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Donzelli G, Sera F, Morales MA, Vozzi F, Roos T, Schaffert A, Paparella M, Murugadoss S, Mertens B, Gehring R, Linzalone N. A systematic review and meta-analysis of human population studies on the association between exposure to toxic environmental chemicals and left ventricular dysfunction (LVD). Environ Res 2024; 249:118429. [PMID: 38354889 DOI: 10.1016/j.envres.2024.118429] [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] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/08/2023] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Exposure to environmental chemicals has been associated with an elevated risk of heart failure (HF). However, the impact on early markers of HF, such as left ventricular dysfunction (LVD), remains limited. OBJECTIVE To establish a foundation of evidence regarding early HF markers and their association with environmental pollutants, a systematic review and meta-analysis was conducted. METHODS The search, conducted on October 13th, 2023, encompassed PubMed, Embase, and Web of Science without filters, focusing on observational studies reporting myocardial geometrical, structural, or functional alterations in individuals without a history of heart disease. This included the general adult population, workers, young people, and the elderly. The risk of bias was assessed using the ROBINS-I tool at both study and item levels. RESULTS The systematic review included 17 studies involving 43.358 individuals exposed to air pollution and 2038 exposed to heavy metals. Approximately 41% of the effect measures of associations reported significant abnormalities in myocardial structure or function. The metanalyses by pollutants categories indicated positive associations between LV systolic and diastolic abnormalities and exposure to PM2.5 [-0.069 (-0.104, -0.033); -0.044 (-0.062, -0.025)] and PM10 [-0.055 (-0.087, -0.022); -0.030 (-0.050, -0.010)] and NO2 [-0.042 (-0.071, -0.013); -0.021 (-0.037, -0.004)], as well as positive associations between lead exposure and LV systolic abnormalities [-0.033 (-0.051, -0.016)]. CONCLUSIONS Existing evidence shows that specific early markers of HF may be associated with exposure to chemical pollutants. It is recommended to include such endpoints in new longitudinal and case-control studies to confirm further risk associations. These studies should consider co-exposures, account for vulnerable groups, and identify cardiotoxic compounds that may require regulation. When examining the link between myocardial abnormalities and environmental exposure, it is also advisable to explore the supportive use of Adverse Outcome Pathway (AOP) approaches to confirm a causal relationship.
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Affiliation(s)
- G Donzelli
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), Pisa, Italy.
| | - F Sera
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy.
| | - M A Morales
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), Pisa, Italy.
| | - F Vozzi
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), Pisa, Italy.
| | - T Roos
- Department of Population Health Sciences, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
| | - A Schaffert
- Institute of Medical Biochemistry, Medical University Innsbruck, Innsbruck, Austria.
| | - M Paparella
- Institute of Medical Biochemistry, Medical University Innsbruck, Innsbruck, Austria.
| | - S Murugadoss
- Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium.
| | - B Mertens
- Scientific Direction of Chemical and Physical Health Risks, Sciensano, Brussels, Belgium.
| | - R Gehring
- Department of Population Health Sciences, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
| | - N Linzalone
- Institute of Clinical Physiology of the National Research Council (CNR-IFC), Pisa, Italy.
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2
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Filippi L, Cavallaro G, Berti E, Padrini L, Araimo G, Regiroli G, Raffaeli G, Bozzetti V, Tagliabue P, Tomasini B, Mori A, Buonocore G, Agosti M, Bossi A, Chirico G, Aversa S, Fortunato P, Osnaghi S, Cavallotti B, Suzani M, Vanni M, Borsari G, Donati S, Nascimbeni G, Nardo D, Piermarocchi S, la Marca G, Forni G, Milani S, Cortinovis I, Calvani M, Bagnoli P, Dal Monte M, Calvani AM, Pugi A, Villamor E, Donzelli G, Mosca F. Propranolol 0.2% Eye Micro-Drops for Retinopathy of Prematurity: A Prospective Phase IIB Study. Front Pediatr 2019; 7:180. [PMID: 31134171 PMCID: PMC6514240 DOI: 10.3389/fped.2019.00180] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 02/01/2019] [Accepted: 04/18/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Oral propranolol reduces retinopathy of prematurity (ROP) progression, although not safely. Propranolol 0.1% eye micro-drops administered to newborns with stage 2 ROP are well-tolerated, but not sufficiently effective. Methods: A multi-center open-label trial was conducted to assess the safety and efficacy of propranolol 0.2% eye micro-drops in newborns with stage 1 ROP. The progression of the disease was evaluated with serial ophthalmologic examinations. Hemodynamic, respiratory, biochemical parameters, and propranolol plasma levels were monitored. Demographic and perinatal characteristics, co-morbidities and co-intervention incidences, together with ROP progression, were compared with a historical control group in the same centers participating in the trial. Results: Ninety-eight newborns were enrolled and compared with the historical control group. Populations were not perfectly homogeneous (as demonstrated by the differences in the Apgar score and the different incidence rate in surfactant administration and oxygen exposure). The progression to ROP stage 2 or 3 plus was significantly lower than the incidence expected on the basis of historical data (Risk Ratio 0.521, 95% CI 0.297- 0.916). No adverse effects related to propranolol were observed and the mean propranolol plasma level was significantly lower than the safety cut-off of 20 ng/mL. Unexpectedly, three newborns treated with oral propranolol before the appearance of ROP, showed a ROP that was unresponsive to propranolol eye micro-drops and required laser photocoagulation treatment. Conclusion: Propranolol 0.2% eye micro-drops were well-tolerated and appeared to reduce the ROP progression expected on the basis of a comparison with a historical control group. Propranolol administered too early appears to favor a more aggressive ROP, suggesting that a β-adrenoreceptor blockade is only useful during the proliferative phase. Further randomized placebo-controlled trials are required to confirm the current results. Clinical Trial Registration The trial was registered at ClinicalTrials.gov with Identifier NCT02504944 and with EudraCT Number 2014-005472-29.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elettra Berti
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Letizia Padrini
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Regiroli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valentina Bozzetti
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Paolo Tagliabue
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Barbara Tomasini
- Neonatal Intensive Care Unit, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Annalisa Mori
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Massimo Agosti
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Angela Bossi
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Gaetano Chirico
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Pina Fortunato
- Pediatric Ophthalmology, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Silvia Osnaghi
- Department of Ophthalmology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milan, Milan, Italy
| | - Barbara Cavallotti
- Department of Ophthalmology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Martina Suzani
- Department of Ophthalmology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Maurizio Vanni
- Pediatric Ophthalmology, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Giulia Borsari
- Pediatric Ophthalmology, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Simone Donati
- Department of Surgical and Morphological Sciences, Section of Ophthalmology, University of Insubria, Varese, Italy
| | - Giuseppe Nascimbeni
- Department of Ophthalmology, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Daniel Nardo
- Department of Women's and Children's Health, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy
| | | | - Giancarlo la Marca
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Giulia Forni
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Silvano Milani
- Laboratory "G.A. Maccacro," Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ivan Cortinovis
- Laboratory "G.A. Maccacro," Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Calvani
- Oncohematology Unit, Department of Pediatric Oncology, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Paola Bagnoli
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Massimo Dal Monte
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Anna Maria Calvani
- Department of Pharmacy, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Alessandra Pugi
- Clinical Trial Office, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Developmental Biology, Maastricht, Netherlands
| | - Gianpaolo Donzelli
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Filippi L, Laudani E, Tubili F, Calvani M, Bartolini I, Donzelli G. Incidence of Sudden Unexpected Postnatal Collapse in the Therapeutic Hypothermia Era. Am J Perinatol 2017; 34:1362-1367. [PMID: 28571078 DOI: 10.1055/s-0037-1603678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective Hypothermia is considered the treatment of choice for newborns with hypoxic-ischemic encephalopathy. Even though currently no consensus exists regarding the opportunity to extend this treatment also to newborns with sudden unexpected postnatal collapse (SUPC), this treatment is frequently adopted. The aim of the study was to evaluate whether the availability of hypothermia also for collapsed newborns in a tertiary level center may impact the estimated incidence of SUPC.
Study Design A retrospective study was performed comparing the number of newborns admitted with the diagnosis of SUPC in the tertiary referral Neonatal intensive care unit of Florence in the period before (2008–2010) and after (2011–2014) the introduction of hypothermia treatment for newborns with SUPC.
Result After introducing active cooling also to newborns with SUPC, the number of newborns with SUPC admitted to our center augmented and, consequently, SUPC incidence apparently increased from 5.3 to 15.5/100,000 live births, even though this difference did not reach statistical significance (odds ratio = 0.340; 95% confidence interval = 0.071–1.639; p = 0.179).
