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Meneghelli M, Peruzzo A, Priante E, Cavicchiolo ME, Bonadies L, Moschino L, De Terlizzi F, Verlato G. Bone Status and Early Nutrition in Preterm Newborns with and without Intrauterine Growth Restriction. Nutrients 2023; 15:4753. [PMID: 38004147 PMCID: PMC10675104 DOI: 10.3390/nu15224753] [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: 09/30/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Intrauterine growth restriction (IUGR) together with preterm birth could be harmful to bone health. The aim of the study was to examine bone status in IUGR versus non-IUGR preterms and to analyze the nutritional management best correlated with its improvement. Newborns < 34 weeks of gestational age (wGA), 75 IUGR and 75 non-IUGR, admitted to the Neonatal Intensive Care Unit of the University Hospital of Padova were enrolled and monitored from birth until 36 wGA through anthropometry (weight, length, head circumference, lower limb length (LLL)), biochemistry, bone quantitative ultrasound assessment of bone status (metacarpus bone transmission time, mc-BTT, us) and nutritional intakes monitoring during parenteral nutrition. IUGR compared to non-IUGR showed lower mean mc-BTT (0.45 vs. 0.51, p = 0.0005) and plasmatic phosphate (1.45 vs. 1.79, p < 0.001) at birth. Mc-BTT at 36 wGA, though equal between groups, correlated in IUGR newborns with basal phosphate, mean total energy of the first week and month (positively) and days to reach full enteral feeding (negatively). Lower i.v. vitamin D intake, LLL and prolonged total parenteral nutrition predicted worse mc-BTT at 36 wGA in the enrolled infants. These results suggest that preterms and in particular IUGR newborns need special nutritional care to promote bone development.
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Affiliation(s)
- Marta Meneghelli
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.M.); (A.P.); (E.P.); (M.E.C.); (L.B.); (L.M.)
| | - Andrea Peruzzo
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.M.); (A.P.); (E.P.); (M.E.C.); (L.B.); (L.M.)
| | - Elena Priante
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.M.); (A.P.); (E.P.); (M.E.C.); (L.B.); (L.M.)
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.M.); (A.P.); (E.P.); (M.E.C.); (L.B.); (L.M.)
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.M.); (A.P.); (E.P.); (M.E.C.); (L.B.); (L.M.)
| | - Laura Moschino
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.M.); (A.P.); (E.P.); (M.E.C.); (L.B.); (L.M.)
| | | | - Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy; (M.M.); (A.P.); (E.P.); (M.E.C.); (L.B.); (L.M.)
- Paediatric Nutrition Service, Department of Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy
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Pin JN, Leonardi L, Nosadini M, Pelizza MF, Capato L, Piretti L, Cavicchiolo ME, Simioni P, Baraldi E, Perilongo G, Luciani M, Sartori S. Deep Medullary Vein Thrombosis in Newborns: A Systematic Literature Review. Neonatology 2023; 120:539-547. [PMID: 37379822 DOI: 10.1159/000530647] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/31/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Deep medullary vein (DMV) thrombosis is a rare cause of brain damage in both preterm and full-term neonates. In this study, we aimed to collect data on clinical and radiological presentation, treatment, and outcome of neonatal DMV thrombosis. METHODS Systematic literature review on neonatal DMV thrombosis was carried out in PubMed, ClinicalTrial.gov, Scopus, and Web of Science up to December 2022. RESULTS Seventy-five published cases of DMV thrombosis were identified and analysed (preterm newborns were 46%). Neonatal distress, respiratory resuscitation, or need for inotropes were present in 34/75 (45%) of patients. Signs and symptoms at presentation included seizures (38/75, 48%), apnoea (27/75, 36%), lethargy or irritability (26/75, 35%). At magnetic resonance imaging (MRI), fan-shaped linear T2 hypointense lesions were documented in all cases. All had ischaemic injuries, most often involving the frontal (62/74, 84%) and parietal lobes (56/74, 76%). Signs of haemorrhagic infarction were present in 53/54 (98%). Antithrombotic treatment was not mentioned in any of the studies included. Although mortality was low (2/75, 2.6%), a large proportion of patients developed neurological sequelae (intellectual disability in 19/51 [37%] and epilepsy in 9/51 [18%] cases). CONCLUSIONS DMV thrombosis is rarely identified in the literature, even if it is possibly under-recognized or under-reported. Presentation in neonatal age is with seizures and non-specific systemic signs/symptoms that often cause diagnostic delay, despite the pathognomonic MRI picture. The high rate of morbidity, which determines significant social and health costs, requires further in-depth studies aimed at earlier diagnosis and evidence-based prevention and therapeutic strategies.
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Affiliation(s)
- Jacopo Norberto Pin
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Letizia Leonardi
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza,", Padua, Italy
| | - Maria Federica Pelizza
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luca Capato
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luca Piretti
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, University Hospital of Padua, Padua, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Giorgio Perilongo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Matteo Luciani
- Department of Paediatric Hematology Oncology, Bambino Gesù Children Hospital IRCSS, Roma, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza,", Padua, Italy
- Department of Neuroscience, University Hospital of Padua, Padua, Italy
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Pin JN, Leonardi L, Nosadini M, Cavicchiolo ME, Guariento C, Zarpellon A, Perilongo G, Raffagnato A, Toldo I, Baraldi E, Sartori S. Efficacy and safety of ketamine for neonatal refractory status epilepticus: case report and systematic review. Front Pediatr 2023; 11:1189478. [PMID: 37334223 PMCID: PMC10275409 DOI: 10.3389/fped.2023.1189478] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Background Evidence-based data on treatment of neonatal status epilepticus (SE) are scarce. We aimed to collect data on the efficacy and safety of ketamine for the treatment of neonatal SE and to assess its possible role in the treatment of neonatal SE. Methods We described a novel case and conducted a systematic literature review on neonatal SE treated with ketamine. The search was carried out in Pubmed, Cochrane, Clinical Trial Gov, Scopus and Web of Science. Results Seven published cases of neonatal SE treated with ketamine were identified and analyzed together with our novel case. Seizures typically presented during the first 24 h of life (6/8). Seizures were resistant to a mean of five antiseizure medications. Ketamine, a NMDA receptor antagonist, appeared to be safe and effective in all neonates treated. Neurologic sequelae including hypotonia and spasticity were reported for 4/5 of the surviving children (5/8). 3/5 of them were seizure free at 1-17 months of life. Discussion Neonatal brain is more susceptible to seizures due to a shift towards increased excitation because of a paradoxical excitatory effect of GABA, a greater density of NMDA receptors and higher extracellular concentrations of glutamate. Status epilepticus and neonatal encephalopathy could further enhance these mechanisms, providing a rationale for the use of ketamine in this setting. Conclusions Ketamine in the treatment of neonatal SE showed a promising efficacy and safety profile. However, further in-depth studies and clinical trials on larger populations are needed.
