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Scabia A, Chorna O, Rocchitelli L, Festante F, Del Secco S, Costagli G, Riparbelli C, Controzzi T, Tuoni C, Filippi L, Guzzetta A. Implementation of Listening Visits with Parents of Preterm Infants in an Italian Neonatal Intensive Care Unit. MCN Am J Matern Child Nurs 2024; 49:151-156. [PMID: 38679826 PMCID: PMC11060059 DOI: 10.1097/nmc.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
PURPOSE To assess the feasibility of implementing Listening Visits (LV) in an Italian neonatal intensive care unit (NICU). STUDY DESIGN AND METHODS This feasibility implementation of LV included empathic listening and problem-solving sessions provided by a psychologist to 26 parents of hospitalized preterm newborns. Using the RE-AIM implementation framework, three facets of feasibility were assessed: reach, adoption, and implementation. RESULTS It is feasible to integrate LV into the NICU: 76% of families were willing to try LV (reach). Listening Visits recipients reported high satisfaction. Twelve of the 16 families (75%) received six or more LV sessions (adoption), with mothers attending more sessions. Implementation fidelity, defined here as the percentage of LV recipients that received at least four sessions, was 94% among mothers and 30% among fathers. CLINICAL IMPLICATIONS The LV intervention for parental support during the NICU stay is feasible and deemed helpful by parents. Parents were motivated to participate even though their levels of depression, stress, and anxiety were not high. In addition to the use of standardized screening questionnaires, parental requests and clinical team indications should be included in the decision-making for the provision of parental support services.
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Farinella R, Falchi F, Tavanti A, Tuoni C, Di Nino MG, Filippi L, Ciantelli M, Rizzato C, Campa D. The genetic variant SLC2A1 -rs1105297 is associated with the differential analgesic response to a glucose-based treatment in newborns. Pain 2024; 165:657-665. [PMID: 37703430 PMCID: PMC10859852 DOI: 10.1097/j.pain.0000000000003051] [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: 02/22/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023]
Abstract
ABSTRACT Neonatal pain is a critical issue in clinical practice. The oral administration of glucose-based solutions is currently one of the most common and effective nonpharmacologic strategies for neonatal pain relief in daily minor procedures. However, a varying degree of analgesic efficacy has been reported for this treatment. Environmental, maternal, and genetic factors may explain this variability and potentially allow for a personalized analgesic approach, maximizing therapeutic efficacy and preventing side effects. We investigated the exposome (ie, the set of clinical and anthropometric variables potentially affecting the response to the therapy) and the genetic variability of the noradrenaline transporter gene (solute carrier family 6 member 2 [ SLC6A2 ]) and 2 glucose transporter genes (solute carrier family 2 member 1 [ SLC2A1 ] and 2 [ SLC2A2 ]) in relation to the neonatal analgesic efficacy of a 33% glucose solution. The study population consisted in a homogeneous sample of more than 1400 healthy term newborns. No association for the exposome was observed, whereas a statistically significant association between the G allele of SLC2A1 -rs1105297 and a fourfold decreased probability of responding to the therapy was identified after multiple-testing correction (odds ratio of 3.98, 95% confidence interval 1.95-9.17; P = 4.05 × 10 -4 ). This allele decreases the expression of SLC2A1-AS1 , causing the upregulation of SLC2A1 in the dorsal striatum, which has been suggested to be involved in reward-related processes through the binding of opioids to the striatal mu-opioid receptors. Altogether, these results suggest the involvement of SLC2A1 in the analgesic process and highlight the importance of host genetics for defining personalized analgesic treatments.