Conclusion The apparent increase of SUPC incidence is probably related to a more effective centralization of newborns in our referral center but suggests that the real incidence of SUPC is probably significantly higher than currently estimated.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Emanuela Laudani
- Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Flavia Tubili
- Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Maura Calvani
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Isabella Bartolini
- Maternal and Children's Department, "Careggi" University Hospital, Florence, Italy
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4
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Verani M, Carducci A, Donzelli G, Palomba G, Ceretti E, Vannini S, Moretti M, Bagordo F, Pignata C, Biggeri A, Gelatti U. Air pollution and health: study of the biological effects in children by buccal micronucleus assay. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.654] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Verani
- Department of Biology, University of Pisa, Pisa, Italy
| | - A Carducci
- Department of Biology, University of Pisa, Pisa, Italy
| | - G Donzelli
- Department of Biology, University of Pisa, Pisa, Italy
| | - G Palomba
- Department of Biology, University of Pisa, Pisa, Italy
| | - E Ceretti
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy
| | - S Vannini
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - M Moretti
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - F Bagordo
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - C Pignata
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A Biggeri
- Department of Statistic, Computing and Application, University of Florence, Florence, Italy
| | - U Gelatti
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy
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5
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Filippi L, Cavallaro G, Berti E, Padrini L, Araimo G, Regiroli G, Bozzetti V, De Angelis C, Tagliabue P, Tomasini B, Buonocore G, Agosti M, Bossi A, Chirico G, Aversa S, Pasqualetti R, Fortunato P, Osnaghi S, Cavallotti B, Vanni M, Borsari G, Donati S, Nascimbeni G, la Marca G, Forni G, Milani S, Cortinovis I, Bagnoli P, Dal Monte M, Calvani AM, Pugi A, Villamor E, Donzelli G, Mosca F. Study protocol: safety and efficacy of propranolol 0.2% eye drops in newborns with a precocious stage of retinopathy of prematurity (DROP-ROP-0.2%): a multicenter, open-label, single arm, phase II trial. BMC Pediatr 2017; 17:165. [PMID: 28709412 PMCID: PMC5513165 DOI: 10.1186/s12887-017-0923-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/22/2016] [Accepted: 07/05/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) still represents one of the leading causes of visual impairment in childhood. Systemic propranolol has proven to be effective in reducing ROP progression in preterm newborns, although safety was not sufficiently guaranteed. On the contrary, topical treatment with propranolol eye micro-drops at a concentration of 0.1% had an optimal safety profile in preterm newborns with ROP, but was not sufficiently effective in reducing the disease progression if administered at an advanced stage (during stage 2). The aim of the present protocol is to evaluate the safety and efficacy of propranolol 0.2% eye micro-drops in preterm newborns at a more precocious stage of ROP (stage 1). METHODS A multicenter, open-label, phase II, clinical trial, planned according to the Simon optimal two-stage design, will be performed to analyze the safety and efficacy of propranolol 0.2% eye micro-drops in preterm newborns with stage 1 ROP. Preterm newborns with a gestational age of 23-32 weeks, with a stage 1 ROP will receive propranolol 0.2% eye micro-drops treatment until retinal vascularization has been completed, but for no longer than 90 days. Hemodynamic and respiratory parameters will be continuously monitored. Blood samplings checking metabolic, renal and liver functions, as well as electrocardiogram and echocardiogram, will be periodically performed to investigate treatment safety. Additionally, propranolol plasma levels will be measured at the steady state, on the 10th day of treatment. To assess the efficacy of topical treatment, the ROP progression from stage 1 ROP to stage 2 or 3 with plus will be evaluated by serial ophthalmologic examinations. DISCUSSION Propranolol eye micro-drops could represent an ideal strategy in counteracting ROP, because it is definitely safer than oral administration, inexpensive and an easily affordable treatment. Establishing the optimal dosage and treatment schedule is to date a crucial issue. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02504944, registered on July 19, 2015, updated July 12, 2016. EudraCT Number 2014-005472-29.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit - Medical Surgical Fetal-Neonatal Department, Meyer University Children's' Hospital, viale Pieraccini 24, 50134, Florence, Italy.
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Elettra Berti
- Neonatal Intensive Care Unit - Medical Surgical Fetal-Neonatal Department, Meyer University Children's' Hospital, viale Pieraccini 24, 50134, Florence, Italy
| | - Letizia Padrini
- Neonatal Intensive Care Unit - Medical Surgical Fetal-Neonatal Department, Meyer University Children's' Hospital, viale Pieraccini 24, 50134, Florence, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giulia Regiroli
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Valentina Bozzetti
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Chiara De Angelis
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Paolo Tagliabue
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Barbara Tomasini
- Department of Pediatrics, Obstetrics and Reproductive Medicine, Neonatal Intensive Care Unit, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Via Banchi di Sotto, 55, 53100, Siena, Italy
| | - Massimo Agosti
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Angela Bossi
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Gaetano Chirico
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Roberta Pasqualetti
- Pediatric Ophthalmology, A. Meyer" University Children's Hospital, Florence, Italy
| | - Pina Fortunato
- Pediatric Ophthalmology, A. Meyer" University Children's Hospital, Florence, Italy
| | - Silvia Osnaghi
- Department of Ophthalmology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Barbara Cavallotti
- Department of Ophthalomolgy, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Maurizio Vanni
- Pediatric Ophthalmology, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Giulia Borsari
- Pediatric Ophthalmology, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Simone Donati
- Department of Surgical and Morphological Sciences, Section of Ophthalmology, University of Insubria, Varese, Italy
| | - Giuseppe Nascimbeni
- Department of Ophthalmology, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Giancarlo la Marca
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Giulia Forni
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Silvano Milani
- Laboratory "G.A. Maccacro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ivan Cortinovis
- Laboratory "G.A. Maccacro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Bagnoli
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Massimo Dal Monte
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Anna Maria Calvani
- Department of Pharmacy, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Alessandra Pugi
- Clinical Trial Office, "A. Meyer" University Children's Hospital, viale Pieraccini 24, 50134, Florence, Italy
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands
| | - Gianpaolo Donzelli
- Neonatal Intensive Care Unit - Medical Surgical Fetal-Neonatal Department, Meyer University Children's' Hospital, viale Pieraccini 24, 50134, Florence, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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6
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Filippi L, Fiorini P, Catarzi S, Berti E, Padrini L, Landucci E, Donzelli G, Bartalena L, Fiorentini E, Boldrini A, Giampietri M, Scaramuzzo RT, la Marca G, Della Bona ML, Fiori S, Tinelli F, Bancale A, Guzzetta A, Cioni G, Pisano T, Falchi M, Guerrini R. Safety and efficacy of topiramate in neonates with hypoxic ischemic encephalopathy treated with hypothermia (NeoNATI): a feasibility study. J Matern Fetal Neonatal Med 2017; 31:973-980. [PMID: 28274169 DOI: 10.1080/14767058.2017.1304536] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 10/20/2022]
Abstract
PURPOSE To investigate the feasibility of a study based on treatment with topiramate (TPM) added to moderate hypothermia in newborns with hypoxic ischemic encephalopathy (HIE). MATERIALS AND METHODS Multicenter randomized controlled trial. Term newborns with precocious metabolic, clinical and electroencephalographic (EEG) signs of HIE were selected according to their amplified integrated EEG pattern and randomized to receive either TPM (10 mg/kg once a day for the first three days of life) plus moderate hypothermia or hypothermia alone. Safety was assessed by monitoring cardiorespiratory parameters and blood samples collected to check renal, liver, metabolic balance and TPM pharmacokinetics. Efficacy was evaluated by the combined frequency of mortality and severe neurological disability as primary outcome. Incidence of magnetic resonance injury, epilepsy, blindness, hearing loss, neurodevelopment at 18-24 months of life was assessed as secondary outcomes. RESULTS Forty-four asphyxiated newborns were enrolled in the study. Twenty one newborns (10 with moderate and 11 with severe HIE) were allocated to hypothermia plus TPM and 23 (12 moderate and 11 severe HIE) to hypothermia. No statistically or clinically significant differences were observed for safety, primary or secondary outcomes. However, a reduction in the prevalence of epilepsy was observed in newborns co-treated with TPM. CONCLUSIONS Results of this pilot trial suggest that administration of TPM in newborns with HIE is safe but does not reduce the combined frequency of mortality and severe neurological disability. The role of TPM co-treatment in preventing subsequent epilepsy deserves further studies.