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Affiliation(s)
- Jacopo Norberto Pin
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University Hospital of Padua, Padova, Italy
| | - Letizia Leonardi
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Margherita Nosadini
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute “Città della Speranza”, Padova, Italy
| | - Maria Elena Cavicchiolo
- Department of Women’s and Children’s Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padova, Italy
| | - Chiara Guariento
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Anna Zarpellon
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Giorgio Perilongo
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Alessia Raffagnato
- Department of Women’s and Children’s Health, Child and Adolescent Neuropsychiatric Unit, University Hospital of Padua, Padova, Italy
| | - Irene Toldo
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Eugenio Baraldi
- Department of Women’s and Children’s Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padova, Italy
| | - Stefano Sartori
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University Hospital of Padua, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute “Città della Speranza”, Padova, Italy
- Department of Neuroscience, University Hospital of Padua, Padova, Italy
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Moschino L, Verlato G, Duci M, Cavicchiolo ME, Guiducci S, Stocchero M, Giordano G, Fascetti Leon F, Baraldi E. The Metabolome and the Gut Microbiota for the Prediction of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation: A Systematic Review. Nutrients 2022; 14:nu14183859. [PMID: 36145235 PMCID: PMC9506026 DOI: 10.3390/nu14183859] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is the most devastating gastrointestinal emergency in preterm neonates. Research on early predictive biomarkers is fundamental. This is a systematic review of studies applying untargeted metabolomics and gut microbiota analysis to evaluate the differences between neonates affected by NEC (Bell’s stage II or III), and/or by spontaneous intestinal perforation (SIP) versus healthy controls. Five studies applying metabolomics (43 cases, 95 preterm controls) and 20 applying gut microbiota analysis (254 cases, 651 preterm controls, 22 term controls) were selected. Metabolomic studies utilized NMR spectroscopy or mass spectrometry. An early urinary alanine/histidine ratio >4 showed good sensitivity and predictive value for NEC in one study. Samples collected in proximity to NEC diagnosis demonstrated variable pathways potentially related to NEC. In studies applying untargeted gut microbiota analysis, the sequencing of the V3−V4 or V3 to V5 regions of the 16S rRNA was the most used technique. At phylum level, NEC specimens were characterized by increased relative abundance of Proteobacteria compared to controls. At genus level, pre-NEC samples were characterized by a lack or decreased abundance of Bifidobacterium. Finally, at the species level Bacteroides dorei, Clostridium perfringens and perfringens-like strains dominated early NEC specimens, whereas Clostridium butyricum, neonatale and Propionibacterium acnei those at disease diagnosis. Six studies found a lower Shannon diversity index in cases than controls. A clear separation of cases from controls emerged based on UniFrac metrics in five out of seven studies. Importantly, no studies compared NEC versus SIP. Untargeted metabolomics and gut microbiota analysis are interrelated strategies to investigate NEC pathophysiology and identify potential biomarkers. Expression of quantitative measurements, data sharing via biorepositories and validation studies are fundamental to guarantee consistent comparison of results.
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Affiliation(s)
- Laura Moschino
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, Padova University Hospital, 35128 Padova, Italy
- Institute of Paediatric Research, Città della Speranza, Laboratory of Mass Spectrometry and Metabolomics, 35127 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-3548
| | - Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, Padova University Hospital, 35128 Padova, Italy
| | - Miriam Duci
- Paediatric Surgery, Department of Women’s and Children’s Health, Padova University Hospital, 35128 Padova, Italy
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, Padova University Hospital, 35128 Padova, Italy
| | - Silvia Guiducci
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, Padova University Hospital, 35128 Padova, Italy
| | - Matteo Stocchero
- Institute of Paediatric Research, Città della Speranza, Laboratory of Mass Spectrometry and Metabolomics, 35127 Padova, Italy
- Laboratory of Mass Spectrometry and Metabolomics, Department of Women’s and Children’s Health, Padova University Hospital, 35128 Padova, Italy
| | - Giuseppe Giordano
- Institute of Paediatric Research, Città della Speranza, Laboratory of Mass Spectrometry and Metabolomics, 35127 Padova, Italy
- Laboratory of Mass Spectrometry and Metabolomics, Department of Women’s and Children’s Health, Padova University Hospital, 35128 Padova, Italy
| | - Francesco Fascetti Leon
- Paediatric Surgery, Department of Women’s and Children’s Health, Padova University Hospital, 35128 Padova, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, Padova University Hospital, 35128 Padova, Italy
- Institute of Paediatric Research, Città della Speranza, Laboratory of Mass Spectrometry and Metabolomics, 35127 Padova, Italy
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Valerio E, Mardegan V, Stocchero M, Cavicchiolo ME, Pirillo P, Poloniato G, D’Onofrio G, Bonadies L, Giordano G, Baraldi E. Urinary metabotypes of newborns with perinatal asphyxia undergoing therapeutic hypothermia. PLoS One 2022; 17:e0273175. [PMID: 35972970 PMCID: PMC9380923 DOI: 10.1371/journal.pone.0273175] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
Perinatal asphyxia (PA) still occurs in about three to five per 1,000 deliveries in developed countries; 20% of these infants show hypoxic-ischemic encephalopathy (HIE) on brain magnetic resonance imaging (MRI). The aim of our study was to apply metabolomic analysis to newborns undergoing therapeutic hypothermia (TH) after PA to identify a distinct metabotype associated with the development of HIE on brain MRI. We enrolled 53 infants born at >35 weeks of gestation with PA: 21 of them showed HIE on brain MRI (the “HIE” group), and 32 did not (the “no HIE” group). Urine samples were collected at 24, 48 and 72 hours of TH. Metabolomic data were acquired using high-resolution mass spectrometry and analyzed with univariate and multivariate methods. Considering the first urines collected during TH, untargeted analysis found 111 relevant predictors capable of discriminating between the two groups. Of 35 metabolites showing independent discriminatory power, four have been well characterized: L-alanine, Creatine, L-3-methylhistidine, and L-lysine. The first three relate to cellular energy metabolism; their involvement suggests a multimodal derangement of cellular energy metabolism during PA/HIE. In addition, seven other metabolites with a lower annotation level (proline betaine, L-prolyl-L-phenylalanine, 2-methyl-dodecanedioic acid, S-(2-methylpropionyl)-dihydrolipoamide-E, 2,6 dimethylheptanoyl carnitine, Octanoylglucuronide, 19-hydroxyandrost-4-ene-3,17-dione) showed biological consistency with the clinical picture of PA. Moreover, 4 annotated metabolites (L-lysine, L-3-methylhistidine, 2-methyl-dodecanedioic acid, S-(2-methylpropionyl)-dihydrolipoamide-E) retained a significant difference between the “HIE” and “no HIE” groups during all the TH treatment. Our analysis identified a distinct urinary metabotype associated with pathological findings on MRI, and discovered 2 putative markers (L-lysine, L-3-methylhistidine) which may be useful for identifying neonates at risk of developing HIE after PA.