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Affiliation(s)
| | - Fabio Falchi
- Department of Biology, University of Pisa, Pisa, Italy
| | | | - Cristina Tuoni
- Division of Neonatology, Santa Chiara Hospital, Pisa, Italy
| | | | - Luca Filippi
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Massimiliano Ciantelli
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Centro Di Formazione e Simulazione Neonatale “NINA”, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cosmeri Rizzato
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
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Tuoni C, Nuzzi G, Scaramuzzo RT, Fiori S, Filippi L. Neonatal hypoxic-ischemic encephalopathy after acute carbon monoxide intoxication during pregnancy. A case report and brief review of the literature. Front Pediatr 2023; 11:1264855. [PMID: 38027275 PMCID: PMC10655077 DOI: 10.3389/fped.2023.1264855] [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: 07/21/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Carbon monoxide (CO) poisoning during pregnancy is a rare occurrence, associated with high maternal and fetal mortality rates. As CO can cross the placenta, leading to intrauterine hypoxia, CO intoxication can result in neurological sequelae and neurologic complications in fetuses who survive. We report a case of a preterm newborn acutely exposed to CO in-utero and delivered by emergent cesarean section at the 31st week of gestation due to the severe burns suffered by the mother following an indoor boiler explosion. As CO has serious adverse effects both on the mother and fetus, it is important to recognize and treat poisoning in a timely manner. Despite maternal blood CO levels, CO intoxication at critical stage of central nervous system development can lead to hypoxic-ischemic lesions, thus interdisciplinary care and follow up for these patients are mandatory.
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Affiliation(s)
- Cristina Tuoni
- Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulia Nuzzi
- Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | | | - Simona Fiori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Luca Filippi
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Tuoni C, Mazzatenta C, Filippi L. Congenital Cutaneous Candidiasis with Nail Involvement. J Pediatr 2023; 260:113470. [PMID: 37179016 DOI: 10.1016/j.jpeds.2023.113470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/09/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Cristina Tuoni
- Department of Clinical and Experimental Medicine, Neonatology and Neonatal Intensive Care Unit, University of Pisa, Pisa, Italy
| | - Carlo Mazzatenta
- Dermatology Unit-Lucca, Azienda USL Toscana Nord Ovest, Lucca, Italy
| | - Luca Filippi
- Department of Clinical and Experimental Medicine, Neonatology and Neonatal Intensive Care Unit, University of Pisa, Pisa, Italy
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Bedetti L, Miselli F, Minotti C, Latorre G, Loprieno S, Foglianese A, Laforgia N, Perrone B, Ciccia M, Capretti MG, Giugno C, Rizzo V, Merazzi D, Fanaro S, Taurino L, Pulvirenti RM, Orlandini S, Auriti C, Haass C, Ligi L, Vellani G, Tzialla C, Tuoni C, Santori D, China M, Baroni L, Nider S, Visintini F, Decembrino L, Nicolini G, Creti R, Pellacani E, Dondi A, Lanari M, Benenati B, Biasucci G, Gambini L, Lugli L, Berardi A. Lumbar Puncture and Meningitis in Infants with Proven Early- or Late-Onset Sepsis: An Italian Prospective Multicenter Observational Study. Microorganisms 2023; 11:1546. [PMID: 37375048 DOI: 10.3390/microorganisms11061546] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Background: To evaluate the rates of lumbar puncture (LP) in infants with culture-proven sepsis. Study design: We prospectively enrolled 400 infants with early- or late-onset sepsis due to Group B streptococcus (GBS) or Eschericha coli, diagnosed within 90 days of life. Rates of LP and potential variables associated with LP performance were evaluated. Moreover, cerebrospinal fluid (CSF) characteristics and results of the molecular analysis were investigated. Results: LP was performed in 228/400 (57.0%) infants; 123/228 LPs (53.9%) were performed after antibiotic initiation, hampering the ability to identify the pathogen in the CSF culture. However, polymerase chain reaction increased the probability of positive results of CSF analysis compared to microbiological culture (28/79, 35.4% vs. 14/79, 17.7%, p = 0.001). Severe clinical presentation and GBS infection were associated with higher LP rates. The rate of meningitis was 28.5% (65/228). Conclusions: Rates of LP are low in culture-proven neonatal sepsis and antibiotics are frequently given before LP is carried out. Thus meningitis may be underestimated, and the chances of giving an effective therapy to the newborn are reduced. LP should be performed before the start of antibiotics when there is a clinical suspicion of infection.
