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Piastra M, Tempera A, De Carolis MP, Pezza L, Genovese O, Benassi C, Morena TC, Picconi E, Zito G, De Rosa G, Conti G, De Luca D. Neonatal Life-Threatening Nonoliguric Hyperkalemia Under Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2021; 11:238-241. [PMID: 34619071 DOI: 10.1089/ther.2021.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To illustrate our experience with two cases of neonatal life-threatening hyperkalemia during therapeutic hypothermia (TH) despite a normal acid-base status, urine output, and preserved renal function. Clinical cases are presented from Pediatric Intensive Care Unit (PICU) admission to the onset of the hyperkalemia, with related complications and after resolution. Similar cases were not retrieved from a critical review of pertinent literature. Severe hyperkalemia pathophysiology and risk factors have been debated. Two full-term adequate for weight female neonates were admitted to PICU because of perinatal asphyxia who underwent TH. Prenatal history was completely uneventful, nor hereditary genetic conditions were reported; moreover, long-term follow-up ruled out any metabolic or renal disease. Despite an accurate evaluation of previous clinical series and literature on TH and perinatal asphyxia, these hyperkalemic episodes remain unexplained. The hypoxic-ischemic insult may affect multiple organs, mainly central nervous system, heart, lung, and kidneys; acute muscle breakdown and consequent rising of myoglobin may also have a precipitating role in acute kidney failure (AKF) and hyperkalemia. Electrolyte imbalance is a possible finding as a consequence of combined cell injury and AKF. In contrast, an isolated severe hyperkalemia is exceedingly rare in nonoliguric neonates.
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Affiliation(s)
- Marco Piastra
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Alessia Tempera
- Neonatal Intensive Care Unit, Maternal-Fetal Department, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Maria Pia De Carolis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucilla Pezza
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Orazio Genovese
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Benassi
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tony C Morena
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enzo Picconi
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Gabriella De Rosa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Centre Antoine Beclere, Paris-Saclay University Hospitals APHP, Paris, Ile-de France, France.,Physiopathology and Therapeutic Innovation Unit INSERUM U999 Paris, Université Paris-Saclay APHP, Ile-de France, France
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Bersani I, De Carolis S, Foell D, Weinhage T, Garufi C, De Carolis MP, Rossi ED, Casella G, Rubortone SA, Speer CP. Impact of chorioamnionitis on maternal and fetal levels of proinflammatory S100A12. Eur J Pediatr 2021; 180:39-45. [PMID: 32514673 DOI: 10.1007/s00431-020-03695-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 11/26/2022]
Abstract
Histologic chorioamnionitis (HCA) may lead to the fetal inflammatory response syndrome (FIRS). The aim of this pilot study was to evaluate S100A12, a marker of innate immune activation, in mothers with or without HCA and in their infants. Concentrations of S100A12, interleukin 6 (IL-6), and C-reactive protein (CRP) were evaluated in maternal, cord, and neonatal blood of very preterm infants. Histologic examinations of the placenta and umbilical cords were performed. The 48 mother-neonate pairs enrolled were subdivided into two groups: HCA group (N = 15) and control group without HCA (N = 33). Maternal S100A12 levels were similar between HCA and control group. Similarly, S100A12 concentrations in cord and neonatal blood did not differ between the groups. However, high S100A12 concentrations were detected in cord and neonatal blood of two out of three neonates exposed to HCA associated with advanced funisitis. Concentrations of IL-6 and CRP were higher in maternal blood of the HCA group compared with controls (p < 0.05, p < 0.001; respectively), but no differences in cord or neonatal blood was found.Conclusion:S100A12 did neither identify mothers with HCA nor very preterm infants exposed to HCA. It is currently unknown if S100A12 may identify neonates with FIRS. What is known: • Histologic chorioamnionitis (HCA) may lead to the fetal inflammatory response syndrome (FIRS). • S100A12 represents an early, sensitive, and specific diagnostic marker of inflammatory processes. What is new: • S100A12 did neither identify mothers with HCA nor very preterm infants exposed to HCA. • It is currently still unclear if S100A12 has a potential in identifying preterm infants with FIRS.