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Affiliation(s)
- Enrico Valerio
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
- * E-mail:
| | - Veronica Mardegan
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
| | - Matteo Stocchero
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
- Institute of Pediatric Research (IRP), Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
| | - Paola Pirillo
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
- Institute of Pediatric Research (IRP), Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Gabriele Poloniato
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
- Institute of Pediatric Research (IRP), Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Gianluca D’Onofrio
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
| | - Giuseppe Giordano
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
- Institute of Pediatric Research (IRP), Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Womens’ and Childrens’ Health, University Hospital of Padua, Padova, Italy
- Institute of Pediatric Research (IRP), Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
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Cavicchiolo ME, Daverio M, Battajon N, Frigo AC, Lago P. A Single Dose of Oral Sucrose Is Enough to Control Pain During Venipuncture: A Randomized Controlled Trial. Front Pain Res 2022; 3:888076. [PMID: 35634454 PMCID: PMC9131008 DOI: 10.3389/fpain.2022.888076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Sucrose is effective in reducing pain during minor procedures in neonates. We evaluated whether a second dose of sucrose was more effective than a single dose during venipuncture. We performed a randomised, double-blind, controlled trial at the NICU of Padua Hospital (August 2016-October 2017). We randomised 72 preterm infants undergoing venipuncture for routine test to a control group, which received a single standard dose of sucrose 2′ before the procedure and a placebo 30″ after the venipuncture, and an experimental group in which they received two doses of 24% sucrose 2′ before and 30″ after the venipuncture. No difference in pain perception was found between the groups at 30″, 60″ and 120″. In conclusion, we do not recommend a second dose of sucrose during venipuncture in prematures.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
- *Correspondence: Maria Elena Cavicchiolo
| | - Marco Daverio
- Paediatric Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Nadia Battajon
- Neonatal Intensive Care Unit, Azienda Unità Locale Socio Sanitaria (ULSS) 2 Marca Trevigiana, Treviso, Italy
| | - Anna Chiara Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Paola Lago
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
- Neonatal Intensive Care Unit, Azienda Unità Locale Socio Sanitaria (ULSS) 2 Marca Trevigiana, Treviso, Italy
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Cavallin F, Doglioni N, Brombin L, Lolli E, Loddo C, Cavicchiolo ME, Mardegan V, Magarotto M, Mainini N, Nardo D, Peloso RL, Piva D, Priante E, Valerio E, Baraldi E, Trevisanuto D. Trends in respiratory management of transferred very preterm infants in the last two decades. Pediatr Pulmonol 2021; 56:2604-2610. [PMID: 34171179 DOI: 10.1002/ppul.25532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/27/2021] [Revised: 05/07/2021] [Accepted: 06/02/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Among infants needing urgent transfer after birth, very preterm infants are a high-risk sub-group requiring special attention. This study aimed to assess trends in early respiratory management in a large series of very preterm infants undergoing postnatal transfer. METHODS Trends in patient characteristics and early respiratory management were assessed in 798 very preterm infants who were transferred by the Eastern Veneto Neonatal Emergency Transport Service in 2000-2019. Trends were analyzed using joinpoint regression analysis and summarized as annual percentage changes (APCs). RESULTS Proportion of neonates with birth weight less than 1 kg decreased from 33% to 16% (APC -3.82%). Use of nasal-continuous-positive-airway pressure increased (at call: APC 15.39%; during transfer: APC 15.60%), while use of self-inflating bag (at call: APC -12.09%), oxygen therapy (at call: APC -13.00%; during transfer: APC -23.77%) and mechanical ventilation (at call: APC -2.71%; during transfer: APC -2.99%) decreased. Use of oxygen concentrations at 21% increased (at call: APC 6.26%; during transfer: APC 7.14%), while oxygen concentrations above 40% decreased (at call: APC -5.73%; at transfer APC -8.89%). Surfactant administration at call increased (APC 3%-10%), while surfactant administration when arriving at referring hospital remained around 7-11% (APC 2.55%). CONCLUSION Relevant trends toward "gentle" approaches in early respiratory management of very preterm infants undergoing postnatal transfer occurred during the last twenty years. In addition, the proportion of transferred extremely low birth weight infants halved. Clinicians and stakeholders should consider such information when allocating assets to both hospitals and transfer services and planning regional perinatal programs.