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Affiliation(s)
- Luca Bedetti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 21124 Modena, Italy
| | - Francesca Miselli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 21124 Modena, Italy
| | - Chiara Minotti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| | - Giuseppe Latorre
- Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Sabrina Loprieno
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessandra Foglianese
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Barbara Perrone
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Matilde Ciccia
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Maggiore Hospital, 40133 Bologna, Italy
| | - Maria Grazia Capretti
- Neonatal Intensive Care Unit, Women's and Children's Health Department, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Chiara Giugno
- Pediatric Unit, Ospedale B. Ramazzini, 41012 Carpi, Italy
| | - Vittoria Rizzo
- Neonatal Intensive Care Unit, Bufalini Hospital, 47521 Cesena, Italy
| | - Daniele Merazzi
- Division of Neonatology, "Valduce" Hospital, 22100 Como, Italy
| | - Silvia Fanaro
- Department of Medical Sciences, Pediatric Section, University Hospital, 44124 Ferrara, Italy
| | - Lucia Taurino
- Neonatal Intensive Care Unit, Ospedali Riuniti, 71122 Foggia, Italy
| | - Rita Maria Pulvirenti
- Pediatric and Neonatal Unit, Morgagni-Pierantoni Hospital of Forlì, 47121 Forli, Italy
| | - Silvia Orlandini
- Neonatal Intensive Care Unit, Carlo Poma Hospital, 46100 Mantova, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Cristina Haass
- Neonatal Intensive Unit, San Pietro-Fatebenefratelli Hospital, 00168 Rome, Italy
| | - Laura Ligi
- Neonatal Intensive Unit, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giulia Vellani
- Neonatal Intensive Unit, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, 27100 Pavia, Italy
| | - Cristina Tuoni
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy
| | - Daniele Santori
- Pediatric and Neonatal Unit, Azienda Ospedaliera Santa Maria degli Angeli, 33170 Pordenone, Italy
| | | | - Lorenza Baroni
- Neonatal Intensive Care Unit, Santa Maria Nuova Hospital, 42123 Reggio Emilia, Italy
| | - Silvia Nider
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy
| | | | - Lidia Decembrino
- ASST Pavia, Unità Operativa di Pediatria e Nido, Ospedale Civile, 27029 Vigevano, Italy
| | | | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Elena Pellacani
- Residency in Pediatrics, Departmento of Medical and Surgical Science, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Belinda Benenati
- Pediatric and Neonatal Unit, Women's and Children's Health Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Giacomo Biasucci
- Pediatric and Neonatal Unit, Women's and Children's Health Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Lucia Gambini
- Neonatal Intensive Care Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
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Berardi A, Trevisani V, Di Caprio A, Caccamo P, Latorre G, Loprieno S, Foglianese A, Laforgia N, Perrone B, Nicolini G, Ciccia M, Capretti MG, Giugno C, Rizzo V, Merazzi D, Fanaro S, Taurino L, Pulvirenti RM, Orlandini S, Auriti C, Haass C, Ligi L, Vellani G, Tzialla C, Tuoni C, Santori D, Baroni L, China M, Bua J, Visintini F, Decembrino L, Creti R, Miselli F, Bedetti L, Lugli L. Timing of Symptoms of Early-Onset Sepsis after Intrapartum Antibiotic Prophylaxis: Can It Inform the Neonatal Management? Pathogens 2023; 12:pathogens12040588. [PMID: 37111474 PMCID: PMC10140896 DOI: 10.3390/pathogens12040588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The effectiveness of "inadequate" intrapartum antibiotic prophylaxis (IAP administered < 4 h prior to delivery) in preventing early-onset sepsis (EOS) is debated. Italian prospective surveillance cohort data (2003-2022) were used to study the type and duration of IAP according to the timing of symptoms onset of group B streptococcus (GBS) and E. coli culture-confirmed EOS cases. IAP was defined "active" when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; E. coli = 72). Among GBS EOS, 25% had received IAP (always active when beta-lactams were administered). Most IAP-exposed neonates with GBS were symptomatic at birth (67%) or remained asymptomatic (25%), regardless of IAP duration. Among E. coli EOS, 60% were IAP-exposed. However, IAP was active in only 8% of cases, and these newborns remained asymptomatic or presented with symptoms prior to 6 h of life. In contrast, most newborns exposed to an "inactive" IAP (52%) developed symptoms from 1 to >48 h of life. The key element to define IAP "adequate" seems the pathogen's antimicrobial susceptibility rather than its duration. Newborns exposed to an active antimicrobial (as frequently occurs with GBS infections), who remain asymptomatic in the first 6 h of life, are likely uninfected. Because E. coli isolates are often unsusceptible to beta-lactam antibiotics, IAP-exposed neonates frequently develop symptoms of EOS after birth, up to 48 h of life and beyond.