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Affiliation(s)
- Iliana Bersani
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Sara De Carolis
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - Toni Weinhage
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - Cristina Garufi
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza University of Rome, Rome, Italy
| | - Maria Pia De Carolis
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giovanna Casella
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Serena Antonia Rubortone
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
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Costa S, De Carolis MP, Iannotta R, Pinna G, Tiberi E, Patti ML, Vento G. Staphylococcal scalded-skin syndrome in preterm infants: A case report. Australas J Dermatol 2020; 62:e129-e130. [PMID: 32656763 DOI: 10.1111/ajd.13396] [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] [Received: 05/04/2020] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Simonetta Costa
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Pia De Carolis
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Rossella Iannotta
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Pinna
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Eloisa Tiberi
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Letizia Patti
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Vento
- Division of Neonatology, Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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De Carolis S, Garufi C, Garufi E, De Carolis MP, Botta A, Tabacco S, Salvi S. Autoimmune Congenital Heart Block: A Review of Biomarkers and Management of Pregnancy. Front Pediatr 2020; 8:607515. [PMID: 33415090 PMCID: PMC7784711 DOI: 10.3389/fped.2020.607515] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
Autoimmune Congenital Heart Block (CHB) is an immune-mediated disease due to transplacental passage of circulating anti-Ro/SSA and anti-La/SSB autoantibodies. It occurs in 2% of anti-Ro/SSA-exposed pregnancies, and recurrence rate is nine times higher in subsequent pregnancies. Aim of this review is to identify biomarkers of CHB and treatment strategies. The Ro-system is constituted by two polypeptides targeted by the anti-Ro52 and anti-Ro60 autoantibodies. The central portion of Ro52 (p200), more than the full amino-acid sequence of Ro-52, is recognized to be the fine specificity of anti-Ro associated to the highest risk of cardiac damage. If anti-p200 antibody should be tested, as biomarker of CHB, over standard commercial ELISAs is still debated. Recent studies indicate that type I-Interferon (IFN) can activate fibroblasts in fetal heart. In the mother the anti-Ro/La antibodies activate the type I IFN-signature, and maternal IFN-regulated genes correlate with a similar neonatal IFN-gene expression. Evaluation of maternal IFN-signature could be used as novel biomarker of CHB. The measurement of "mechanical" PR interval with weekly fetal echocardiogram (ECHO) from 16 to at least 24 weeks of gestation is strongly recommended for CHB prenatal diagnosis. However, ECHO screening presents some limitations due to difficult identification of first-degree block and possible occurrence of a complete block from a normal rhythm in few days. Maternal administration of Hydroxychloroquine from the tenth week of gestation, modulating toll-like receptor and autoantibody-dependent type I IFN activation on the fetus, has an important role in preventing CHB in pregnant women with high risk for recurrent CHB.
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Affiliation(s)
- Sara De Carolis
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Department of Obstetrics, Gynaecology and Pediatrics, Rome, Italy
| | - Cristina Garufi
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, UOC Reumatologia, Sapienza University of Rome, Rome, Italy
| | - Ester Garufi
- Medical School, University of Florence, Florence, Italy
| | - Maria Pia De Carolis
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Department of Obstetrics, Gynaecology and Pediatrics, Rome, Italy
| | - Angela Botta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Department of Obstetrics, Gynaecology and Pediatrics, Rome, Italy
| | - Sara Tabacco
- Department of Gynecological Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Salvi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Department of Obstetrics, Gynaecology and Pediatrics, Rome, Italy
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De Carolis MP, Casella G, Serafino E, Pinna G, Cocca C, De Carolis S. Delivery room interventions to improve the stabilization of extremely-low-birth-weight infants. J Matern Fetal Neonatal Med 2019; 34:1925-1931. [PMID: 31394952 DOI: 10.1080/14767058.2019.1651278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To retrospectively verify whether the positioning of the umbilical venous catheter (UVC) in the delivery room (DR) and the early start of the preheated infusion of 10% glucose solution conditioned temperature and glycemia values of ELBW neonates in the first hours of life. METHODS Neonates (N = 137) were divided into two groups on the basis of timing of positioning of the UVC. In Group I the UVC was placed in DR, while in Group II after Neonatal Intensive Care Unit (NICU) admission. Data were assessed in different times: body temperature at neonatal admission to NICU (T1); after 2 hours (T2); then, every 2 hours until normothermia; glycemia value at NICU admission, every 1-2 hours in the first 12 hours, every 4 hours from 12 to 24 hours, and every 6-12 hours until normalization. Time slot childbirth was also detected since only in the morning shift there was a dedicated resuscitation team always present in DR, while during the afternoon and night it was available on-call. Preventive measures to limit heat dispersion were adopted in both Groups. RESULTS In Group I respect to Group II, both at T1 and T2: (a) the rate of normothermic neonates was higher and (b) the rate of neonates with moderate hypothermia was lower. The hourly temperature increase was similar between the groups and the time needed to reach normothermia was significantly lower in Group I than in Group II. Glycemic values at T1 were lower in Group II. In Group II, after UVC positioning and glucose solution administration, the 42.2% of infants immediately brought glycemia back to normal, while the 57.8% needed specific treatment. The majority of newborns of Group I was born during the morning shift. CONCLUSIONS The early UVC placement by a dedicated interdisciplinary team is a relevant intervention to carry out during the "Golden minutes" to improve the ELBW stabilization soon after birth.