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Affiliation(s)
| | - Nicoletta Doglioni
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Laura Brombin
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Elisabetta Lolli
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Cristina Loddo
- Department of Pediatrics, University of Cagliari, Cagliari, Italy
| | | | - Veronica Mardegan
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Mariella Magarotto
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Nicoletta Mainini
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Daniel Nardo
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Rebecca Luisa Peloso
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Daniele Piva
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Elena Priante
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Enrico Valerio
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Eugenio Baraldi
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
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Trevisanuto D, Cavallin F, Cavicchiolo ME, Borellini M, Calgaro S, Baraldi E. Coronavirus infection in neonates: a systematic review. Arch Dis Child Fetal Neonatal Ed 2021; 106:330-335. [PMID: 32943533 DOI: 10.1136/archdischild-2020-319837] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [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: 06/01/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To summarise currently reported neonatal cases of SARS-CoV-2 infection. METHODS A search strategy was designed to retrieve all articles published from 1 December 2019 to 12 May 2020, by combining the terms 'coronavirus' OR 'covid' OR 'SARS-CoV-2') AND ('neonat*' OR 'newborn') in the following electronic databases: MEDLINE/Pubmed, Scopus, Web of Science, MedRxiv, the Cochrane Database of Systematic Review and the WHO COVID-19 database, with no language restrictions. Quality of studies was evaluated by using a specific tool for assessment of case reports and/or case series. RESULTS Twenty-six observational studies (18 case reports and 8 case series) with 44 newborns with confirmed SARS-CoV-2 infection were included in the final analysis. Studies were mainly from China and Italy. Half of neonates had a documented contact with the infected mother and one out of three infected neonates was admitted from home. Median age at diagnosis was 5 days. One out of four neonates was asymptomatic, and the remaining showed mild symptoms typical of acute respiratory infections and/or gastrointestinal symptoms. The majority of neonates were left in spontaneous breathing (room air) and had good prognosis after a median duration of hospitalisation of 10 days. CONCLUSIONS Most neonates with SARS-CoV-2 infection were asymptomatic or presented mild symptoms, generally were left in spontaneous breathing and had a good prognosis after median 10 days of hospitalisation. Large epidemiological and clinical cohort studies, as well as the implementation of collaborative networks, are needed to improve the understanding of the impact of SARS-CoV-2 infection in neonates.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | - Martina Borellini
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Serena Calgaro
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, University of Padova, Padova, Italy
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Galderisi A, Lolli E, Cavicchiolo ME, Bonadies L, Trevisanuto D, Baraldi E. The aftermath of SARS-CoV-2 in NICU: saving or checking accounts? Projected cost-effectiveness analysis. Eur J Pediatr 2021; 180:1631-1635. [PMID: 33415468 PMCID: PMC7790311 DOI: 10.1007/s00431-020-03884-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/20/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 11/21/2022]
Abstract
In the aftermath of the SARS-CoV-2 pandemic, we revised the cost-effectiveness of the exploited interventions in neonatal intensive care unit, to redefine future strategies for hospital management. Costs were revised with respect to the lockdown R0 or under different R0 scenarios to estimate the cost-effectiveness of the screening program adopted. Weekly nasopharyngeal swabs for parents, neonates, and personnel were the major cost during the pandemic, although they effectively reduced the number of cases in our unit.Conclusion: Parents and healthcare personnel testing appears to be an effective strategy due to the high number of contact they have within the hospital environment and outside, able to minimize the cases within our unit. What is Known: • Costs of universal COVID-19 tests for parents, neonates, and NICU personnel have not been evaluated during the COVID-19 pandemic in neonatal intensive care unit in Europe. What is New: • Weekly nasopharyngeal swabs for parents, neonates, and personnel were the major cost during the COVID-19 pandemic in NICU. • Parents and healthcare personnel testing was effective to reduce costs related to COVID-19 due to the high number of contact they have within the hospital environment and outside.
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Affiliation(s)
- Alfonso Galderisi
- Department of Women's and Children's Health, University Hospital of Padova, Via N. Giustiniani, 3, 35128, Padova, Italy.
| | - Elisabetta Lolli
- Department of Women's and Children's Health, University Hospital of Padova, Via N. Giustiniani, 3, 35128, Padova, Italy.
| | - Maria Elena Cavicchiolo
- grid.411474.30000 0004 1760 2630Department of Women’s and Children’s Health, University Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
| | - Luca Bonadies
- grid.411474.30000 0004 1760 2630Department of Women’s and Children’s Health, University Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
| | - Daniele Trevisanuto
- grid.411474.30000 0004 1760 2630Department of Women’s and Children’s Health, University Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
| | - Eugenio Baraldi
- grid.411474.30000 0004 1760 2630Department of Women’s and Children’s Health, University Hospital of Padova, Via N. Giustiniani, 3, 35128 Padova, Italy
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10
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Cavicchiolo ME, Trevisanuto D, Lolli E, Mardegan V, Saieva AM, Franchin E, Plebani M, Donato D, Baraldi E. Universal screening of high-risk neonates, parents, and staff at a neonatal intensive care unit during the SARS-CoV-2 pandemic. Eur J Pediatr 2020; 179:1949-1955. [PMID: 32767137 PMCID: PMC7410953 DOI: 10.1007/s00431-020-03765-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
Since February 21, 2020, SARS-CoV-2 has spread exponentially worldwide. Neonatal patients needing intensive care are considered a vulnerable population. To report the results of a policy based on multi-timepoint surveillance for SARS-CoV-2 of all neonates admitted to the neonatal intensive care unit (NICU), their parents, and all healthcare providers in a part of Italy with a high prevalence of the infection. Observational study conducted from 21 February to 21 April 2020. Intervention consisted of (a) parental triage on arrival at the neonatal ward; (b) universal testing with nasopharyngeal swabs and blood testing for SARS-CoV-2 IgM and IgG antibodies; (c) use of continuous personal protective equipment at the NICU by parents and staff. A total of 6726 triage procedures were performed on 114 parents, and 954 nasopharyngeal swabs were collected from 226 individuals. Five (2.2%) asymptomatic individuals (2 parents and 3 healthcare providers) tested positive on nasopharyngeal swabs and were kept isolated for 14 days. Of 75 admitted newborn, no one tested positive on nasopharyngeal swabs or antibody tests. Three parents presented with fever or flu-like symptoms at triage; they tested negative on swabs.Conclusion: With universal screening of neonates, parents, and staff, there were no cases of SARS-CoV-2 infection among the neonates admitted to a NICU in an area with a high incidence of SARS-CoV-2. Our experience could be usefully compared with other strategies with a view to developing future evidence-based guidelines for managing high-risk neonates in case of new epidemics. What is Known: • The novel coronavirus named SARS-CoV-2 has since spread worldwide at a remarkable rate, with more than 2.5 million confirmed cases. • Pediatric population may be less affected from COVID-19 than adult population but infants and newborn babies seem to be more vulnerable to SARS-CoV-2 infection. What is New: • Using an approach based on triage; testing with nasopharyngeal swabs and serology; and use of personal protective equipment, there were no cases of SARS-CoV-2 infection among neonates in a NICU in a high incidence of SARS-CoV-2 area. • Positive and asymptomatic individuals were identified and isolated early allowing the containment of infection's spread among healthcare providers and parents.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy
| | - Daniele Trevisanuto
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy
| | - Elisabetta Lolli
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy
| | - Veronica Mardegan
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy
| | | | - Elisa Franchin
- Department of Molecular Medicine, Microbiology and Virology Unit, Padova University Hospital, Padova, Italy
| | - Mario Plebani
- Department of Clinical Chemistry and Laboratory Medicine, Department of Medicine, Padova University Hospital, Padova, Italy
| | | | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy.