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Affiliation(s)
- Luca Filippi
- a Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department , "A. Meyer" University Children's Hospital , Florence , Italy
| | - Patrizio Fiorini
- a Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department , "A. Meyer" University Children's Hospital , Florence , Italy
| | - Serena Catarzi
- a Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department , "A. Meyer" University Children's Hospital , Florence , Italy
| | - Elettra Berti
- a Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department , "A. Meyer" University Children's Hospital , Florence , Italy
| | - Letizia Padrini
- a Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department , "A. Meyer" University Children's Hospital , Florence , Italy
| | - Elisa Landucci
- b Department of Health Sciences, Section of Clinical Pharmacology and Oncology , University of Florence , Florence , Italy
| | | | - Laura Bartalena
- d Neonatal Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Erika Fiorentini
- d Neonatal Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Antonio Boldrini
- d Neonatal Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Matteo Giampietri
- d Neonatal Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Rosa Teresa Scaramuzzo
- d Neonatal Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Giancarlo la Marca
- e Laboratory for Diseases of the Nervous System and Metabolism , "A. Meyer" University Children's Hospital , Florence , Italy
| | - Maria Luisa Della Bona
- e Laboratory for Diseases of the Nervous System and Metabolism , "A. Meyer" University Children's Hospital , Florence , Italy
| | - Simona Fiori
- f Department of Developmental Neuroscience , Stella Maris Scientific Institute , Pisa , Italy
| | - Francesca Tinelli
- f Department of Developmental Neuroscience , Stella Maris Scientific Institute , Pisa , Italy
| | - Ada Bancale
- f Department of Developmental Neuroscience , Stella Maris Scientific Institute , Pisa , Italy
| | - Andrea Guzzetta
- f Department of Developmental Neuroscience , Stella Maris Scientific Institute , Pisa , Italy
| | - Giovanni Cioni
- f Department of Developmental Neuroscience , Stella Maris Scientific Institute , Pisa , Italy
| | - Tiziana Pisano
- g Pediatric Neurology Unit and Laboratories , "A. Meyer" Children's Hospital, University of Florence , Florence , Italy
| | - Melania Falchi
- g Pediatric Neurology Unit and Laboratories , "A. Meyer" Children's Hospital, University of Florence , Florence , Italy
| | - Renzo Guerrini
- g Pediatric Neurology Unit and Laboratories , "A. Meyer" Children's Hospital, University of Florence , Florence , Italy
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Filippi L, Cavallaro G, Bagnoli P, Dal Monte M, Fiorini P, Berti E, Padrini L, Donzelli G, Araimo G, Cristofori G, Fumagalli M, la Marca G, Della Bona ML, Pasqualetti R, Fortunato P, Osnaghi S, Tomasini B, Vanni M, Calvani AM, Milani S, Cortinovis I, Pugi A, Agosti M, Mosca F. Propranolol 0.1% eye micro-drops in newborns with retinopathy of prematurity: a pilot clinical trial. Pediatr Res 2017; 81:307-314. [PMID: 27814346 DOI: 10.1038/pr.2016.230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/29/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oral propranolol reduces retinopathy of prematurity (ROP) progression, although not safely. This study evaluated safety and efficacy of propranolol eye micro-drops in preterm newborns with ROP. METHODS A multicenter open-label trial, planned according to the Simon optimal two-stage design, was performed to analyze safety and efficacy of propranolol micro-drops in newborns with stage 2 ROP. To this end, hemodynamic and respiratory parameters were monitored, and blood samples were collected weekly, for 3 wk. Propranolol plasma levels were also monitored. The progression of the disease was evaluated with serial ophthalmologic examinations. RESULTS Twenty-three newborns were enrolled. Since the fourth of the first 19 newborns enrolled in the first stage of the study showed a progression to stage 2 or 3 with plus, the second stage was prematurely discontinued. Even though the objective to complete the second stage was not achieved, the percentage of ROP progression (26%) was similar to that obtained previously with oral propranolol administration. However, no adverse effects were observed and propranolol plasma levels were significantly lower than those measured after oral administration. CONCLUSION Propranolol 0.1% eye micro-drops are well tolerated, but not sufficiently effective. Further studies are required to identify the optimal dose and administration schedule.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paola Bagnoli
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Massimo Dal Monte
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Patrizio Fiorini
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Elettra Berti
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Letizia Padrini
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Gianpaolo Donzelli
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Gloria Cristofori
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giancarlo la Marca
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Maria Luisa Della Bona
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Roberta Pasqualetti
- Pediatric Ophthalmology, A. Meyer" University Children's Hospital, Florence, Italy
| | - Pina Fortunato
- Pediatric Ophthalmology, A. Meyer" University Children's Hospital, Florence, Italy
| | - Silvia Osnaghi
- Department of Ophthalmology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Polclinico, Milan, Italy
| | - Barbara Tomasini
- Department of Pediatrics, Obstetrics and Reproductive Medicine, Neonatal Intensive Care Unit, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Maurizio Vanni
- Department of Pediatrics, Obstetrics and Reproductive Medicine, Neonatal Intensive Care Unit, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Anna Maria Calvani
- Department of Pharmacy, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Silvano Milani
- Laboratory "G.A. Maccacro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ivan Cortinovis
- Laboratory "G.A. Maccacro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandra Pugi
- Clinical Trial Office, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Massimo Agosti
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Casini B, Carducci A, Verani M, Donzelli G, Palomba G, Ceretti E, Zani C, Carraro E, Schiliro T, De Donno A, Grassi T, Villarini M, Bonizzoni S, Zagni L, Gelatti U. Awareness-raising on air quality and health effects in primary school children. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.002] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- B Casini
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - A Carducci
- Department of Biology, University of Pisa, Pisa, Italy
| | - M Verani
- Department of Biology, University of Pisa, Pisa, Italy
| | - G Donzelli
- Department of Biology, University of Pisa, Pisa, Italy
| | - G Palomba
- Department of Biology, University of Pisa, Pisa, Italy
| | - E Ceretti
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - C Zani
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - E Carraro
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - T Schiliro
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A De Donno
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - T Grassi
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - M Villarini
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | | | - L Zagni
- Centro Servizi Multisettoriale e Tecnologico, Brescia, Italy
| | - U Gelatti
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
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9
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Carducci A, Donzelli G, Casini B, Verani M, Palomba G, Mascagni G, Ceretti E, Zani C, Bagordo F, Serio F, Carraro E, Schilirò T, Villarini M, Bonizzoni S, Bonetti A, Gelatti U. Air pollution and health: study of citizen's attitudes and behaviours using multiple sources. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.022] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Carducci
- Department of Biology, University of Pisa, Pisa, Italy
| | - G Donzelli
- Department of Biology, University of Pisa, Pisa, Italy
| | - B Casini
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - M Verani
- Department of Biology, University of Pisa, Pisa, Italy
| | - G Palomba
- Department of Biology, University of Pisa, Pisa, Italy
| | - G Mascagni
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - E Ceretti
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - C Zani
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - F Bagordo
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - F Serio
- Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy
| | - E Carraro
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - T Schilirò
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - M Villarini
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | | | - A Bonetti
- Centro Servizi Multisettoriale e Tecnologico – CSMT Gestione S.c.a.r.l., Brescia, Italy
| | - U Gelatti
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
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Orlandi S, Reyes Garcia CA, Bandini A, Donzelli G, Manfredi C. Application of Pattern Recognition Techniques to the Classification of Full-Term and Preterm Infant Cry. J Voice 2016; 30:656-663. [DOI: 10.1016/j.jvoice.2015.08.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/07/2015] [Indexed: 10/22/2022]
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Affiliation(s)
- A. Dal pozzo
- Istituto di Chimica e Biochimica G. Ronzoni Via Giuseppe Colombo n. 81 20133 Milano, Italy
| | - G. Donzelli
- Istituto di Chimica e Biochimica G. Ronzoni Via Giuseppe Colombo n. 81 20133 Milano, Italy
| | - P. Ferruti
- Facolta di Ingegneria Universita di Brescia Viale Europa n. 39 25060 Brescia, Italy
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Filippi L, Tamburini A, Berti E, Perrone A, Defilippi C, Favre C, Calvani M, Della Bona ML, la Marca G, Donzelli G. Successful Propranolol Treatment of a Kaposiform Hemangioendothelioma Apparently Resistant to Propranolol. Pediatr Blood Cancer 2016; 63:1290-2. [PMID: 27100060 DOI: 10.1002/pbc.25979] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/28/2016] [Indexed: 12/15/2022]
Abstract
A newborn with unresectable kaposiform hemangioendothelioma associated with Kasabach Merritt phenomenon, unresponsive to vincristine and prednisone, received second-line treatment with propranolol at a dose of 2 mg/kg/day, starting at 2 months of life and continued for 13 months. There was only slight reduction in tumor mass, but measurement of propranolol levels showed extremely low plasma concentrations. The propranolol dose was progressively increased to 3.5 mg/kg/day, leading to a substantial increase in plasma levels associated with clinically relevant tumor reduction. This case highlights the importance of relating propranolol dose to its plasma concentration before considering the treatment ineffective for this vascular tumor.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Angela Tamburini
- Department of Pediatric Hematology-Oncology, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Elettra Berti
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Anna Perrone
- Radiology Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Claudio Defilippi
- Radiology Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Claudio Favre
- Department of Pediatric Hematology-Oncology, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Maura Calvani
- Department of Pediatric Hematology-Oncology, "A. Meyer" University Children's Hospital, Florence, Italy
| | | | - Giancarlo la Marca
- Department of Neurosciences, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Gianpaolo Donzelli
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
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Donzelli G, McGreevy KS. Perinatal care at the confluence of narrative medicine and personalized medicine: what lies downstream? J Matern Fetal Neonatal Med 2016; 29:2807-9. [PMID: 26794262 DOI: 10.3109/14767058.2015.1105210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gianpaolo Donzelli
- a Fetal-Neonatal Department , Meyer Children's Hospital, University of Florence , Florence , Italy and
| | - Kathleen S McGreevy
- b Research, Innovation and International Relations Office, Meyer Children's Hospital , Florence , Italy
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Donzelli G, Carnesecchi G, Amador C, di Tommaso M, Filippi L, Caporali R, Codullo V, Riccieri V, Valesini G, Gabrielli A, Bagnati R, McGreevy KS, De Masi S, Matucci Cerinic M. Fetal programming and systemic sclerosis. Am J Obstet Gynecol 2015; 213:839.e1-8. [PMID: 26232509 DOI: 10.1016/j.ajog.2015.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/09/2014] [Revised: 06/16/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study investigated whether birthweight is linked to an increased risk of the development of systemic sclerosis. STUDY DESIGN This was a multicenter case-control study with perinatal data that were obtained from 332 cases with systemic sclerosis and 243 control subjects. Birthweight was treated as a dichotomous variable (<2500 g vs ≥2500 g); low birthweight was defined as a weight <2500 g; small for gestational age was defined as birthweight <10th percentile for gestational age adjusted for sex. The relationship between systemic sclerosis and both low birthweight and small for gestational age was expressed with the crude (univariate analysis) and adjusted (multivariate analysis) odds ratio (OR). RESULTS Significantly increased ORs were observed in the univariate analysis for low birthweight (OR, 2.59; 95% confidence interval [CI], 1.39-5.05) and small for gestational age (OR, 2.60; 95% CI, 1.34-5.32) subjects. Similarly increased risks were confirmed for both conditions in the multivariate analysis (OR, 3.93; 95% CI, 1.92-8.07; and OR, 2.58; 95% CI, 1.28-5.19), respectively. CONCLUSION Low birthweight and small for gestational age at birth are risk factors for the adult onset of systemic sclerosis.
