18:253-8. [PMID: 8966124] [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: 02/03/2023] Open
Abstract
Advance in the science and technology of neonatal and pediatric critical care have resulted in improved outcome for high risk newborn and children. Effective interhospital transport programmes are necessary for the appropriate use of resources and has become an integral component of regionalized perinatal care. It is now well established that use of an organized neonatal and pediatric transport team results in a fall in mortality and morbidity of infant. The American College of Obstetrician and Gynecologist and, recently, American Academy of Pediatrics published guidelines and recommendations for safe interhospital transfer of neonates, infants and children. Training of personnel, selection of equipment, organization and communication between hospitals are critical elements of a successful transport system. We present an overview of the role, principles and operating procedures of such neonatal-pediatric transport team and the basis of clinical stabilization before and during transfer. We also discuss data of the first 17 month experience of the Neonatal-Pediatric Transport Service of the Department of Pediatrics, University of Padua.
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Affiliation(s)
- P Ferrarese
- Dipartimento di Pediatria, Università di Padova, Italia
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Abstract
BACKGROUND The role of medium-chain triglycerides (MCTs) in the management of patients with pancreatic insufficiency is controversial. The aim of the study was to evaluate the absorption of MCTs in the presence of pancreatic insufficiency and the effect of pancreatic extracts on MCT absorption so as to clarify whether the replacement of usual dietary fats with MCTs is cost-effective. METHODS Six patients with severe pancreatic steatorrhea were for 5 days fed a low-fat diet to which butter (long-chain triglycerides (LCTs)) or MCT oil was added, with and without pancreatic extracts, in a crossover design. RESULTS Fecal weight and nitrogen losses were the same during MCT and LCT intake. Steatorrhea was substantial during both periods but was significantly lower during MCT than LCT intake. Fecal weight and nitrogen and fat losses were reduced by pancreatic extracts in both diets. Steatorrhea was the same when MCTs and LCTs were consumed together with pancreatic extracts. CONCLUSIONS MCTs are absorbed better than LCTs in the presence of pancreatic insufficiency but require pancreatic extracts for optimal absorption. No advantage is to be expected from replacing usual dietary fats with MCTs if pancreatic supplements are used.
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Affiliation(s)
- S Caliari
- Division of Gastroenterologic Rehabilitation, University of Verona, Italy
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Carnielli V, Montini G, Da Riol R, Dall'Amico R, Cantarutti F. Effect of high doses of human recombinant erythropoietin on the need for blood transfusions in preterm infants. J Pediatr 1992; 121:98-102. [PMID: 1625101 DOI: 10.1016/s0022-3476(05)82552-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 3.7] [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: 12/27/2022]
Abstract
To determine whether prophylactic treatment with recombinant human erythropoietin (rHuEPO) and iron would reduce the need for blood transfusions, we randomly assigned 22 premature infants with gestational ages less than or equal to 32 weeks and birth weights less than or equal to 1.75 kg to receive rHuEPO, 400 IU/kg three times a week, plus iron, 20 mg/wk intravenously, from the second day of life (11 infants), or no rHuEPO and no iron (11 infants). The two groups had similar birth weights and clinical variables. The treated infants required fewer blood transfusions (0.8 +/- 1.5 vs 3.1 +/- 2.1; p = 0.01) and less volume of packed erythrocytes (14.2 +/- 25.9 vs 48.4 +/- 34.0 ml/kg; p = 0.02). The amounts of blood sampled were not different (19.5 +/- 21.1 vs 27.8 +/- 19.1 ml/kg; p = 0.35). Reticulocyte and hematocrit values were higher in the treated group (4.46% +/- 0.8% vs 1.49% +/- 1.1% (p = 0.0001) and 48.1% +/- 7.3% vs 43.8% +/- 4.7% (p = 0.004), respectively). No side effects of either rHuEPO or intravenously administered iron were noted. These data indicate that rHuEPO, in combination with iron supplementation, is effective in reducing the need for blood transfusions in the premature infant. More information is needed on dosage, timing, and iron and vitamin supplementation.