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11
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Daverio M, Amigoni A, Cavicchiolo ME. Testing for Novel Coronavirus Antibodies: A Necessary Adjunct. J Infect Dis 2020; 222:517-518. [PMID: 32442248 PMCID: PMC7313906 DOI: 10.1093/infdis/jiaa283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/20/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Marco Daverio
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Italy
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Italy
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12
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Spigolon E, Cimolato I, Priante E, Bonadies L, Visentin S, De Terlizzi F, Cavicchiolo ME, Verlato G. Diet in pregnant women that delivered prematurely and preterm newborn's bone status. J Matern Fetal Neonatal Med 2020; 35:2859-2866. [PMID: 32814481 DOI: 10.1080/14767058.2020.1807507] [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: 10/23/2022]
Abstract
OBJECTIVES Inadequate maternal dietary pattern has been associated to negative pregnancy and fetal outcomes. With this study, we aimed to evaluate the adequacy of diet in pregnant women that delivered prematurely and its possible correlations with bone status of preterm newborns. STUDY DESIGN We prospectively enrolled women who delivered prematurely (≤than 34 gestational weeks) and their newborns (Neonatal Intensive Care, University Hospital of Padova) from January 2017 to May 2018. Maternal nutritional status and diet supplementations were assessed using a validated questionnaire. The preterm newborns were evaluated with anthropometric measurements and bone status by Quantitative Ultrasound of the second metacarpal bone within 72 h from birth. RESULTS One hundred and eighty mothers and 202 preterm newborns were evaluated. The mothers assumed more calories, proteins, total lipids and simple sugars compared to the revised National Guidelines. The intake of calcium, phosphorus and Vitamin D was inadequate despite the use of multivitamin supplements. The mothers assumption of vitamin D and zinc positively correlated with bone status and mothers with very low intake of vitamin D during gestation (<7 µg/die) had preterm newborns with a worst bone status at birth compared to those with a better intake (>7 µg/die). CONCLUSIONS Nutrition of pregnant women could be improved and maternal intakes of Vitamin D and zinc positively correlated with preterm newborn's bone status.
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Affiliation(s)
- Eleonora Spigolon
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Irene Cimolato
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Elena Priante
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Silvia Visentin
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | | | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
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Cavicchiolo ME, Lolli E, Trevisanuto D, Baraldi E. Managing a tertiary-level NICU in the time of COVID-19: Lessons learned from a high-risk zone. Pediatr Pulmonol 2020; 55:1308-1310. [PMID: 32315113 PMCID: PMC7264787 DOI: 10.1002/ppul.24788] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Maria Elena Cavicchiolo
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Elisabetta Lolli
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Daniele Trevisanuto
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy
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14
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Lago P, Cavicchiolo ME, Rusalen F, Benini F. Summary of the Key Concepts on How to Develop a Perinatal Palliative Care Program. Front Pediatr 2020; 8:596744. [PMID: 33344387 PMCID: PMC7744474 DOI: 10.3389/fped.2020.596744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/23/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose of review: The aim of this study is to assess the most significant Perinatal Palliative Care (PnPC) development projects in the literature and summarize the shared key principles. Recent findings: PnPC is a new concept in neonatal intensive care approach. Advancements in perinatal diagnostics and medical technology have changed the landscape of the perinatal world. The threshold of viability continues to decrease, and diagnostic information is available earlier in pregnancy and more rapidly at the bedside; overall outcomes continue to improve. This rapid technological improvement brings ethical debates on the quality of life of patients with life-limiting and life-threatening conditions and the need to involve the family in the decision-making process, according to their wishes and cultural beliefs. Although the Perinatal Hospice concept was developed in the 1980s in the US, the first recommendations on how to develop a PnPC pathway were published in the early 2000s. We considered the most relevant position statements or guidelines on PnPC published in the last two decades. Some of them were more pertinent to pediatrics but still useful for the fundamental concepts and PnPC project's development. Summary: Health care providers and institutions are encouraged to develop PnPC programs, which have the goal of maximizing the quality of life of infants with non-curable conditions. These may generally include the following: a formal prenatal consultation; development of a coordinated birth plan between obstetrician, newborn care, and family; access to other neonatal and pediatric specialties, as needed; comfort palliative care during the prenatal, birth, and postnatal periods; and psychosocial and spiritual support for families, siblings, and staff.
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Affiliation(s)
- Paola Lago
- Neonatal Intensive Care Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Maria Elena Cavicchiolo
- Department of Woman and Child Health, Neonatal Intensive Care Unit, University of Padua, Padua, Italy
| | - Francesca Rusalen
- Department of Woman and Child Health, Paediatric Pain and Palliative Care Service, University of Padua, Padua, Italy
| | - Franca Benini
- Department of Woman and Child Health, Paediatric Pain and Palliative Care Service, University of Padua, Padua, Italy
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15
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Affiliation(s)
- Franca Benini
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy
| | - Sabrina Congedi
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy
| | - Francesca Rusalen
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy
| | - Maria Elena Cavicchiolo
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padua, Italy
| | - Paola Lago
- Neonatal Intensive Care Unit, Treviso's Hospital, Treviso, Italy
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16
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Cavicchiolo ME, Magnani M, Calgaro S, Bonadies L, Castagliulo I, Morelli L, Verlato G, Baraldi E. Neonatal sepsis associated with Lactobacillus supplementation. J Perinat Med 2019; 48:87-88. [PMID: 31714890 DOI: 10.1515/jpm-2019-0268] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Margherita Magnani
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Serena Calgaro
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | | | - Lorenzo Morelli
- Department for Sustainable Food Processes - DiSTAS, Università Cattolica del Sacro Cuore, Piacenza, Italy
| | - Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
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Cavicchiolo ME, Amigoni A, Martinolli F, Daverio M. Letter to the Editor. J Paediatr Child Health 2019; 55:1288. [PMID: 31629383 DOI: 10.1111/jpc.14585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/13/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Angela Amigoni
- Paediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Francesco Martinolli
- Paediatric Emergency Department, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Marco Daverio
- Paediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
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18
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Affiliation(s)
- Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Francesca Rusalen
- Paediatric Pain and Palliative Care Service, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Franca Benini
- Paediatric Pain and Palliative Care Service, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Paola Lago
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy.,Neonatal Intensive Care Unit, Ca' Foncello Hospital, Treviso, Italy
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19
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Rusalen F, Cavicchiolo ME, Lago P, Salvadori S, Benini F. Perinatal palliative care: a dedicated care pathway. BMJ Support Palliat Care 2019; 11:329-334. [PMID: 31324614 DOI: 10.1136/bmjspcare-2019-001849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/16/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Ensure access to perinatal palliative care (PnPC) to all eligible fetuses/infants/parents. DESIGN During 12 meetings in 2016, a multidisciplinary work-group (WG) performed literature review (Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method was applied), including the ethical and legal references, in order to propose shared care pathway. SETTING Maternal-Infant Department of Padua's University Hospital. PATIENTS PnPC eligible population has been divided into three main groups: extremely preterm newborns (first group), newborns with prenatal/postnatal diagnosis of life-limiting and/or life-threatening disease and poor prognosis (second group) and newborns for whom a shift to PnPC is appropriate after the initial intensive care (third group). INTERVENTIONS The multidisciplinary WG has shared care pathway for these three groups and defined roles and responsibilities. MAIN OUTCOME MEASURES Prenatal and postnatal management, symptom's treatment, end-of-life care. RESULTS The best care setting and the best practice for PnPC have been defined, as well as the indications for family support, corpse management and postmortem counselling, as well suggestion for conflicts' mediation. CONCLUSIONS PnPC represents an emerging field within the paediatric palliative care and calls for the development of dedicated shared pathways, in order to ensure accessibility and quality of care to this specific population of newborns.