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Affiliation(s)
- Gianpaolo Donzelli
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy.
| | - Giulia Carnesecchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carolina Amador
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Luca Filippi
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Roberto Caporali
- Department of Rheumatology, University and IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Veronica Codullo
- Department of Rheumatology, University and IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Valeria Riccieri
- Department of Internal Medicine and Clinical Specialties, Rheumatology Unit, "La Sapienza" University, Rome, Italy
| | - Guido Valesini
- Department of Internal Medicine and Clinical Specialties, Rheumatology Unit, "La Sapienza" University, Rome, Italy
| | - Armando Gabrielli
- Institute of General Clinical Medicine, Hematology, and Clinical Immunology, University of Ancona, Ancona, Italy
| | - Roberta Bagnati
- Institute of General Clinical Medicine, Hematology, and Clinical Immunology, University of Ancona, Ancona, Italy
| | - Kathleen S McGreevy
- Research, Innovation, and International Relations Office, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Salvatore De Masi
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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15
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Ambrosini A, Paddeu EM, Donzelli G, Stanghellini G. The perception of the fetus in mothers with liver transplantation. Brief communication. Ann Ist Super Sanita 2015; 51:79-82. [PMID: 25857389 DOI: 10.4415/ann_15_01_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In this brief note we present the preliminary findings of a study of 16 women who underwent liver transplants before becoming pregnant and giving birth. The aim of the study was to show the similarities and differences between ways women experience the transplanted organ (liver) and the fetus. METHODS To explore bodily experiences, a semi-structured ad hoc interview was done on a sample of 16 transplanted women who had completed a pregnancy. The interview was designed to explore the possible similarities between their perception of the transplanted organ (liver) and of the fetus. RESULTS The main findings that emerge from our study are the following: a) in the post-transplant, pre-pregnancy phase, these women develop a polarized attention on the transplanted organ; b) during pregnancy this attention shifts towards the fetus; c) after childbirth the hyper-attention on the transplanted organ disappears and the subject resumes a normal relationship with her body. CONCLUSIONS Therefore, pregnancy and childbirth are experiences that can normalize relations between a person who has undergone a transplant and their transplanted organ.
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Baraldi E, Lanari M, Manzoni P, Rossi GA, Vandini S, Rimini A, Romagnoli C, Colonna P, Biondi A, Biban P, Chiamenti G, Bernardini R, Picca M, Cappa M, Magazzù G, Catassi C, Urbino AF, Memo L, Donzelli G, Minetti C, Paravati F, Di Mauro G, Festini F, Esposito S, Corsello G. Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Ital J Pediatr 2014; 40:65. [PMID: 25344148 PMCID: PMC4364570 DOI: 10.1186/1824-7288-40-65] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 01/14/2023] Open
Abstract
Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (<90-92%), moderate-to-severe respiratory distress, dehydration and presence of apnea. Children with pre-existing risk factors should be carefully assessed.To date, there is no specific treatment for viral bronchiolitis, and the mainstay of therapy is supportive care. This consists of nasal suctioning and nebulized 3% hypertonic saline, assisted feeding and hydration, humidified O2 delivery. The possible role of any pharmacological approach is still debated, and till now there is no evidence to support the use of bronchodilators, corticosteroids, chest physiotherapy, antibiotics or antivirals. Nebulized adrenaline may be sometimes useful in the emergency room. Nebulized adrenaline can be useful in the hospital setting for treatment as needed. Lacking a specific etiological treatment, prophylaxis and prevention, especially in children at high risk of severe infection, have a fundamental role. Environmental preventive measures minimize viral transmission in hospital, in the outpatient setting and at home. Pharmacological prophylaxis with palivizumab for RSV bronchiolitis is indicated in specific categories of children at risk during the epidemic period. Viral bronchiolitis, especially in the case of severe form, may correlate with an increased incidence of recurrent wheezing in pre-schooled children and with asthma at school age.The aim of this document is to provide a multidisciplinary update on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications, identify gaps in knowledge and drive future research.