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Affiliation(s)
- Maria Pia De Carolis
- Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanna Casella
- Department of Obstetrics and Gynecology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Erika Serafino
- Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Pinna
- Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmen Cocca
- Department of Pediatrics, Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Sara De Carolis
- Department of Obstetrics and Gynecology, Policlinico Universitario Agostino Gemelli, Rome, Italy
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De Carolis MP, Muzii U, Romagnoli C, Zuppa AA, Zecca E, Tortorolo G. Phenobarbital for Treatment of Seizures in Preterm Infant:
A New Administration Scheme. ACTA ACUST UNITED AC 2019. [DOI: 10.1159/000480923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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De Carolis MP, Romagnoli C, Muzii U, Tortorolo G, Chiarotti M, De Giovanni N, Carnevale A. Pharmacokinetic Aspects of Caffeine in Premature Infants. ACTA ACUST UNITED AC 2019. [DOI: 10.1159/000480570] [Citation(s) in RCA: 13] [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: 11/19/2022]
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De Rosa G, De Carolis MP, Tempera A, Pedicelli A, Rollo M, Morena TC, Luca E, De Luca D, Conti G, Piastra M. Outcome of Neonates with Vein of Galen Malformation Presenting with Severe Heart Failure: A Case Series. Am J Perinatol 2019; 36:169-175. [PMID: 29991070 DOI: 10.1055/s-0038-1666813] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 10/28/2022]
Abstract
BACKGROUND Neonatal presentation of vein of Galen aneurysmal malformations (VGAMs) complicated by cardiac failure and pulmonary hypertension is frequently associated with a poor prognosis. Interventional neuroradiology with embolization can offer a chance for survival, although neurological damage can represent a limitation. OBJECTIVE This article determines if aggressive intensive care and drug management of cardiac failure before urgent embolization can influence morbidity and mortality. PATIENTS AND METHODS Twelve infants (7 boys, 5 girls) were diagnosed with symptomatic vein of Galen malformations in the neonatal period during the period 2000 to 2014. Due to high output cardiac failure, endovascular treatment was attempted as soon as stabilization was achieved. RESULTS Endovascular procedures successfully reverted cardiac failure in 5 patients who survived without significant neurological damage, while in 7 patients the causes of death were refractory cardiac failure, multiorgan failure, and severe brain damage. Bidimensional echocardiography assessment was performed at presentation and after early embolization procedures. CONCLUSION Aggressive intensive care approach to heart failure and pulmonary hypertension leading to early neurointervention results in good survival rates with low morbidity even in cases of high-risk neonatal VGAM. Combined hemodynamic treatment can improve outcome in neonates with cardiac failure secondary to VGAM, although there is the risk of precipitating systemic hypoperfusion and renal failure. A moderate prematurity may not prevent both interventional approach and good outcome.