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Affiliation(s)
- Francesca Rusalen
- Woman's and Child's Department, Pediatric Pain and Palliative Care Service, University of Padua, Padova, Italy
| | - Maria Elena Cavicchiolo
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padova, Veneto, Italy
| | - Paola Lago
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padova, Veneto, Italy
| | - Sabrina Salvadori
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padova, Veneto, Italy
| | - Franca Benini
- Woman's and Child's Department, Pediatric Pain and Palliative Care Service, University of Padua, Padova, Italy
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20
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Cavallin F, Pavan G, Cavicchiolo ME, Doglioni N, Trevisanuto D. Multicentre study found that documentation on resuscitating asphyxiated neonates was often unsatisfactory. Acta Paediatr 2019; 108:562-563. [PMID: 30378701 DOI: 10.1111/apa.14632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Gaia Pavan
- Department of Woman's and Child's Health University of Padua Padua Italy
| | | | - Nicoletta Doglioni
- Department of Woman's and Child's Health University of Padua Padua Italy
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21
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Verlato G, Simonato M, Giambelluca S, Fantinato M, Correani A, Cavicchiolo ME, Priante E, Carnielli V, Cogo P. Surfactant Components and Tracheal Aspirate Inflammatory Markers in Preterm Infants with Respiratory Distress Syndrome. J Pediatr 2018; 203:442-446. [PMID: 30270169 DOI: 10.1016/j.jpeds.2018.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 05/17/2018] [Revised: 07/11/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
In 93 preterm infants ≤32 weeks of gestational age and 12 control infants, epithelial lining fluid disaturated-phosphatidylcholine, surfactant protein A and B, albumin, and myeloperoxidase activity were assessed after intubation and before exogenous surfactant administration. We found that disaturated-phosphatidylcholine, surfactant protein B, and myeloperoxidase were significantly higher in preterms with chorioamnionitis.
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Affiliation(s)
- Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Manuela Simonato
- Pediatric Research Foundation Institute "Città della Speranza", Padova, Italy; Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
| | - Sonia Giambelluca
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Margherita Fantinato
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Alessio Correani
- Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Elena Priante
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Virgilio Carnielli
- Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Paola Cogo
- Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy
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22
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Cavicchiolo ME, Cavallin F, Staffler A, Pizzol D, Matediana E, Wingi OM, Da Dalt L, Putoto G, Trevisanuto D. Decision making and situational awareness in neonatal resuscitation in low resource settings. Resuscitation 2018; 134:41-48. [PMID: 30391367 DOI: 10.1016/j.resuscitation.2018.10.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/01/2018] [Revised: 09/17/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Data on non-technical skills (i.e. task management, team working, situation awareness and decision-making) of healthcare providers during real-life newborn resuscitation in low-resource settings are lacking. We aimed to assess non-technical skills of trained midwives during real-life newborn resuscitation in a low-resource setting before and after participation in a modified NRP course, and after a low-dose/high-frequency training. METHODS One-hundred and fifty video-recorded resuscitations (50 before and 50 after participation in a modified NRP course, and 50 after a low-dose/high-frequency training) collected at the Beira Central Hospital (Mozambique) were independently viewed and rated by two neonatologists with expertise in high fidelity simulation. Non-technical skills regarding task management, situation awareness and decision-making were evaluated using the modified Anesthetists' Non-Technical Skills tool. RESULTS Overall, most non-technical skills were scored as poor or marginal. Small improvements were observed in task management (planning and preparing p = 0.02; providing/maintaining standards p = 0.03) after the course. Limited improvements were observed in task management (prioritizing p = 0.03; providing/maintaining standards p = 0.04; identifying and utilizing resources p = 0.02) and decision-making (identifying options p = 0.04; balancing risk/selecting options p = 0.02) after the low-dose/high-frequency training. No differences were observed in situation awareness, apart from a small improvement in recognizing/understanding (p = 0.04) after the low-dose/high-frequency training. CONCLUSION An educational intervention including a modified NRP course and a low-dose/high-frequency training on neonatal resuscitation had a limited impact on non-technical skills of participants. All items remained significantly under the recommended standards. Behavioral skills should be considered in training programs in order to improve the quality of neonatal resuscitation in low resource settings.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Department of Woman's and Child's Health, University of Padua, Padua, Italy; Doctors with Africa CUAMM, Padua, Italy
| | | | - Alex Staffler
- Division of Neonatology, Central Teaching Hospital of Bolzano/Bozen, Italy
| | | | - Eduardo Matediana
- Department of Obstetrics and Gynaecology, Beira Central Hospital, Beira, Mozambique
| | | | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padua, Padua, Italy.
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Pietravalle A, Cavallin F, Opocher A, Madella S, Cavicchiolo ME, Pizzol D, Putoto G, Trevisanuto D. Neonatal tactile stimulation at birth in a low-resource setting. BMC Pediatr 2018; 18:306. [PMID: 30236090 PMCID: PMC6146550 DOI: 10.1186/s12887-018-1279-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stimulation is the most common intervention during neonatal resuscitation at birth, but scarce information is available on the actual methods, timing and efficacy of this basic step. To evaluate the occurrence, patterns and response to tactile stimulation at birth in a low-resource setting. METHODS We reviewed 150 video recordings of neonatal resuscitation at Beira Central Hospital (Beira, Mozambique). Timing, method, duration and response to tactile stimulation were evaluated. RESULTS One hundred two out of 150 neonates (68.0%) received stimulation, while the remaining 48 (32.0%) received positive pressure ventilation and/or chest compressions directly. Overall, 546 stimulation episodes (median 4 episodes per subject, IQR 2-7) were performed. Median time to the first stimulation episode was 134 s (IQR 53-251); 29 neonates (28.4%) received stimulation within the first minute after birth. Multiple techniques of stimulation were administered in 66 neonates (64.7%), while recommended techniques (rubbing the back or flicking the soles of the feet) only in 9 (8.8%). Median duration of stimulation was 17 s (IQR 9-33). Only 9 neonates (8.8%) responded to stimulation. CONCLUSIONS In a low-resource setting, stimulation of newly born infants at birth is underperformed. Adherence to international guidelines is low, resulting in delayed initiation, inadequate technique, prolonged duration and low response to stimulation. Back rubs may provide some benefits, but large prospective studies comparing different methods of stimulation are required.