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Affiliation(s)
- Eugenio Baraldi
- />SIMRI-Società Italiana per le Malattie Respiratorie Infantili, Kragujevac, Italy
- />Women’s and Children’s Health Department, Unit of Pediatric Respiratory Medicine and Allergy, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | | | - Paolo Manzoni
- />SIN-Società Italiana di Neonatologia, Kragujevac, Italy
| | - Giovanni A Rossi
- />SIMRI-Società Italiana per le Malattie Respiratorie Infantili, Kragujevac, Italy
| | - Silvia Vandini
- />SIN-Società Italiana di Neonatologia, Kragujevac, Italy
| | - Alessandro Rimini
- />SICP-Società Italiana di Cardiologia Pediatrica, Kragujevac, Italy
| | | | - Pierluigi Colonna
- />SICP-Società Italiana di Cardiologia Pediatrica, Kragujevac, Italy
| | - Andrea Biondi
- />AIEOP - Società Italiana di Ematologia e Oncologia Pediatrica, Kragujevac, Italy
| | - Paolo Biban
- />AMIETIP - Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica, Kragujevac, Italy
| | | | - Roberto Bernardini
- />SIAIP - Società Italiana di Allergologia e Immunologia Pediatrica, Kragujevac, Italy
| | - Marina Picca
- />SICuPP - Società Italiana delle Cure Primarie Pediatriche, Kragujevac, Italy
| | - Marco Cappa
- />SIEDP - Società Italiana di Endocrinologia e Diabetologia Pediatrica, Kragujevac, Italy
| | - Giuseppe Magazzù
- />SIFC - Società Italiana per lo studio della Fibrosi Cistica, Kragujevac, Italy
| | - Carlo Catassi
- />SIGENP - Società Italiana Gastroenterologia Epatologia e Nutrizione Pediatrica, Kragujevac, Italy
| | | | - Luigi Memo
- />SIMGePeD - Società Italiana Malattie Genetiche Pediatriche e Disabilità Congenite, Kragujevac, Italy
| | | | - Carlo Minetti
- />SINP - Società Italiana di Neurologia Pediatrica, Kragujevac, Italy
| | | | - Giuseppe Di Mauro
- />SIPPS - Società Italiana di Pediatria Preventiva e Sociale, Kragujevac, Italy
| | - Filippo Festini
- />SISIP - Società Italiana di Scienze Infermieristiche Pediatriche, Kragujevac, Italy
| | - Susanna Esposito
- />SITIP - Società Italiana di Infettivologia Pediatrica, Kragujevac, Italy
| | | | - on behalf of their respective Scientific Pediatric Societies
- />SIMRI-Società Italiana per le Malattie Respiratorie Infantili, Kragujevac, Italy
- />Women’s and Children’s Health Department, Unit of Pediatric Respiratory Medicine and Allergy, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- />SIN-Società Italiana di Neonatologia, Kragujevac, Italy
- />SICP-Società Italiana di Cardiologia Pediatrica, Kragujevac, Italy
- />AIEOP - Società Italiana di Ematologia e Oncologia Pediatrica, Kragujevac, Italy
- />AMIETIP - Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica, Kragujevac, Italy
- />FIMP - Federazione Italiana Medici Pediatri, Kragujevac, Italy
- />SIAIP - Società Italiana di Allergologia e Immunologia Pediatrica, Kragujevac, Italy
- />SICuPP - Società Italiana delle Cure Primarie Pediatriche, Kragujevac, Italy
- />SIEDP - Società Italiana di Endocrinologia e Diabetologia Pediatrica, Kragujevac, Italy
- />SIFC - Società Italiana per lo studio della Fibrosi Cistica, Kragujevac, Italy
- />SIGENP - Società Italiana Gastroenterologia Epatologia e Nutrizione Pediatrica, Kragujevac, Italy
- />SIMEUP - Società Italiana di Medicina di Emergenza ed Urgenza Pediatrica, Kragujevac, Italy
- />SIMGePeD - Società Italiana Malattie Genetiche Pediatriche e Disabilità Congenite, Kragujevac, Italy
- />SIMP - Società Italiana di Medicina Perinatale, Kragujevac, Italy
- />SINP - Società Italiana di Neurologia Pediatrica, Kragujevac, Italy
- />SIPO - Società Italiana Pediatria Ospedaliera, Kragujevac, Italy
- />SIPPS - Società Italiana di Pediatria Preventiva e Sociale, Kragujevac, Italy
- />SISIP - Società Italiana di Scienze Infermieristiche Pediatriche, Kragujevac, Italy
- />SITIP - Società Italiana di Infettivologia Pediatrica, Kragujevac, Italy
- />SIP-Società Italiana di Pediatria, Kragujevac, Italy
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Donzelli G, Paddeu EM, D’Alessandro F, Nanni Costa A. The role of narrative medicine in pregnancy after liver transplantation. J Matern Fetal Neonatal Med 2014; 28:158-61. [DOI: 10.3109/14767058.2014.906578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cetin I, Assandro P, Massari M, Sagone A, Gennaretti R, Donzelli G, Knowles A, Monasta L, Davanzo R. Breastfeeding during pregnancy: position paper of the Italian Society of Perinatal Medicine and the Task Force on Breastfeeding, Ministry of Health, Italy. J Hum Lact 2014; 30:20-7. [PMID: 24305595 DOI: 10.1177/0890334413514294] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As more women breastfeed for longer, it is increasingly likely that women may be still breastfeeding when they become pregnant again. The Italian Society of Perinatal Medicine (SIMP) Working Group on Breastfeeding has reviewed the literature to determine the medical compatibility of pregnancy and breastfeeding. We found no evidence indicating that healthy women are at higher risk of miscarriage or preterm delivery if they breastfeed while pregnant. No evidence indicates that the pregnancy-breastfeeding overlap might cause intrauterine growth restriction, particularly in women from developed countries. Little information is available on the composition of human milk of pregnant women, and we found no data on the growth of infants nursed by a pregnant woman. However, both the composition of postpartum breast milk and the growth of the subsequent newborn appear to be partly affected, at least in developing countries. SIMP supports breastfeeding during pregnancy in the first 2 trimesters, and we believe it to be sustainable in the third trimester. Based on the hypothetical risk, caution may be warranted for women at risk of premature delivery, although no evidence exists that breastfeeding could trigger labor inducing uterine contractions. In conclusion, currently available data do not support routine discouragement of breastfeeding during pregnancy. Further studies are certainly needed to explore the consequences of breastfeeding during pregnancy on maternal health, on the breastfed infant, on the embryo/fetus, and, subsequently, on the growth of the newborn.
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Affiliation(s)
- Irene Cetin
- 1Obstetrics and Gynecology Unit, Department of Biomedical and Clinical Sciences, Hospital L. Sacco, University of Milan, Milan, Italy
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Abstract
We report a case of fatal intra-abdominal bleeding in a term newborn delivered by vacuum extractor and Kristeller manouvre. Although autopsy was not performed in compliance with the parents′ wishes, there is strong evidence of a massive abdominal haemorrhage due to injuries of the hypochondriac organs probably leading to disconnection of a vascular pedicle.
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Affiliation(s)
- Maria Serenella Pignotti
- Department of Paediatrics, Neonatal Medicine, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
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Filippi L, Cavallaro G, Fiorini P, Malvagia S, Della Bona M, Giocaliere E, Bagnoli P, Dal Monte M, Mosca F, Donzelli G, la Marca G. Propranolol concentrations after oral administration in term and preterm neonates. J Matern Fetal Neonatal Med 2013. [DOI: 10.3109/14767058.2012.755169] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Filippi L, Fiorini P, Daniotti M, Catarzi S, Savelli S, Fonda C, Bartalena L, Boldrini A, Giampietri M, Scaramuzzo R, Papoff P, Del Balzo F, Spalice A, la Marca G, Malvagia S, Della Bona ML, Donzelli G, Tinelli F, Cioni G, Pisano T, Falchi M, Guerrini R. Safety and efficacy of topiramate in neonates with hypoxic ischemic encephalopathy treated with hypothermia (NeoNATI). BMC Pediatr 2012; 12:144. [PMID: 22950861 PMCID: PMC3478965 DOI: 10.1186/1471-2431-12-144] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 08/31/2012] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite progresses in neonatal care, the mortality and the incidence of neuro-motor disability after perinatal asphyxia have failed to show substantial improvements. In countries with a high level of perinatal care, the incidence of asphyxia responsible for moderate or severe encephalopathy is still 2-3 per 1000 term newborns. Recent trials have demonstrated that moderate hypothermia, started within 6 hours after birth and protracted for 72 hours, can significantly improve survival and reduce neurologic impairment in neonates with hypoxic-ischemic encephalopathy. It is not currently known whether neuroprotective drugs can further improve the beneficial effects of hypothermia. Topiramate has been proven to reduce brain injury in animal models of neonatal hypoxic ischemic encephalopathy. However, the association of mild hypothermia and topiramate treatment has never been studied in human newborns. The objective of this research project is to evaluate, through a multicenter randomized controlled trial, whether the efficacy of moderate hypothermia can be increased by concomitant topiramate treatment. METHODS/DESIGN Term newborns (gestational age ≥ 36 weeks and birth weight ≥ 1800 g) with precocious metabolic, clinical and electroencephalographic (EEG) signs of hypoxic-ischemic encephalopathy will be randomized, according to their EEG pattern, to receive topiramate added to standard treatment with moderate hypothermia or standard treatment alone. Topiramate will be administered at 10 mg/kg once a day for the first 3 days of life. Topiramate concentrations will be measured on serial dried blood spots. 64 participants will be recruited in the study. To evaluate the safety of topiramate administration, cardiac and respiratory parameters will be continuously monitored. Blood samplings will be performed to check renal, liver and metabolic balance. To evaluate the efficacy of topiramate, the neurologic outcome of enrolled newborns will be evaluated by serial neurologic and neuroradiologic examinations. Visual function will be evaluated by means of behavioural standardized tests. DISCUSSION This pilot study will explore the possible therapeutic role of topiramate in combination with moderate hypothermia. Any favourable results of this research might open new perspectives about the reduction of cerebral damage in asphyxiated newborns.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, A. Meyer University Children's Hospital, Viale Pieraccini, 24, I-50139, Florence, Italy.
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Filippi L, Catarzi S, Gozzini E, Fiorini P, Falchi M, Pisano T, la Marca G, Donzelli G, Guerrini R. Hypothermia for neonatal hypoxic-ischemic encephalopathy: may an early amplitude-integrated EEG improve the selection of candidates for cooling? J Matern Fetal Neonatal Med 2012; 25:2171-6. [PMID: 22506547 DOI: 10.3109/14767058.2012.683896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To report our experience in the selection of newborns candidate to therapeutic hypothermia. METHODS Retrospective study involving 47 newborns suffering from perinatal asphyxia from January 2008 to September 2011. RESULTS Thirty-five of 47 newborns admitted to our hospital fulfilled metabolic and neurological criteria for recruitment and were cooled. aEEG was carried out in 26 of them and resulted always abnormal. In three of the 12 newborns with only metabolic criteria, aEEG was moderately abnormal. They were cooled and their outcome (evaluated by General Movements and Griffiths Mental Development Scales for children aged 0-2 years) is good. Three additional newborns who only met the metabolic criterion reached our hospital after the therapeutic window for hypothermia and exhibited seizures; their outcome is poor. CONCLUSIONS In our experience, the inclusion of aEEG in the entry criteria would not have precluded newborns with neurological criteria from cooling. On the contrary, without an early aEEG, we would have excluded from hypothermia infants with moderate hypoxic-ischemic encephalopathy without precocious neurological signs who exhibited only the metabolic criterion, but with abnormal aEEG. If further studies will confirm that early aEEG might identify newborns suitable for cooling even in the absence of clinical signs, a revision of the entry criteria should be considered.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, Florence, Italy.