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Affiliation(s)
- Gabriella De Rosa
- Department of Paediatric Cardiology, Catholic University "A. Gemelli" Hospital, Rome, Italy
| | - Maria Pia De Carolis
- Neonatal Intensive Care Unit, Catholic University "A. Gemelli" Hospital, Rome, Italy
| | - Alessia Tempera
- Neonatal Intensive Care Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Alessandro Pedicelli
- Department of Neuroradiology, Catholic University "A. Gemelli" Hospital, Rome, Italy
| | - Massimo Rollo
- Department of Neuroradiology, Catholic University "A. Gemelli" Hospital, Rome, Italy
| | - Tony Christian Morena
- Paediatric Intensive Care Unit, Catholic University "A. Gemelli" Hospital, Rome, Italy
| | - Ersilia Luca
- Paediatric Intensive Care Unit, Catholic University "A. Gemelli" Hospital, Rome, Italy
| | - Daniele De Luca
- Neonatal Intensive Care Unit, Paris-Sud University Hospital, Paris, France
| | - Giorgio Conti
- Paediatric Intensive Care Unit, Catholic University "A. Gemelli" Hospital, Rome, Italy
| | - Marco Piastra
- Paediatric Intensive Care Unit, Catholic University "A. Gemelli" Hospital, Rome, Italy
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Romeo DM, Bompard S, Cocca C, Serrao F, De Carolis MP, Zuppa AA, Ricci D, Gallini F, Maddaloni C, Romagnoli C, Mercuri E. Neonatal neurological examination during the first 6h after birth. Early Hum Dev 2017; 108:41-44. [PMID: 28390243 DOI: 10.1016/j.earlhumdev.2017.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/21/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few neurological assessments are easily performed during the first 6h after birth. AIMS To assess a cohort of low risk term born newborns within the first 6h and at 48h after birth using the Hammersmith Neonatal Neurological Examination. STUDY DESIGN AND SUBJECTS A population of low risk term born newborns was examined within 3h from birth or between 3 and 6h. Each infant was re-assessed at 48h, establishing the range and frequency distribution of neonatal neurological scores at each time point. RESULTS Of the 124 full-term born newborns, 62 were assessed at 0-3h and 62 at 3-6h. All infants were re-assessed at 48h. For 23/34 of the neurological items, the range and median scores were similar across the 3 time points. In the remaining 11 items the three groups had a similar range of scores but the median scores were different with different rates of changes. In 6 of the 11 the median scores at 3-6h were similar to those observed at 48h but they appeared to be 'less mature' at 0-3h. Only in one item the median scores were consistently different at the 3 time points. CONCLUSIONS Our results suggest that a neurological examination can already be reliably performed soon after birth. These findings will help in the interpretation of the few items that show changes with increasing postnatal age.
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Affiliation(s)
| | - Sarah Bompard
- Pediatric Neurology Unit, Catholic University, Rome, Italy
| | | | | | | | | | - Daniela Ricci
- Pediatric Neurology Unit, Catholic University, Rome, Italy; National Centre of Services and Research for Prevention of Blindness and Rehabilitation of Visually Impaired, Italy
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De Carolis MP, Cocca C, Cota F, Pinna G, Rubortone SA, Romagnoli C, Mirabile L, Serio P. Double Tracheoesophageal Fistula and Azygos Lobe. Pediatr Neonatol 2016; 57:546-547. [PMID: 27251121 DOI: 10.1016/j.pedneo.2016.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/03/2016] [Accepted: 02/12/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Maria Pia De Carolis
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy.
| | - Carmen Cocca
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Cota
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Pinna
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Serena Antonia Rubortone
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Costantino Romagnoli
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Lorenzo Mirabile
- Intensive Care Unit, Children's Hospital "A. Meyer", University of Florence, Florence, Italy
| | - Paola Serio
- Intensive Care Unit, Children's Hospital "A. Meyer", University of Florence, Florence, Italy
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Frezza S, Gallini F, Palazzo R, Carollo M, De Carolis MP, D'Andrea V, Catenazzi P, Romagnoli C, Ausiello CM. T-cell polarization: Potential serological markers in preterm and term infants. Early Hum Dev 2016; 101:69-71. [PMID: 27416057 DOI: 10.1016/j.earlhumdev.2016.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/28/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The immaturity of immune system characterizes newborn infants. Possible serological markers of Th1 and Th2 immune response are the lymphocyte activation gene-3 (CD223) and soluble CD30, respectively (sCD30). AIMS The aim of our study was to evaluate the relationship between Th1 and Th2 immune response and gestational age (GA), comparing data in preterm and term neonates. STUDY DESIGN Cord blood from 20 preterm (GA: 33±2weeks, BW 1950±490g) and 20 term infants (GA: 38±1weeks, BW: 3177±330g) were tested for sCD30 and CD223 levels by ELISA. IFNγ levels produced by cord blood lymphocytes were also analyzed, both before and after stimulation with phytohaemagglutinin (PHA). RESULTS sCD30 resulted significantly higher in preterm neonates when compared with term neonates (60±7.6 vs 42.6±3.9U/ml p<0.05). CD223 was undetectable in preterm neonates while resulting at a level of 176.1±112.6ng/ml in term neonates. After stimulation with PHA, a significant increase in IFNγ levels was only observed in term neonates (326.6±72.7pg/ml p<0.05). CONCLUSIONS Our findings show that sCD30 is present and measurable in term and preterm infants, while CD223 is detectable only in term infants and that Th-cell polarization could also depend on gestational age. Our data suggest that a Th2 immune response seems predominant in preterm neonates.