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Affiliation(s)
- Andrea Pietravalle
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
| | | | - Anna Opocher
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
| | - Stefania Madella
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
| | - Maria Elena Cavicchiolo
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
| | | | | | - Daniele Trevisanuto
- Department of Woman’s and Child’s Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128 Padua, Italy
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Rusalen F, Cavicchiolo ME, Lago P, Salvadori S, Benini F. Perinatal palliative care: is palliative care really available to everyone? Ann Palliat Med 2018; 7:487-488. [PMID: 30180742 DOI: 10.21037/apm.2018.07.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Francesca Rusalen
- Woman's and Child's Department, Pediatric Pain and Palliative Care Service, University of Padua, Padua, Italy.
| | - Maria Elena Cavicchiolo
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padua, Italy
| | - Paola Lago
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padua, Italy
| | - Sabrina Salvadori
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padua, Italy
| | - Franca Benini
- Woman's and Child's Department, Pediatric Pain and Palliative Care Service, University of Padua, Padua, Italy
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Abstract
PURPOSE Necrotizing enterocolitis (NEC) is a severe neonatal disease. The present study aimed to identify factors predisposing the development of severe forms of NEC. METHODS This retrospective study examined NEC patients in a single centre between 2002 and 2015. Data concerning clinical characteristics, therapeutic management as well as short-term outcomes were collected. We compared the patients receiving successful medical treatment and those requiring surgical intervention. Patients who underwent surgery were distinguished in three subcategories. Bivariate and multivariate analyses were used for the statistical analysis. RESULTS We identified 155 patients in the study period. 102 were treated conservatively and 53 required surgery. 8 received a primary peritoneal drainage, 31 received a drainage and a subsequent laparotomy and 14 received a laparotomy. Multivariate regression analysis identified a lower risk for surgery with a later onset and higher serum pH values, whereas an increased risk with higher C reactive Protein (CRP) levels at the onset. Pneumatosis intestinalis was identified as a protective factor. Overall mortality was 6.4%, with higher percentage in surgical NEC. CONCLUSION This study suggests that a later onset is a protective sign for the progression to surgery, whereas lower pH values and higher CRP levels are prognostic factors associated with the need for surgery. The line of treatment involving explorative laparotomy in case of perforation seems to be rewarded by low morbidity and mortality rate.
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Affiliation(s)
- Miriam Duci
- Division of Paediatric Surgery, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
| | - Francesco Fascetti-Leon
- Division of Paediatric Surgery, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy.
| | - Marta Erculiani
- Division of Paediatric Surgery, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
| | - Elena Priante
- Division on Neonatal Intensive Care Unit, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
| | - Maria Elena Cavicchiolo
- Division on Neonatal Intensive Care Unit, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
| | - Giovanna Verlato
- Division on Neonatal Intensive Care Unit, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
| | - Piergiorgio Gamba
- Division of Paediatric Surgery, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
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Gaio P, Verlato G, Daverio M, Cavicchiolo ME, Nardo D, Pasinato A, de Terlizzi F, Baraldi E. Incidence of metabolic bone disease in preterm infants of birth weight <1250 g and in those suffering from bronchopulmonary dysplasia. Clin Nutr ESPEN 2018; 23:234-239. [PMID: 29460805 DOI: 10.1016/j.clnesp.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/02/2017] [Revised: 08/15/2017] [Accepted: 09/26/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Preterm infants are exposed to a higher risk of developing Metabolic Bone Disease (MBD) with an increased bone fragility, a higher fracture risk and a long-term reduced linear growth and childhood height. Monitoring bone growth has become mandatory in neonatology. Several risk factors have been identified among the population of extremely low birth weight infants, but we still do not know which is the real incidence of MBD since its evaluation is not routinely performed worldwide. The aim of this study was to evaluate the incidence of MBD in preterm infants and in those suffering from bronchopulmonary dysplasia (BPD). METHODS Prospective evaluation of patients who developed BPD (BPD group) versus infants who did not develop it (no-BPD group). We examined, in preterms <1.250 g, the metacarpus bone transmission time (mc-BTT) at birth, 21 days and 36 weeks of gestational age (GA) together with biochemical markers of bone status. RESULTS We included 135 patients, 55 with BPD. BPD patients received less total proteins in the first two weeks and less energy in the first month of life (p = 0.007 and p < 0.001 respectively). BPD patients had a worse growth velocity at two weeks of age (12.36 ± 7.86 vs 16.59 ± 7.05 g/kg/day, p = 0.001). At 21 days, BPD patients had lower phosphatemia (1.65 ± 0.031 mmol/L vs 1.85 ± 0.034 mmol/L, p = 0.007) and higher alkaline phosphatase levels (411.62 ± 135.31 IU/l vs 338.98 ± 102.20 IU/l, p = 0.005). BPD patients had significantly worse mc-BTT at 36 weeks GA (0.45 ± 0.06 vs 0.50 ± 0.08 μsec, p < 0.001) and a higher incidence of MBD (60% vs 34%; p = 0.012). CONCLUSIONS BPD infants are a special subset of patients among preterms who receive, in the first month of life, a lower energy intake than patients without BPD. BPD patients have a suboptimal bone growth and a higher incidence of MBD. Monitoring growth, bone status and optimizing nutritional intakes need to be further improved in preterm infants with BPD.