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Ambrosini A, Donzelli G, Stanghellini G. Early perinatal diagnosis of mothers at risk of developing post-partum depression--a concise guide for obstetricians, midwives, neonatologists and paediatricians. J Matern Fetal Neonatal Med 2011; 25:1096-101. [PMID: 21919554 DOI: 10.3109/14767058.2011.622011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE In this article, we tried to provide all those involved in perinatal medicine with a concise guide to detect mothers at risk of developing post-partum depression. Motherhood is a critical situation characterized by role conflicts because conflicts among the role of mother, worker and wife are the norm in the post-partum period and may jeopardize the mother's existence. METHODS We have described a kind of personality that is at great risk of developing post-partum depression because of the incapacity to creatively manage situations of role conflict. This personality structure is called typus melancholicus, and we operationally defined its main features: orderliness, conscientiousness, hypernomia/heteronomia and intolerance of ambiguity. RESULTS We have shown how these mothers may typically behave during pregnancy and early motherhood: they cannot avoid behaving with feverish perfectionism, developing an exaggerated preoccupation towards the unborn child and hostility towards persons and events that are experienced as an obstacle to their search for perfection. They ultra-carefully follow all the steps concerning paediatric check-ups and feel all the responsibility relating to the care of the child, without being able to delegate to someone else or share their feelings. CONCLUSION We hope to provide those clinicians who are engaged in the care of pregnant women and their children with a valuable and user-friendly instrument for understanding and making a timely diagnoses of at-risk psychopathological phenomena.
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Filippi L, la Marca G, Cavallaro G, Fiorini P, Favelli F, Malvagia S, Donzelli G, Guerrini R. Phenobarbital for neonatal seizures in hypoxic ischemic encephalopathy: a pharmacokinetic study during whole body hypothermia. Epilepsia 2011; 52:794-801. [PMID: 21371018 DOI: 10.1111/j.1528-1167.2011.02978.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Therapeutic hypothermia has recently been introduced to treat term newborns with hypoxic-ischemic encephalopathy, of whom more than half have seizures. Phenobarbital is widely used to treat neonatal seizures, but it is unknown whether its pharmacokinetics is affected by hypothermia. We evaluated the influence of hypothermia on phenobarbital pharmacokinetics in asphyxiated newborns. METHODS Nineteen term asphyxiated newborns treated with mild whole body hypothermia, started within 6 h after birth and protracted for 72 h, received phenobarbital for clinical seizures. Treatment schedule consisted of a loading dose of 20 mg/kg, titrated to response, up to a maximum dose of 40 mg/kg, followed by a maintenance dose of 2.5 or 1.5 mg/kg every 12 h. Phenobarbital concentrations were measured on 28 dried blood spots in each newborn. KEY FINDINGS Eighteen newborns showed plasma concentrations within the reference range after receiving a loading dose of 20 mg/kg. In the remaining newborn, who had received a loading dose of 35 mg/kg, phenobarbital concentrations exceeded the upper reference limit. Phenobarbital concentrations reached a virtual steady state in all newborns. Pharmacokinetic parameters were then calculated. Minimum and maximum concentration (24.7 ± 8.8 and 30.63 ± 10.3 mg/L), average plasma concentration (27.37 ± 9.4 mg/L), and half-life (173.9 ± 62.5 h) were considerably higher than reported in literature for normothermic newborns. Pharmacokinetic parameters did not differ significantly between infants receiving different maintenance doses. SIGNIFICANCE Phenobarbital administered to newborns under whole body hypothermia results in higher plasma concentrations and longer half-lives than expected in normothermic newborns.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Department of Perinatal Medicine, A. Meyer University Children's Hospital, Florence, Italy.
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Filippi L, Cavallaro G, Fiorini P, Daniotti M, Benedetti V, Cristofori G, Araimo G, Ramenghi L, La Torre A, Fortunato P, Pollazzi L, la Marca G, Malvagia S, Bagnoli P, Ristori C, Dal Monte M, Bilia AR, Isacchi B, Furlanetto S, Tinelli F, Cioni G, Donzelli G, Osnaghi S, Mosca F. Study protocol: safety and efficacy of propranolol in newborns with Retinopathy of Prematurity (PROP-ROP): ISRCTN18523491. BMC Pediatr 2010; 10:83. [PMID: 21087499 PMCID: PMC2993687 DOI: 10.1186/1471-2431-10-83] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [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: 07/25/2010] [Accepted: 11/18/2010] [Indexed: 02/07/2023] Open
Abstract
Background Despite new therapeutic approaches have improved the prognosis of newborns with retinopathy of prematurity (ROP), an unfavourable structural and functional outcome still remains high. There is high pressure to develop new drugs to prevent and treat ROP. There is increasing enthusiasm for anti-VEGF drugs, but angiogenic inhibitors selective for abnormal blood vessels would be considered as an optimal treatment. In an animal experimental model of proliferative retinopathy, we have recently demonstrated that the pharmacological blockade of beta-adrenoreceptors improves retinal neovascularization and blood retinal barrier breakdown consequent to hypoxia. The purpose of this study is to evaluate the propranolol administration in preterm newborns suffering from a precocious phase of ROP in terms of safety and efficacy in counteracting the progression of retinopathy. Methods/Design Preterm newborns (gestational age at birth lower than 32 weeks) with stage 2 ROP (zone II-III without plus) will be randomized, according to their gestational age, to receive propranolol added to standard treatment (treatment adopted by the ETROP Cooperative Group) or standard treatment alone. Propranolol will be administered until retinal vascularization will be completely developed, but not more than 90 days. Forty-four participants will be recruited into the study. To evaluate the safety of propranolol administration, cardiac and respiratory parameters will be continuously monitored. Blood samplings will be performed to check renal, liver and metabolic balance. To evaluate the efficacy of propranolol, the progression of the disease, the number of laser treatments or vitrectomies, the incidence of retinal detachment or blindness, will be evaluated by serial ophthalmologic examinations. Visual function will be evaluated by means of behavioural standardized tests. Discussion This pilot study is the first research that explores the possible therapeutic role of beta blockers in ROP. The objective of this research is highly ambitious: to find a treatment simple, inexpensive, well tolerated and with few adverse effects, able to counteract one of the major complications of the prematurity. Any favourable results of this research could open new perspectives and original scenarios about the treatment or the prevention of this and other proliferative retinopathies. Trial Registration Current Controlled Trials ISRCTN18523491; ClinicalTrials.gov Identifier NCT01079715; EudraCT Number 2010-018737-21
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Department of Perinatal Medicine, A, Meyer University Children's Hospital, Florence, Italy.
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Skupski DW, Chervenak FA, McCullough LB, Bancalari E, Haumont D, Simeoni U, Saugstad O, Donn S, Arabin B, Greenough A, Donzelli G, Levene M, Sen C, Carbonell X, Dudenhausen JW, Vladareanu R, Antsaklis A, Papp Z, Aksit M, Carrapato M. Ethical dimensions of periviability. J Perinat Med 2010; 38:579-83. [PMID: 20807009 DOI: 10.1515/jpm.2010.098] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The birth of neonates at the limits of viability, or periviability, poses numerous challenges to health care providers and to systems of care, and the care of these pregnancies and neonates is fraught with ethical controversies. This statement summarizes the ethical principles involved in the care of periviable pregnancies and neonates, and provides expert clinical opinion about the numerous challenges posed by this problem around the world. Topics addressed include a summary of the published experience, an ethical framework, translating neonatal outcome data to the obstetric arena, management as a trial of intervention, referral to tertiary centers, neonatal resuscitation, cesarean delivery for fetal indication, and limits on life-sustaining neonatal treatment.
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Affiliation(s)
- Daniel W Skupski
- Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY 10021, USA.