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Affiliation(s)
- Simonetta Frezza
- Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Francesca Gallini
- Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Raffaella Palazzo
- Department of Infectious, Parasitic and Immune-Mediate Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Carollo
- Department of Infectious, Parasitic and Immune-Mediate Disease, Istituto Superiore di Sanità, Rome, Italy
| | | | - Vito D'Andrea
- Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Piero Catenazzi
- Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy.
| | | | - Clara Maria Ausiello
- Department of Infectious, Parasitic and Immune-Mediate Disease, Istituto Superiore di Sanità, Rome, Italy
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De Carolis MP, Salvi S, Bersani I, Lacerenza S, Romagnoli C, De Carolis S. Fetal hypoxia secondary to severe maternal anemia as a causative link between blueberry muffin baby and erythroblastosis: a case report. J Med Case Rep 2016; 10:155. [PMID: 27291942 PMCID: PMC4904358 DOI: 10.1186/s13256-016-0924-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background Neonatal blueberry muffin lesions are rare cutaneous eruptions, presenting as transient, non-blanching, red-violaceous papules, mostly localized in the trunk, head and neck, attributable to a marked dermal hematopoietic activity. Congenital infections of the TORCH complex (toxoplasmosis, other, rubella, cytomegalovirus and herpes) and hematological disorders have been classically associated with this neonatal dermatological manifestation. We report for the first time an unusual presentation of blueberry muffin lesions in a neonate born from a mother affected by severe anemia during pregnancy. Case presentation A male, white Caucasian, neonate showed a cutaneous rash at birth, suggestive of “blueberry muffin”-like lesions. These cutaneous lesions were associated with marked elevation of the circulating nucleated red blood cells, and with ultrasound findings of peculiar brain ischemic porencephalic lesions. The clinical features of spontaneous disappearance and the association with marked erythroblastosis strongly suggest that these dermatological findings may be the consequence of an extramedullary hematopoiesis unexpectedly evoked by the intrauterine chronic exposure to hypoxia caused by severe maternal anemia. Conclusions In conclusion, fetal hypoxia secondary to severe maternal anemia may play a causative and unreported role in the development of neonatal blueberry muffin lesions.
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Affiliation(s)
- Maria Pia De Carolis
- Division of Neonatology, Department of Obstetrics, Gynaecology and Paediatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Salvi
- High Risk Pregnancies Unit, Department of Obstetrics, Gynaecology and Paediatrics, Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy.
| | - Iliana Bersani
- Division of Neonatology, Department of Obstetrics, Gynaecology and Paediatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - Serafina Lacerenza
- Division of Neonatology, Department of Obstetrics, Gynaecology and Paediatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - Costantino Romagnoli
- Division of Neonatology, Department of Obstetrics, Gynaecology and Paediatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - Sara De Carolis
- High Risk Pregnancies Unit, Department of Obstetrics, Gynaecology and Paediatrics, Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
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Bersani I, De Carolis MP, Foell D, Weinhage T, Rossi ED, De Carolis S, Rubortone SA, Romagnoli C, Speer CP. Interleukin-22: biomarker of maternal and fetal inflammation? Immunol Res 2015; 61:4-10. [PMID: 25407645 DOI: 10.1007/s12026-014-8568-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 12/22/2022]
Abstract
Histologic chorioamnionitis (HCA) is an intrauterine status of inflammation which may lead to the fetal inflammatory response syndrome. Inflammation is a pathogenetic mechanism also of preeclampsia, although not of microbial origin. The aim of the present pilot study was to evaluate the pattern of inflammatory cytokines in mothers and high-risk preterm infants during the perinatal period. Concentrations of proinflammatory and anti-inflammatory cytokines and C-reactive protein were evaluated in maternal, cord, and neonatal blood of very preterm infants <1,500 g birth weight. Histologic examinations of placentae and umbilical cords were performed. The 65 mother-neonate pairs enrolled were subdivided into three groups: (1) HCA group (n = 15), (2) preeclampsia group (n = 17), and (3) control group, in the absence of HCA/preeclampsia (n = 33). Maternal Interleukin (IL)-6 levels were significantly higher in women of the HCA group compared with the preeclampsia and control groups (p < 0.05). IL-22 was detected in nearly all maternal samples [median value 693.115 pg/ml (599.91-809.91 pg/ml)], with no statistical difference between the groups, but with a tendency to increased levels among preeclamptic women. Increased concentrations of IL-22 were detected in cord blood of neonates exposed to preeclampsia, compared with controls and infants exposed to HCA (p < 0.05). We speculate that the tendentially higher concentrations of IL-22 in preeclamptic mothers and the significantly higher concentrations in cord blood may reflect placental dysfunction and the underlying reparative processes at the maternal-fetal interface. Therefore, IL-22 could be an important biomarker of inflammation in preeclampsia.