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Affiliation(s)
- Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| | - Viola Trevisani
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Antonella Di Caprio
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Paola Caccamo
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Giuseppe Latorre
- Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Sabrina Loprieno
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessandra Foglianese
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Barbara Perrone
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | | | - Matilde Ciccia
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Maggiore Hospital, 40133 Bologna, Italy
| | - Maria Grazia Capretti
- Neonatal Intensive Care Unit, Women's and Children's Health Department, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Chiara Giugno
- Pediatric Unit, Ospedale B. Ramazzini, 41012 Carpi, Italy
| | - Vittoria Rizzo
- Neonatal Intensive Care Unit, Bufalini Hospital, Cesena, 47521 Cesena, Italy
| | - Daniele Merazzi
- Division of Neonatology, "Valduce" Hospital, 22100 Como, Italy
| | - Silvia Fanaro
- Department of Medical Sciences, Pediatric Section, University Hospital, 44124 Ferrara, Italy
| | - Lucia Taurino
- Neonatal Intensive Care Unit, Ospedali Riuniti, 71122 Foggia, Italy
| | - Rita Maria Pulvirenti
- Pediatric and Neonatal Unit, Morgagni-Pierantoni Hospital of Forlì, 47121 Forlì, Italy
| | - Silvia Orlandini
- Neonatal Intensive Care Unit, Carlo Poma Hospital, 46100 Mantova, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Cristina Haass
- Neonatal Intensive Unit, San Pietro-Fatebenefratelli Hospital, 00168 Rome, Italy
| | - Laura Ligi
- Neonatal Intensive Unit, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giulia Vellani
- Neonatal Intensive Unit, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, 27100 Pavia, Italy
| | - Cristina Tuoni
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy
| | - Daniele Santori
- Pediatric and Neonatal Unit, Azienda Ospedaliera Santa Maria degli Angeli, 33170 Pordenone, Italy
| | - Lorenza Baroni
- Neonatal Intensive Care Unit, Santa Maria Nuova Hospital, 42123 Reggio Emilia, Italy
| | | | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, "IRCCS Burlo Garofolo", 34137 Trieste, Italy
| | | | - Lidia Decembrino
- ASST Pavia, Unità Operativa di Pediatria e Nido, Ospedale Civile, 27029 Vigevano, Italy
| | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Francesca Miselli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Luca Bedetti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
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Farinella R, Rizzato C, Bottai D, Bedini A, Gemignani F, Landi S, Peduzzi G, Rosati S, Lupetti A, Cuttano A, Moscuzza F, Tuoni C, Filippi L, Ciantelli M, Tavanti A, Campa D. Maternal anthropometric variables and clinical factors shape neonatal microbiome. Sci Rep 2022; 12:2875. [PMID: 35190600 PMCID: PMC8861021 DOI: 10.1038/s41598-022-06792-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/30/2021] [Indexed: 11/09/2022] Open
Abstract