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Filippi L, Poggi C, la Marca G, Furlanetto S, Fiorini P, Cavallaro G, Plantulli A, Donzelli G, Guerrini R. Oral topiramate in neonates with hypoxic ischemic encephalopathy treated with hypothermia: a safety study. J Pediatr 2010; 157:361-6. [PMID: 20553846 DOI: 10.1016/j.jpeds.2010.04.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 03/26/2010] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate whether topiramate associated with mild or deep hypothermia in asphyxiated term infants is safe in relation to the short-term outcome. STUDY DESIGN We report on 27 consecutive asphyxiated newborns who were treated with whole body hypothermia and 27 additional consecutive newborns with hypothermia who were co-treated with oral topiramate, once a day for 3 consecutive days, at 2 different doses. RESULTS Newborns were divided in 6 groups according to the depth of hypothermia and the association with higher or lower topiramate dosage. A statistical comparison of the groups identified some differences in biochemical and hemodynamic variables, but no adverse effects attributable to topiramate were detected. There were no statistically significant differences in the groups in short-term outcomes, survival rate at discharge, or incidence of pathologic brain magnetic resonance imaging. CONCLUSION Although the number of newborns in this study was limited, the short-term outcome and the safety data appear to support the evaluation of topiramate in clinical trials to explore its possible additive neuroprotective action.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Department of Critical Care Medicine, A. Meyer University Children's Hospital, and Department of Pharmacology, University of Florence, Florence, Italy.
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Filippi L, Gozzini E, Cavicchi C, Morrone A, Fiorini P, Donzelli G, Malvagia S, la Marca G. Insulin-resistant hyperglycaemia complicating neonatal onset of methylmalonic and propionic acidaemias. J Inherit Metab Dis 2009; 32 Suppl 1:S179-86. [PMID: 19588269 DOI: 10.1007/s10545-009-1141-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 05/07/2009] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Insulin-resistant hyperglycaemia may occasionally complicate the clinical course of organic acidaemias. STUDY DESIGN Clinical observation. RESULTS Two term infants, one suffering from acute early-onset methylmalonic acidaemia, the other suffering from acute early-onset propionic acidaemia, presented acutely with dehydration, ketoacidosis, and hyperammonaemia. Urinary organic acid, plasma amino acids, and blood and plasma acylcarnitine analysis allowed the diagnosis of methylmalonic and propionic acidaemias. The detection of the novel c.481G>A (p.Gly161Arg) and the known c.655A>T (p.Asn219Tyr) MUT gene mutations identified the first patient as affected by methylmalonic acidaemia mut type. The high increase of propionylcarnitine after carnitine administration in both patients suggested a greatly elevated metabolic intoxication. Both newborns showed insulin-resistant hyperglycaemia. Patient 1 died, but patient 2, after a strong reduction of glucose administration, survived. To our knowledge, this is the only patient with this complication who survived. CONCLUSION Insulin-resistant hyperglycaemia complicating neonatal onset of methylmalonic and propionic acidaemias is probably a marker of a serious disease. One patient with this complication survived after a strong reduction of glucose administration. Even if this is probably only a partial intervention, we hypothesize that in this situation a reduction of glucose administration can reduce almost the risk of persistent hyperglycaemia. Further studies are required to confirm our hypothesis.
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Affiliation(s)
- L Filippi
- Neonatal Intensive Care Unit, Department of Critical Care Medicine, A. Meyer University Children's Hospital, viale Pieraccini, 24, 50134, Florence, Italy.
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Piumelli R, Di Pietro P, Longhi L, Donzelli G, Cutrera R, Nespoli L, Magnani C, Nassi N, Becherucci P, Chiappini E, Lapi F, Vannacci A, Mari F, Nosetti L, Rimini A, Salvatore S, Paglietti MG, Palmieri A, Pomo R, Vitale A, Dalla Casa P, De Angelis GL, Macchiarini A, Nonnis-Marzano F, Pisani F, Podestà A. [Assistential-diagnostic guidelines: apparent life-threatening events (ALTE)]. Minerva Pediatr 2009; 61:891-893. [PMID: 19935585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
BACKGROUND Although oxidative stress-related diseases mostly affect neonates with extremely low birthweight, healthy preterm newborns might also be at risk of oxidative damages. The aim of the present study was to verify this possibility. METHODS Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), erythrocyte glutathione peroxidase (GSHPx) and superoxide dismutase (SOD), plasma and erythrocyte concentrations of selenium, zinc and copper were measured until 100 days of life in 30 preterm infants with mean +/- SD birthweight and gestational age of 1605 +/- 122 g and 34.5 +/- 0.5 weeks. The control group included 30 term infants with birthweight 3123 158 g and gestational age 39.6 0.7 weeks. RESULTS Throughout the study period urinary 8-OHdG, taken as a marker of oxidative stress, was significantly higher in the preterm than in the term group. Up until 20 days of life, GSHPx activity was significantly lower in the preterm than in the term infants but this was not associated with any apparent selenium deficiency. Conversely, up until 100 days, preterm infants had significantly reduced SOD levels that appeared to reflect a shortage of the elements needed for this enzyme's activity, notably copper, the plasma concentrations of which were constantly and significantly below the control values. CONCLUSION The nutritional status of the elements related to the anti-oxidant enzymes, especially zinc and copper, should be carefully assessed in preterm infants, even if their birthweight is not extremely low.
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Affiliation(s)
- Niccolò Nassi
- Department of Paediatrics, University of Florence, Florence, Italy. .it
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Abstract
With the advancement of medical technology, the outcomes for high-risk infants have greatly improved. However, hand and hand with the more positive result of saving neonates, modern neonatal intensive care has also brought to light several issues regarding the ethical grounds in infant care. One of the greatest problems concerns newborns at the threshold of viability. Treatment guidelines have been formulated for these babies in different countries all around the world and there is the general consensus to withhold resuscitation in neonates when gestational age in less than, or equal to 23 weeks, with intensive care ensured for infants at 25 weeks' gestational age. In order to provide helpful suggestions during the initial management of the threatened birth of an infant with a gestational age of 25 completed weeks or less, we conducted a study for reviewing international studies on survival and morbidity rates, international guidelines and practice recommendations. This gave rise to the creation of a consensus document subsequently submitted to the Italian Scientific Societies for approval. The 'Carta di Firenze' does not attempt to deal with the problems related to pediatric euthanasia or eugenetics: its aim is to protect the infant and the mother from undue suffering although addressing recommendations for the work of clinicians.
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Donzelli G. Declaration of the newborn's rights. J Matern Fetal Neonatal Med 2009; 23:241-3. [DOI: 10.1080/14767050903125457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fiorillo C, Becatti M, Pensalfini A, Cecchi C, Lanzilao L, Donzelli G, Nassi N, Giannini L, Borchi E, Nassi P. Curcumin protects cardiac cells against ischemia-reperfusion injury: effects on oxidative stress, NF-kappaB, and JNK pathways. Free Radic Biol Med 2008; 45:839-46. [PMID: 18638545 DOI: 10.1016/j.freeradbiomed.2008.06.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 06/06/2008] [Indexed: 11/20/2022]
Abstract
In this study we explored the effects of curcumin in cardiac cells subjected to a protocol simulating ischemia-reperfusion (IR). Curcumin (10 microM) was administered before ischemia (pretreatment) or at the moment of reperfusion (posttreatment) and its effects were compared to those produced by a reference antioxidant (Trolox) with an equal antioxidant capacity. IR cardiac cells showed clear signs of oxidative stress, impaired mitochondrial activity, and a marked development of both necrotic and apoptotic processes; at the same time, increases in NF-kappaB nuclear translocation and JNK phosphorylation were observed. Curcumin pretreatment was revealed to be the most effective in attenuating all these modifications and, in particular, in reducing the death of IR cells. This confirms that the protective effect of curcumin is not related simply to its antioxidant properties but involves other mechanisms, notably interactions in the NF-kappaB and JNK pathways. These findings suggest that curcumin administration, in particular before the hypoxic challenge, represents a promising approach to protecting cardiac cells against IR injury. In this scenario our results point out the importance of the chronology for the outcome of the treatment and provide a differential valuation of the degree of protection that curcumin can exert by its antioxidant activity or by other mechanisms.
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Affiliation(s)
- Claudia Fiorillo
- Department of Biochemical Sciences University of Florence, 50134 Florence, Italy.
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Nassi N, Piumelli R, Lombardi E, Landini L, Donzelli G, de Martino M. Comparison between pulse oximetry and transthoracic impedance alarm traces during home monitoring. Arch Dis Child 2008; 93:126-32. [PMID: 17893118 DOI: 10.1136/adc.2007.118513] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare transthoracic impedance (TTI/ECG) and pulse oximetry alarm traces detected during home monitoring in infants at risk of apnoea, bradycardia and hypoxaemia. STUDY DESIGN A retrospective evaluation of the monitor downloads of 67 infants who had undergone either TTI/ECG or pulse oximetry home monitoring using a device which can detect both parameters. METHODS The patients were categorised as: apparent life-threatening events (n = 39), preterm infants (n = 21) and miscellaneous (n = 7). TTI/ECG and pulse oximetry alarm traces were scored as either true or false alarms. Classification criteria were based on visual analysis of the impedance and plethysmographic waveforms captured by the memory monitor every time alarm thresholds were violated. RESULTS 5242 alarms occurred over 3452 days of monitoring: 4562 (87%) were false and 680 (13%) true. The mean duration of monitoring was 51 days (range 5-220 days). There were 2982 TTI/ECG false alarms (65% of the total) and 1580 pulse oximetry false alarms (35%) (p = 0.0042). Of the 680 true alarms, 507 (74%) were desaturations not attributable to central apnoea and 173 (26%) were true TTI/ECG alarms (p = 0.0013). CONCLUSIONS Comparison of pulse oximetry and TTI/ECG alarm traces shows that true events were mostly attributable to desaturations, while false alarms were mainly provoked by TTI/ECG. The total number of false alarms is lower than reported in other studies using TTI/ECG only, thus indicating that monitoring using both pulse oximetry and TTI/ECG is suitable for home use. When the combination of both techniques is not feasible or not required, we recommend the use of motion resistant pulse oximetry alone.