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Affiliation(s)
- Iliana Bersani
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
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Affiliation(s)
- Silvia Salvi
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Sara De Carolis
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Serafina Garofalo
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Gelsomina Del Sordo
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Cristina Garufi
- University of Rome "La Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - Maria Pia De Carolis
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
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De Carolis MP, Cocca C, Valente E, Lacerenza S, Rubortone SA, Zuppa AA, Romagnoli C. Individualized follow up programme and early discharge in term neonates. Ital J Pediatr 2014; 40:70. [PMID: 25024007 PMCID: PMC4223512 DOI: 10.1186/1824-7288-40-70] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/30/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Early discharge of mother/neonate dyad has become a common practice, and its effects are measured by readmission rates. We evaluated the safety of early discharge followed by an individualized Follow-up programme and the efficacy in promoting breastfeeding initiation and duration. METHODS During a nine-month period early discharge followed by an early targeted Follow-up was carried out in term neonates in the absence of weight loss <10% or hyperbilirubinaemia at risk of treatment. Follow-up visits were performed at different timepoints with a specific flow-chart according to both bilirubin levels and weight loss at discharge. RESULTS During the study period early discharge was performed in 419 neonates and Follow-up was carried out in 408 neonates (97.4%). No neonates required readmission for hyperbilirubinaemia and dehydration during the first 28 days of life. Breastfeeding rate was 90.6%, 75.2%, 41.5% at 30, 90 and 180 days of life, respectively. A six-month phone interview was performed for 383 neonates (93.8%) and satisfaction of parents about early discharge was high in 345 cases (90.1%). CONCLUSIONS Early discharge in association with an individualized Follow-up programme resulted safe for the neonate and effective for breastfeeding initation and duration.
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Affiliation(s)
- Maria Pia De Carolis
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Carmen Cocca
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Elisabetta Valente
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Serafina Lacerenza
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Serena Antonia Rubortone
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Antonio Alberto Zuppa
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Costantino Romagnoli
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
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Occhipinti F, De Carolis MP, De Rosa G, Bersani I, Lacerenza S, Cota F, Rubortone SA, Romagnoli C. Correlation analysis between echocardiographic flow pattern and N-terminal-pro-brain natriuretic peptide for early targeted treatment of patent ductus arteriosus. J Matern Fetal Neonatal Med 2014; 27:1800-4. [DOI: 10.3109/14767058.2014.880879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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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De Carolis S, Salvi S, Botta A, Garofalo S, Garufi C, Ferrazzani S, De Carolis MP. The impact of primary Sjogren's syndrome on pregnancy outcome: Our series and review of the literature. Autoimmun Rev 2014; 13:103-7. [DOI: 10.1016/j.autrev.2013.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/01/2013] [Indexed: 10/26/2022]
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Piastra M, Briganti V, Luca E, De Carolis MP, Domenico P, Conti G, Stival E, Tempera A, Calisti A, Serio P. Recurrent tracheoesophageal fistula and respiratory failure: the role of early airway endoscopic approach. Eur J Pediatr Surg 2013; 23:153-6. [PMID: 22782321 DOI: 10.1055/s-0032-1315805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marco Piastra
- Department of Emergency, Pediatric Intensive Care Unit, Catholic University of the Sacred Heart, Rome, Italy
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De Carolis MP, Rubortone SA, Bersani I, Lacerenza S, Cota F, Garufi C, Romagnoli C. Heat loss prevention in the delivery room in term and preterm infants. Turk J Pediatr 2013; 55:63-68. [PMID: 23692834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study was conducted to determine whether or not simultaneous use of additional measures to prevent heat loss and efficient training of caregivers influenced the incidence of hypothermia at birth. Two cohorts of term/late-preterm and preterm infants were compared before (Group IA and IB) and after (Group IIA and IIB) the introduction of additional measures and a specific training of caregivers. In term/late-preterm neonates of Group IIA, admission temperature was higher (36.3°C vs 36°C; p<0.001) and incidence of hypothermia lower (61.2% vs 81.0%; p<0.001) compared to Group IA, with reduction of moderate hypothermia (8.8% vs 27.3%; p<0.001). Among preterm neonates, admission temperature was higher (36.0°C vs 35.5°C; p<0.001) and incidence of hypothermia lower (68.1% vs 92.3%; p<0.001) during the second period, when no cases of severe hypothermia and reduction of moderate forms were observed (42.5% vs 70.7%; p<0.001). Additional interventions to prevent hypothermia and caregivers' training were effective in preventing hypothermia.