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Affiliation(s)
- V Carnielli
- Department of Pediatrics, University of Padua, Italy
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Abstract
Variations in energy expenditure (EE) and substrate utilization were investigated in 12 surgical neonates (body weight, 2.81 +/- 0.15 kg) receiving total parenteral nutrition (TPN) at an energy intake of 66.34 +/- 2.16 kcal/kg/d in a thermoneutral environment of 32 degrees C to 34 degrees C. Respiratory gas exchange was continuously recorded for 12 hours by a computerized, open-circuit indirect calorimeter. Physical activity was monitored on a modified Freymond scale. Urine was collected over 3 days, including the time of the calorimetry study to determine the urinary nitrogen excretion rate. Oxygen consumption, carbon dioxide production, nonprotein respiratory quotient, and EE were calculated according to the principles of indirect calorimetry for each 30-minute period and for the entire 12 hours. During the indirect calorimetry study the patients were receiving a fat-free TPN mixture consisting of 10% glucose and 2% amino acids (GL/AA) for 8 hours. The fat-free TPN was interrupted by an isocaloric and isovolemic infusion of intralipid 10% (IL) for 4 hours. The effect of physical activity on EE was evaluated separately according to the macronutrient intake (GL/AA for 8 hours v IL for 4 hours) and then combined throughout the 12 hours of intravenous alimentation. The neonates were resting during 80% of the 12-hour study time (range, 38% to 90%). The partition of EE expressed as mean +/- SEM in kcal/kg/d was: total EE 48.5 +/- 2.1; resting EE 43.9 +/- 1.6; energy cost of activity 4.6 +/- 1.3.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Pierro
- Department of Surgery, University of Toronto, Ontario, Canada
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Pierro A, Koletzko B, Carnielli V, Superina RA, Roberts EA, Filler RM, Smith J, Heim T. Resting energy expenditure is increased in infants and children with extrahepatic biliary atresia. J Pediatr Surg 1989; 24:534-8. [PMID: 2738818 DOI: 10.1016/s0022-3468(89)80500-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.3] [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: 01/02/2023]
Abstract
To determine if liver dysfunction in children affects energy and macronutrient homeostasis, we performed 13 metabolic studies in 11 patients (age, 17.8 +/- 5.9 months [mean +/- SEM]) with extrahepatic biliary atresia (EHBA). Nutritional balance, indirect calorimetry, anthropometry, and biochemical liver function tests were utilised. Sixty-four percent of the energy losses were in the form of stool fat. Energy expenditure (68 kcal/kg/d) was 29% higher than normal (P less than 0.0025). Only one third of the metabolisable energy intake (37 kcal/kg/d) was stored in the body for new tissue synthesis. In spite of the bountiful protein intake for age, the increased protein oxidation (2g/kg/d) resulted in a virtually zero mean nitrogen balance. In addition, four patients oxidised endogenous protein as well. The respiratory quotient was 0.96, and did not change significantly between pre- and post-meal measurements, suggesting a predominant utilisation of carbohydrate for energy metabolism. Net lipid oxidation was severely diminished. We found that the higher the serum aspartate aminotransferase level (previously named SGOT), the lower the net fat oxidation, and the higher the conversion of glucose to fat. These data suggest that markedly increased energy expenditure contributes to the malnutrition of patients with EHBA. We characterised for the first time how severe liver disease in infants and children affects carbohydrate, fat, and protein metabolism, thus inducing protein-energy malnutrition.
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Affiliation(s)
- A Pierro
- Department of Surgery, University of Toronto, Ontario, Canada
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20
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Abstract
The metabolism of an intravenous (IV) fat emulsion was investigated by the combination of chemical balance and computerized indirect calorimetry techniques in 21 newborns (birth weight, 3.0 +/- 0.1 kg; mean +/- SE). All babies were appropriate for gestational age and received total parenteral nutrition after a major surgical procedure. The study was divided into two consecutive periods. Phase 1 consisted of infusion of 10% glucose and 2% amino acid solutions for 24 hours, and phase 2 involved the "Intralipid utilization test" (isocaloric and isovolemic infusion of Intralipid 10% for four hours). The caloric intake was 67.1 +/- 1.9 kcal/kg/d during both phases of the study. The resting energy expenditure was 44.8 +/- 1.6 and 46.5 +/- 1.8 kcal/kg/d during phases 1 and 2 respectively. During glucose/amino acid infusion, 12 patients oxidized endogenous fat, and de novo lipogenesis from glucose was observed in nine. During the Intralipid infusion, there was a significant and progressive decrease of carbon dioxide production, respiratory quotient, and carbohydrate utilization (oxidation plus conversion to fat). Net lipogenesis ended and fat utilization significantly increased. By the second hour of Intralipid infusion, 58% of energy expenditure was derived from fat oxidation. The drop in carbon dioxide production correlated positively with the decrease in carbohydrate utilization (r = .07; P less than .001). During the third and fourth hours of phase 2, the percentage of fat utilized was negatively correlated with the amount of fat given (r = -.07; P less than .01). The surgical neonate showed rapid metabolic adaptation to Intralipid infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Pierro
- Department of Surgery, University of Toronto, Ontario, Canada
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21
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Abstract
To determine the best formula to prevent protein depletion, 31 surgical infants on intravenous (IV) diet were studied. The study was divided into two phases. Phase I diet included 5% glucose and 1.5% or 2% amino acid infusion; phase II diet consisted of 5% glucose and 1.5% or 2% aminoacid plus 10% Intralipid. In each phase, oxygen consumption, carbon dioxide production, and energy expenditure were determined. The utilization of carbohydrate, fat, and protein was calculated from urinary nitrogen excretion and nonprotein respiratory quotient. The mean caloric intake during phase I and phase II was 62 and 94 kcal/kg/d, respectively. A positive nitrogen balance was obtained in infants receiving fat-free total parenteral nutrition (TPN) with a mean protein intake of 2.6 g/kg/d and a mean energy intake exceeding the energy expenditure by 24%. Infusion of more calories as Intralipid (phase II) caused a significant reduction in protein oxidation, thus protein contribution to the energy expenditure and an increase in protein retention. We conclude that supplementation of low-calorie TPN diets with Intralipid increases protein sparing and is preferable to the administration of very high glucose loads.