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Affiliation(s)
- Paola Gaio
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Marco Daverio
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Daniel Nardo
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Alessandra Pasinato
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | | | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
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Cavicchiolo ME, Cavallin F, Bertuola F, Pizzol D, Segafredo G, Wingi OM, Da Dalt L, Putoto G, Trevisanuto D. Effect of a Low-Dose/High-Frequency Training on Real-Life Neonatal Resuscitation in a Low-Resource Setting. Neonatology 2018; 114:294-302. [PMID: 30011393 DOI: 10.1159/000490370] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 02/23/2018] [Accepted: 05/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND As intrapartum-related events represent a quarter of all neonatal deaths, education on neonatal resuscitation is a critical priority. OBJECTIVE To assess the impact of a low-dose/high-frequency neonatal resuscitation training on clinical practice of midwives in a low-resource setting. METHODS Eight months after a modified Neonatal Resuscitation Program (NRP) course, we implemented a low-dose/high-frequency training for midwives at Beira Central Hospital, Mozambique. The training lasted 6 months and included weekly practice sessions. Fifty consecutive resuscitations after the low-dose/high-frequency training were compared with those registered before (n = 50) and after (n = 50) participation in the adapted NRP course using video recording. RESULTS All 150 neonates received the initial steps; 103 required bag-mask ventilation and 41 required chest compressions. The scores for initial steps, bag-mask ventilation and chest compressions improved after the course (p < 0.0001, p = 0.005 and p = 0.03) and did not change after the low-dose/high-frequency training (p = 0.34, p = 0.99 and p = 0.30). The low-dose/high-frequency training decreased the total time of the procedure (p < 0.0001) and anticipated start time of airway suctioning and tactile stimulation (p = 0.003 and p < 0.0001), but had no effect on the time of initiation of bag-mask ventilation (p = 0.30). CONCLUSIONS In a low- income setting, a low-dose/high-frequency training after participation in an adapted NRP course contributed to improving the initiation and times of some procedures. However, many aspects of neonatal resuscitation remained poor. Low-dose/high-frequency training should focus on improving the prevention of thermal loss, face mask ventilation and heart rate assessment.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Department of Woman's and Child's Health, University of Padua, Padua, Italy.,Doctors with Africa CUAMM, Padua, Italy
| | | | | | | | | | | | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padua, Padua, Italy
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Cavicchiolo ME, Daverio M, Lanzoni P, Segafredo G, Pizzol D, Putoto G, Trevisanuto D. Participants' opinions of the limited impact of an adapted neonatal resuscitation course in a low-resource setting. Acta Paediatr 2017; 106:344. [PMID: 27862301 DOI: 10.1111/apa.13661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maria Elena Cavicchiolo
- Department of Woman's and Child's Health University of Padua Padua Italy
- Doctors with Africa CUAMM Beira Mozambique
| | - Marco Daverio
- Department of Woman's and Child's Health University of Padua Padua Italy
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Cavicchiolo ME, Lanzoni P, Wingi MO, Pizzol D, Daverio M, Da Dalt L, Putoto G, Trevisanuto D. Reduced neonatal mortality in a regional hospital in Mozambique linked to a Quality Improvement intervention. BMC Pregnancy Childbirth 2016; 16:366. [PMID: 27876013 PMCID: PMC5120470 DOI: 10.1186/s12884-016-1170-y] [Citation(s) in RCA: 24] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal mortality remains a serious health issue especially in low resource countries, where 99% of neonatal deaths occur. Doctors with Africa CUAMM is an Italian non-governmental organization in the field of healthcare that has been working in Africa since 1955. In Mozambique, at the Central Beira Hospital (CBH), it has a project with the aim of supporting the neonatal intensive care unit (NICU) and the Obstetrical Department of the CBH through a multi-level intervention. Our aim was to evaluate the effectiveness of CUAMM continuous Quality Improvement intervention in terms of reduction of the overall neonatal mortality rate in the NICU of CBH. METHODS A baseline analysis was performed in order to assess the actual standard of neonatal care. Subsequently, the intervention was focused on three main areas: infrastructure, equipment and clinical protocols improvement. A retrospective pre- (2013)/post- (2014) implementation analysis of clinical outcomes was performed. RESULTS Total population included 4,276 newborns, 2,118 (50%) born in 2013 and 2158 (50%) born after implementation. Baseline characteristics of the two groups were similar apart from a higher incidence of outborn neonates (33% vs 30%, p = 0.02) and a lower incidence of Apgar score < 7 at 5 min (37% vs 43%, p < 0.01). The rates of admissions for asphyxia (22% vs 30%), sepsis (4% vs 7%) and prematurity (18% vs 28%) increased between the two study period. Mortality rate for each of these causes decreased from before to after the implementation: asphyxia (34% vs 19%, p < 0.01), sepsis (39% vs 28%, p = 0.06) and prematurity (43% vs 33%, p < 0.01). CONCLUSION We found a reduction in mortality rate among newborns admitted to CBH's NICU after the first year of CUAMM intervention. Most of this reduction can be attributed to the decrease in deaths for asphyxia, sepsis and prematurity. A Quality Improvement intervention based on infrastructural, equipment and clinical objectives was associated with a reduction of neonatal mortality rate in a low-resource NICU.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Doctors with Africa CUAMM, Padova, Italy. .,Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy.
| | | | | | | | - Marco Daverio
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
| | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
| | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
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Da Dalt L, Chillemi C, Cavicchiolo ME, Bressan S, Calistri A, Palù G, Perilongo G. Pandemic influenza A (H1N1v) infection in pediatric population: a multicenter study in a north-east area of Italy. Ital J Pediatr 2011; 37:24. [PMID: 21595917 PMCID: PMC3125342 DOI: 10.1186/1824-7288-37-24] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/19/2011] [Indexed: 11/29/2022] Open
Abstract
Background - Data on clinical presentation, morbidity and mortality of 2009 pandemic influenza virus (H1N1v) in paediatric population are still emerging; most of the data so far available came from selected cohorts of children admitted to tertiary care paediatric hospitals. Methods - An observational study involving all the 19 Divisions of Paediatrics of the Veneto Region was conducted with the aim of investigating into the demographic and clinical characteristics, the treatment, the outcome and the risk factors for disease severity of H1N1v infection occurring in children. Results - Two hundred children, median age of 4.15 years (range 0-15) were enrolled from the last week of October till the first week of January 2010 for an overall hospitalization rate of 23/100.000. At least one underlying medical condition was found in 44% of patients. Fever and cough were the most frequent symptoms (93% and 65% respectively). 11 patients (6%) were admitted to a PICU and 5 (2.5%) required mechanical ventilation. Antiviral therapy was administered in 103 patients (51.5%) Death occurred in 2 patients (1%); both had severe prior medical conditions. Pre-existing neurologic diseases (OR 7.82; 95%CI: 1.15-53.34), the presence of hypoxemia (OR 10.47; 95%CI: 2.12-51.70) and anemia (Haemoglobin < 10 g/dL) (OR 14.15; 95%CI: 2.36-84.64) were risk factor for Intensive Care Unit admission. Conclusions - This observational study in a given area of North-East Italy confirms the rather favourable prognosis of children with influenza A H1N1 (2009). Pre-existing conditions, and which is new, significant anemia, are risk factors for a complicated course.
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Affiliation(s)
- Liviana Da Dalt
- Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padova, Italy
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