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De Carolis MP, Bersani I, Piersigilli F, Rubortone SA, Occhipinti F, Lacerenza S, Romagnoli C. Peripheral nerve blockade and neonatal limb ischemia: our experience and literature review. Clin Appl Thromb Hemost 2012; 20:55-60. [PMID: 22952214 DOI: 10.1177/1076029612458968] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Considering the high frequency of bleeding complications following fibrinolytic treatment in neonates, peripheral nerve blockade (PNB) has been proposed alone or in association with lower doses of tissue plasminogen activator, as a possible new therapeutic approach in the management of neonatal limb ischemia (LI) secondary to vasospasm and/or thrombosis. The present article provides a review of the current knowledge about the topic, in order to evaluate the efficacy and safety of this therapeutic approach. According to the few case reports documented in literature and to our experience, PNB could be considered as valid procedure for the treatment of LI, especially during neonatal period, when the risk of serious bleeding associated with fibrinolytic or anticoagulant therapy is higher. Peripheral nerve blockade resulted in a safe and effective procedure for the treatment of neonatal vascular spasm and thrombosis.
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Affiliation(s)
- Maria Pia De Carolis
- 1Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
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De Carolis MP, Rubortone SA, Romano V, De Carolis D, De Carolis S. An interlabial mass. Arch Dis Child Fetal Neonatal Ed 2012; 97:F376. [PMID: 22933098 DOI: 10.1136/fetalneonatal-2011-300655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rubortone SA, De Carolis MP, Lacerenza S, Bersani I, Occhipinti F, Romagnoli C. Use of a combined SpO₂/PtcCO₂ sensor in the delivery room. Sensors (Basel) 2012; 12:10980-9. [PMID: 23112642 PMCID: PMC3472870 DOI: 10.3390/s120810980] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/16/2012] [Accepted: 07/31/2012] [Indexed: 11/16/2022]
Abstract
Arterial oxygen saturation (SaO2) and partial arterial pressure of carbon dioxide (PaCO2) are important respiratory parameters in critically ill neonates. A sensor combining a pulse oximeter with the Stow-Severinghaus electrode, required for the measurement of peripheral oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (PtcCO2), respectively, has been recently used in neonatal clinical practice (TOSCA500ÒRadiometer). We evaluated TOSCA usability and reliability in the delivery room (DR), throughout three different periods, on term, late-preterm, and preterm neonates. During the first period (period A), 30 healthy term neonates were simultaneously monitored with both TOSCA and a MASIMO pulse oximeter. During the second period (period B), 10 healthy late-preterm neonates were monitored with both TOSCA and a transcutaneous device measuring PtcCO2 (TINAÒ TCM3, Radiometer). During the third period (period C), 15 preterm neonates were monitored with TOSCA and MASIMO after birth, during stabilization, and during transport to the neonatal intensive care unit (NICU). Blood gas analyses were performed to compare transcutaneous and blood gas values. TOSCA resulted easily and safely usable in the DR, allowing reliable noninvasive SaO2 estimation. Since PtcCO2 measurements with TOSCA required at least 10 min to be stable and reliable, this parameter was not useful during the early resuscitation immediately after birth. Moreover, PtcCO2 levels were less precise if compared to the conventional transcutaneous monitoring. However, PtcCO2 measurement by TOSCA was useful as trend-monitoring after stabilization and during transport to NICU.
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Affiliation(s)
- Serena Antonia Rubortone
- Division of Neonatology, Department of Paediatrics, Catholic University of Sacred Heart, Largo Gemelli 8, I-00168 Rome, Italy.