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Affiliation(s)
- N Nassi
- Department of Pediatrics, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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Pignotti MS, Donzelli G. Perinatal care at the threshold of viability: an international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics 2008; 121:e193-8. [PMID: 18166538 DOI: 10.1542/peds.2007-0513] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Over the last 2 decades, the survival rate of infants born at < or = 25 weeks of gestation has increased; however, significant morbidity and disability persist. The commitment for their care gives rise to a variety of complex medical, social, and ethical aspects. Decision-making is a crucial issue that involves the infant, the family, health care providers, and society. In a review of the existing guidelines, we investigated the different approaches in the care of extremely preterm births in various countries. We found that many scientific societies and professional organizations have issued guidelines that address the recommendations for the care of these fetuses/neonates although to varying degrees. In this article we compare different approaches and assess the scientific grounds of the specific recommendations. With current standards, intensive care is generally considered justifiable at > or = 25 weeks, compassionate care at < or = 22 weeks, and an individual approach at 23 to 24 weeks, consistent with the parents' wishes and the infant's clinical conditions at birth.
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Affiliation(s)
- Maria Serenella Pignotti
- Neonatal Medicine, A. Meyer Children's Hospital, University of Florence, via Luca Giordano 13, 50132 Firenze, Italy.
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Pignotti MS, Scarselli G, Barberi I, Barni M, Bevilacqua G, Branconi F, Bucci G, Campogrande M, Curiel P, Di Iorio R, Di Renzo GC, Di Tommaso M, Moscarini M, Norelli GA, Pagni A, Panti A, Pela I, Rondini G, Saggese G, Salvioli G, Scarano E, Donzelli G. Perinatal care at an extremely low gestational age (22-25 weeks). An Italian approach: the "Carta di Firenze". Arch Dis Child Fetal Neonatal Ed 2007; 92:F515-6. [PMID: 17951554 PMCID: PMC2675411 DOI: 10.1136/adc.2007.119446] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2007] [Indexed: 11/03/2022]
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Pignotti MS, Toraldo di Francia M, Donzelli G. [Intensive care at extremely low gestational age: ethical issues and treatment choices]. Pediatr Med Chir 2007; 29:84-93. [PMID: 17461095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
With the continuing progress of obstetrical and neonatal care, the limit of human viability has continued to shift towards younger gestational ages. The survival rate as well as the survival without disability increases with each additional week of gestation but, for infants born from 22 to 25 w GA, it is still really low, and the threshold of human viability appears to be limited to the physiological development of the lungs, which take place around the 23rd-24th w GA. At present, the care of such infants, born at the threshold of human viability, presents a variety of complex medical, social, and economical decisions assuming the characteristics of ethical decisions in that the limits between benefits and disadvantages is not so clearcut. What is the true infant's best interest is far to be understood and concern about the ethical basis of providing such intensive care is arising in the scientific community. In this paper the authors provide a review of the ethical basis of decisions related to the care of such infants: to treat, not to treat, intensive or compassionate care, withhold or withdraw treatment.
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Affiliation(s)
- M S Pignotti
- Neonatal Medicine, Anna Meyer Children's Hospital, Firenze.
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Pignotti MS, Catarzi S, Donzelli G. A 4-year survey on palivizumab respiratory syncytial virus (RSV)-prophylaxis: how can compliance be improved? J Matern Fetal Neonatal Med 2006; 19:221-4. [PMID: 16854695 DOI: 10.1080/14767050600591290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify compliance-influencing factors and to suggest strategies for overcoming barriers in a preventive medicine program. METHODS A survey was conducted to evaluate compliance in children receiving palivizumab prophylaxis for respiratory syncytial virus (RSV) infections. Demographics, neonatal variables, and parental attitudes capable of influencing the outcome of prophylaxis were studied in 216 children over a four-year period. RESULTS The overall compliance rate with all recommended doses of palivizumab was 87%. Among the neonatal characteristics, low birth weight and a younger age at the beginning of the program were significantly associated with good compliance (p < 0.05). The strongest factor influencing poor compliance was being foreign-born or a non-native speaker (p < 0.01). CONCLUSIONS Compliance to RSV infection prophylaxis is reduced in infants born to foreign-born or non-native speakers. In order to enhance compliance, parents should be provided with adequate information in their own language explaining the advantages of the palivizumab prophylaxis program for RSV infections.
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Affiliation(s)
- Maria Serenella Pignotti
- Neonatal Medicine, Anna Meyer Children's Hospital, University of Florence, Via L. Giordano 13, 50132 Florence, Italy.
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Affiliation(s)
- Maria Serenella Pignotti
- Department of Paediatrics, Anna Meyer Children's Hospital, Via L Giordano 13, 50132 Florence, Italy.
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Abstract
We describe a case of bilateral parenchymal consolidation with sudden respiratory distress in a preterm baby as a complication of peripherally inserted central catheter (PICC) dislocation. The X-rays showed bilateral pulmonary consolidation with the catheter tip initially located in the right, and later in the left pulmonary artery. The catheter was withdrawn. As soon as the catheter was repositioned all clinical signs and symptoms disappeared. Neonatologists should consider the possibility of dramatic respiratory distress deriving from PICC dislocation. Careful tip catheter placement and conscientious monitoring may reduce morbidity.
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Affiliation(s)
- Maria Serenella Pignotti
- Department of Pediatrics, Neonatal Intensive Care Unit, Meyer Children's Hospital, University of Florence, Florence, Italy.
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Indolfi G, Pignotti MS, Piumelli R, Donzelli G. The sudden infant death syndrome dilemma: a challenge. J Matern Fetal Neonatal Med 2004; 16 Suppl 2:33-5. [PMID: 15590432 DOI: 10.1080/14767050410001727161] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- G Indolfi
- Neonatal Intensive Care Unit, A. Meyer Children's Hospital, Department of Pediatrics, University of Florence, Florence, Italy
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Indolfi G, Pignotti MS, Piumelli R, Donzelli G. The sudden infant death syndrome dilemma: a challenge. J Matern Fetal Neonatal Med 2004. [DOI: 10.1080/jmf.16.2.33.35] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- G Indolfi
- Neonatal Intensive Care Unit, A. Meyer Children's Hospital, Department of Pediatrics University of Florence Florence Italy
| | - MS Pignotti
- Neonatal Intensive Care Unit, A. Meyer Children's Hospital, Department of Pediatrics University of Florence Florence Italy
| | - R Piumelli
- Neonatal Intensive Care Unit, A. Meyer Children's Hospital, Department of Pediatrics University of Florence Florence Italy
| | - G Donzelli
- Neonatal Intensive Care Unit, A. Meyer Children's Hospital, Department of Pediatrics University of Florence Florence Italy
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Affiliation(s)
- Maria Serenella Pignotti
- Neonatal Intensive Care Unit, Anna Meyer Children's Hospital, via Luca Giordano 13, 50132 Firenze, Italy.
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Villa MP, Brunetti L, Bruni O, Cirignotta F, Cozza P, Donzelli G, Ferini Strambi L, Levrini L, Mondini S, Nespoli L, Nosetti L, Pagani J, Zucconi M. [Guidelines for the diagnosis of childhood obstructive sleep apnea syndrome]. Minerva Pediatr 2004; 56:239-53. [PMID: 15252374] [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: 04/30/2023]
Affiliation(s)
- M P Villa
- Gruppo di Studio interdisciplinare disturbi respiratori nel sonno, Società Italiana di Pediatria, Rome, Italy.
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Abstract
An 840 g infant developed a rapid onset of shock-like symptoms. Pericardial and pleural effusions from an indwelling central catheter were diagnosed via echocardiography. A thoracentesis was promptly performed with immediate clinical improvement. The fluid withdrawn from the pleural space was analysed as hyperalimentation. The infant survived because of early diagnosis and aggressive therapeutic intervention. A pericardial effusion should be drained if there is cardiovascular compromise and because pericardiocentesis represents a high risk technique, attempts should be made to rectify the extravasation via thoracentesis.
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Affiliation(s)
- Maria Serenella Pignotti
- Department of Neonatology and Neonatal Intensive Care, Anna Meyer, Children's Hospital, University of Florence, Florence, Italy.
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