AbstractRecent studies indicate the existence of a complex microbiome in the meconium of newborns that plays a key role in regulating many host health-related conditions. However, a high variability between studies has been observed so far. In the present study, the meconium microbiome composition and the predicted microbial metabolic pathways were analysed in a consecutive cohort of 96 full-term newborns. The effect of maternal epidemiological variables on meconium diversity was analysed using regression analysis and PERMANOVA. Meconium microbiome composition mainly included Proteobacteria (30.95%), Bacteroidetes (23.17%) and Firmicutes (17.13%), while for predicted metabolic pathways, the most abundant genes belonged to the class “metabolism”. We observed a significant effect of maternal Rh factor on Shannon and Inverse Simpson indexes (p = 0.045 and p = 0.049 respectively) and a significant effect of delivery mode and maternal antibiotic exposure on Jaccard and Bray–Curtis dissimilarities (p = 0.001 and 0.002 respectively), while gestational age was associated with observed richness and Shannon indexes (p = 0.018 and 0.037 respectively), and Jaccard and Bray–Curtis dissimilarities (p = 0.014 and 0.013 respectively). The association involving maternal Rh phenotype suggests a role for host genetics in shaping meconium microbiome prior to the exposition to the most well-known environmental variables, which will influence microbiome maturation in the newborn.
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Tuoni C, Ciantelli M, Morganti R, Violi M, Tamagnini S, Filippi L. Procalcitonin levels in preterm newborns: Reference ranges during the first three days of life. Front Pediatr 2022; 10:925788. [PMID: 36105855 PMCID: PMC9464813 DOI: 10.3389/fped.2022.925788] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Sepsis is one of the most important causes of morbidity and mortality in the neonatal period, especially in preterms. Diagnosis is difficult because of specific signs and symptoms. The diagnostic gold standard is blood culture, but its sensibility is low. Much effort has been made to identify early, sensitive, and specific diagnostic markers; among these markers particular attention was paid to procalcitonin. However, reference ranges of serum procalcitonin (PCT) shortly after birth have not been sufficiently studied in healthy preterms, and literature is still contradictory. OBJECTIVES The aim of the study is to define PCT age-specific reference ranges in the first 72 h of life in uninfected VLBW preterms. METHODS Serum levels of PCT were assessed for each newborn at birth and every 24 h until the 3rd day of life. The eligible patients were classified into two groups according to their sepsis status. RESULTS Approximately 343 patients were enrolled; 28 were septic and 315 non-septic. In non-septic infants, 1,015 determinations of PCT values were performed. Our data showed a trend in average value of PCT to increase after birth up to a peak between 24 and 48 h of life and, subsequently, to fall. The average peak value was 15.12 ng/ml achieved at nearly 36 h of life. CONCLUSION Our study shows a PCT nomogram of healthy preterms, which is different from the one of term newborns. Data agree with what is reported in literature on the reference ranges and trends of PCT in non-septic preterms shortly after birth.