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Affiliation(s)
- A Pierro
- Department of Surgery, University of Toronto, Ontario, Canada
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22
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Abstract
After birth, the main energy fuel for the newborn is constituted by fat. Carnitine is necessary for the beta-oxidation of long chain fatty acids at the mitochondrial level, and seems also to have a role in the metabolism of the branched-chain amino acids, in ammonia detoxification, and in urea production. Colostrum is particularly rich in carnitine whereas semi-elemental formulae and soy-based formulae contain little or no carnitine. Since the newborn has a low capacity for carnitine biosynthesis, it seems useful to administer L-carnitine to infants on total parenteral nutrition, soy-based or semi-elemental formulae.
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Granati B, Rondinelli M, Capoti C, Carnielli V, Bottos M, Rubaltelli FF. The premature breech presentation: outcome of newborn infants born by vaginal or abdominal delivery. Am J Perinatol 1984; 1:145-7. [PMID: 6542795 DOI: 10.1055/s-2007-999990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is ample documentation that breech full-term infants delivered vaginally have a higher perinatal morbidity and mortality rate than breech infants born via cesarean section. Until now, little emphasis has been placed on the risks to premature newborns born in breech presentation. Therefore, the authors have considered all singleton pregnancies with infants in breech presentation admitted to the Department of Obstetrics, University of Padova, from January 1978 to December 1979 and delivered before 36-weeks gestation. On the basis of obstetric management, the authors have obtained two groups: Group A comprised 36 infants born by vaginal delivery; Group B totaled 32 newborns delivered by cesarean section. Mean gestational age and birthweight were comparable. Of the neonatal events considered, the following were significantly different: Apgar score at 5 minutes less than 7 (A = 30.6%; B = 9.3%), mortality (A = 13.8%; B = 0), neurologic sequelae in the infants discharged from the neonatal intensive care unit (NICU) (A = 50%; B = 9.1%) and the sum of mortality and long term sequelae (A = 22.2%; B = 3.1%). The authors conclude that cesarean section performed in mothers with impending preterm breech delivery decreases the neonatal mortality rate and improves the long-term outcome.
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Saia OS, Carnielli V, Zanardo V, Pollazzon P. Congenital choanal atresia: the postoperative care. Helv Paediatr Acta 1983; 38:347-50. [PMID: 6654685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A case of congenital bilateral bony choanal atresia treated by surgery is reported. A new method of insertion and retention of the modelling tubes to prevent stenosis is described. This method has the following advantages: 1. it provides a good insertion and retention of the modelling tubes; 2. it doesn't provoke any trauma of the nasal septum, soft palate and nostril; 3. the insertion of the tubes doesn't require general anesthesia; 4. it's well tolerated.
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Granati B, Zorzi C, Carnielli V, Giancola G, Temporin GF, Donzelli F, Rubaltelli FF. [Total parenteral feeding of the newborn infant. Evaluation of various blood chemistry parameters and of weight patterns with different therapeutic regimens]. Minerva Pediatr 1983; 35:331-4. [PMID: 6408369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
MESH Headings
- Blood Chemical Analysis
- Body Weight
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/therapy
- Infant, Premature
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/therapy
- Parenteral Nutrition/methods
- Parenteral Nutrition, Total/methods
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