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Affiliation(s)
- Cristina Tuoni
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Massimiliano Ciantelli
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Riccardo Morganti
- SOD Clinical Trial Statistical Support, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Martina Violi
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Sara Tamagnini
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Luca Filippi
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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Laccetta G, Ciantelli M, Tuoni C, Sigali E, Miccoli M, Cuttano A. Early-onset sepsis risk calculator: a review of its effectiveness and comparative study with our evidence-based local guidelines. Ital J Pediatr 2021; 47:73. [PMID: 33766096 PMCID: PMC7992929 DOI: 10.1186/s13052-021-01028-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background According to most early-onset sepsis (EOS) management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. A review of literature demonstrates the effectiveness of EOS calculator in reducing antibiotic overtreatment and NICU admission among neonates ≥34 weeks’ gestational age (GA); however, some missed cases of culture-positive EOS have also been described. Methods Single-center retrospective study from 1st January 2018 to 31st December 2018 conducted in the Division of Neonatology at Santa Chiara Hospital (Pisa, Italy). Neonates ≥34 weeks’ GA with birth weight ≤ 1500 g, 34–36 weeks’ GA neonates with suspected intraamniotic infection and neonates ≥34 weeks’ GA with three clinical signs of EOS or two signs and one risk factor for EOS receive empirical antibiotics. Neonates ≥34 weeks’ GA with risk factors for EOS or with one clinical indicator of EOS undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 h of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of EOS. Two hundred sixty-five patients at risk for EOS met inclusion criteria; they were divided into 3 study groups: 34–36 weeks’ GA newborns (n = 95, group A), ≥ 37 weeks’ GA newborns (n = 170, group B), and ≥ 34 weeks’ GA newborns (n = 265, group A + B). For each group, we compared the number of patients for which antibiotics would have been needed, based on EOS calculator, and the number of the same patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar’s test and statistical significance was set at p < 0.05; post-hoc power analysis was carried out to evaluate the sample sizes. Results 32/265 (12.1%) neonates ≥34 weeks’ GA received antibiotics within the first 12 h of life. According to EOS calculator 55/265 (20.7%) patients would have received antibiotics with EOS incidence 2/1000 live births (p < 0.0001). Conclusion Our evidence-based protocol entails a further decrease of antibiotic overtreatment compared to EOS calculator. No negative consequences for patients were observed.
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Affiliation(s)
- Gianluigi Laccetta
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy.
| | - Massimiliano Ciantelli
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy.,Centro di Formazione e Simulazione Neonatale "NINA", Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Tuoni
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Emilio Sigali
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, Faculty of Medicine, University of Pisa, Pisa, Italy
| | - Armando Cuttano
- Division of Neonatology and Neonatal Intensive Care Unit, Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, Italy.,Centro di Formazione e Simulazione Neonatale "NINA", Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Farinella R, Erbi I, Bedini A, Donato S, Gentiluomo M, Angelucci C, Lupetti A, Cuttano A, Moscuzza F, Tuoni C, Rizzato C, Ciantelli M, Campa D. Polymorphic variants in Sweet and Umami taste receptor genes and birthweight. Sci Rep 2021; 11:4971. [PMID: 33654187 PMCID: PMC7925569 DOI: 10.1038/s41598-021-84491-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
The first thousand days of life from conception have a significant impact on the health status with short, and long-term effects. Among several anthropometric and maternal lifestyle parameters birth weight plays a crucial role on the growth and neurological development of infants. Recent genome wide association studies (GWAS) have demonstrated a robust foetal and maternal genetic background of birth weight, however only a small proportion of the genetic hereditability has been already identified. Considering the extensive number of phenotypes on which they are involved, we focused on identifying the possible effect of genetic variants belonging to taste receptor genes and birthweight. In the human genome there are two taste receptors family the bitter receptors (TAS2Rs) and the sweet and umami receptors (TAS1Rs). In particular sweet perception is due to a heterodimeric receptor encoded by the TAS1R2 and the TAS1R3 gene, while the umami taste receptor is encoded by the TAS1R1 and the TAS1R3 genes. We observed that carriers of the T allele of the TAS1R1-rs4908932 SNPs showed an increase in birthweight compared to GG homozygotes Coeff: 87.40 (35.13-139.68) p-value = 0.001. The association remained significant after correction for multiple testing. TAS1R1-rs4908932 is a potentially functional SNP and is in linkage disequilibrium with another polymorphism that has been associated with BMI in adults showing the importance of this variant from the early stages of conception through all the adult life.
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Affiliation(s)
| | - Ilaria Erbi
- Department of Biology, University of Pisa, Pisa, Italy
| | - Alice Bedini
- Division of Neonatology, Santa Chiara Hospital, Via Roma, 67, 56126, Pisa, Italy
| | - Sara Donato
- Department of Biology, University of Pisa, Pisa, Italy
| | | | - Claudia Angelucci
- Division of Neonatology, Santa Chiara Hospital, Via Roma, 67, 56126, Pisa, Italy
| | - Antonella Lupetti
- Department of Translation Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Armando Cuttano
- Division of Neonatology, Santa Chiara Hospital, Via Roma, 67, 56126, Pisa, Italy
| | - Francesca Moscuzza
- Division of Neonatology, Santa Chiara Hospital, Via Roma, 67, 56126, Pisa, Italy
| | - Cristina Tuoni
- Division of Neonatology, Santa Chiara Hospital, Via Roma, 67, 56126, Pisa, Italy
| | - Cosmeri Rizzato
- Department of Translation Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
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Tuoni C, Vierucci F, Cesaretti G, Saggese G. Poststreptococcal acute glomerulonephritis presenting as posterior reversible encephalopathy syndrome in an eleven-year-old boy. Minerva Pediatr 2015; 67:531-533. [PMID: 26530495] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C Tuoni
- Department of Pediatrics, S. Chiara University Hospital, Pisa, Italy -
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Vierucci F, Tuoni C, Moscuzza F, Saggese G, Consolini R. Erythema multiforme as first sign of incomplete Kawasaki disease. Ital J Pediatr 2013; 39:11. [PMID: 23406772 PMCID: PMC3632492 DOI: 10.1186/1824-7288-39-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 11/21/2012] [Accepted: 01/09/2013] [Indexed: 12/18/2022] Open
Abstract
Incomplete Kawasaki disease represents a diagnostic challenge for pediatricians. In the absence of classical presentation, the laboratoristic evaluation of systemic inflammation can help in placing the correct diagnosis to promptly start adequate therapy. Erythema multiforme is an acute, self-limiting condition considered to be a hypersensitivity reaction commonly associated with various infections or medications. This aspecific skin condition has been rarely described as a sign of Kawasaki disease. We report on the case of a 4 years old boy presenting high-grade fever associated with erythema multiforme and evidence of systemic inflammation who showed a good response to prompt treatment with intravenous immunoglobulins.
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Affiliation(s)
- Francesco Vierucci
- Pediatric Unit, Maternal & Infant Department, S. Chiara University-Hospital, Via Roma 67, Pisa 56126, Italy.
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Tuoni C, Scaramuzzo RT, Ghirri P, Boldrini A, Bartalena L. Kangaroo Mother Care: four years of experience in very low birth weight and preterm infants. Minerva Pediatr 2012; 64:377-383. [PMID: 22728609] [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: 06/01/2023]
Abstract
AIM Kangaroo Mother Care (KMC) is a method of providing care for preterm infants through skin-to-skin contact with the mother and, preferably, exclusive breastfeeding. The growing interest in KMC at the Neonatology Unit of Pisa has provided the occasion for a retrospective analysis of the last four years, comparing the clinical effects of the kangaroo method vs. those obtained with conventional care (CNC) with respect to indicators of the general health of the infants (indices of growth, and duration of breastfeeding and hospitalization). METHODS A total of 213 infants, aged <37 gestational weeks and weighing ≤1500 g were enrolled for the study; these were divided into two groups for the purpose of comparison (91 in KMC vs. 71 in CNC). RESULTS The indices of growth and the duration of the infants in hospital were not significantly different in the two groups. Nevertheless, it is worth noting how KMC is more efficacious in the very tiny VLBW infants, and that the means of the growth parameters in the KMC infants are greater than those referring to the CNC subjects, body temperatures taken at the beginning and end of a KMC session are higher, and that the mother-child relationship facilitates better sucking-feeding. CONCLUSION While KMC is equivalent to CNC in terms of safety, thermal protection, morbidity and auxologic development, it appears to promote humanisation of infant care and mother-child bond more quickly.
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Affiliation(s)
- C Tuoni
- Neonatology Unit, Mother and Child Department, University Hospital of Pisa, Pisa, Italy.
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