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Piastra M, De Luca D, De Carolis MP, Tempera A, Stival E, Caliandro F, Pietrini D, Conti G, De Rosa G. Nebulized iloprost and noninvasive respiratory support for impending hypoxaemic respiratory failure in formerly preterm infants: a case series. Pediatr Pulmonol 2012; 47:757-62. [PMID: 22170702 DOI: 10.1002/ppul.21619] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [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: 06/01/2011] [Accepted: 11/08/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe a series of ex-preterm infants admitted to pediatric intensive care unit due to impending hypoxaemic respiratory failure complicated by pulmonary hypertension (PH) who were treated electively combining noninvasive ventilation (NIV) and nebulized iloprost (nebILO). DESIGN Open uncontrolled observational study. SETTING Pediatric Intensive Care Unit, University Hospital. PATIENTS Ten formerly preterm infants with impending hypoxaemic respiratory failure and PH, of whom eight had moderate to severe bronchopulmonary dysplasia. MEASUREMENTS AND MAIN RESULTS Median age and body weight were 6.0 (2.75-9.50) months and 4.85 (3.32-7.07) kg, respectively. We observed a significant early oxygenation improvement in terms of PaO(2) /FiO(2) increase (P = 0.001) and respiratory rate reduction (P = 0.01). Hemodynamic also improved, as shown by heart rate (P = 0.002) and pulmonary arterial pressure systolic/systolic systemic pressure (PAPs/SSP) ratio reduction (P = 0.0137). NebILO was successfully weaned in positive response cases: 4 infants were discharged on oral sildenafil. Three patients failed noninvasive modality and needed invasive mechanical ventilation; hypoxic-hypercarbic patients were most likely to fail noninvasive approach. Only one patient requiring invasive ventilation died and surviving babies had a satisfactory 1-month post-discharge follow-up. CONCLUSIONS.: The noninvasive approach combining NIV and nebILO for ex-preterm babies with impending respiratory failure and PH resulted to be feasible and quickly achieved significant oxygenation and hemodynamic improvements.
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Affiliation(s)
- Marco Piastra
- Department of Anaesthesiology and Intensive Care, Paediatric Intensive Care Unit, University Hospital A Gemelli, Catholic University of the Sacred Heart, Rome, Italy
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De Carolis MP, Salvi S, Bersani I, De Carolis S. Isolated cerebral sinovenous thrombosis: a rare case of neonatal antiphospholipid syndrome. Indian Pediatr 2012; 49:411-412. [PMID: 22700668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We describe a case of neonatal cerebral sinovenous thrombosis associated with the presence of anti-phospholipid antibodies (aPL). We recommend that in all cases of neonatal thrombosis, the couple mother-infant should be extensively tested for the presence of both acquired (aPL) and congenital thrombophilia.
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Affiliation(s)
- Maria Pia De Carolis
- Division of Neonatology, Department of Paediatrics, Catholic University of Sacred Heart, Rome, Italy.
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De Carolis MP, Piastra M, Bersani I, Pardeo M, Stival E, Tempera A, Romagnoli C, Conti G, De Rosa G. Levosimendan in two neonates with ischemic heart failure and pulmonary hypertension. Neonatology 2012; 101:201-5. [PMID: 22067520 DOI: 10.1159/000329848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 04/26/2011] [Accepted: 06/06/2011] [Indexed: 11/19/2022]
Abstract
We report the successful and safe use of levosimendan, a new calcium-sensitizing agent with positive inotropic and vasodilatory action, in 2 critically ill term newborns with acute heart failure and pulmonary hypertension in the absence of any underlying heart malformation and/or previous cardiosurgical procedures. During the neonatal period, levosimendan may represent an ideal drug for immature myocardium characterized by a higher calcium-dependent contractility than in adults.
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Affiliation(s)
- Maria Pia De Carolis
- Neonatal ICU, Department of Pediatrics, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy. mpia.decarolis @ rm.unicatt.it
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26
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Romagnoli C, Bersani I, Rubortone SA, Lacerenza S, De Carolis MP. Current evidence on the safety profile of NSAIDs for the treatment of PDA. J Matern Fetal Neonatal Med 2011; 24 Suppl 3:10-3. [PMID: 21749302 DOI: 10.3109/14767058.2011.604987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patent ductus arteriosus (PDA) complicates the clinical course of preterm infants. Nonsteroidal anti-inflammatory drugs, especially Indomethacin and Ibuprofen, have been widely used for both prevention and treatment of PDA. Short-term efficacy of Indomethacin or Ibuprofen is equivalent, while Ibuprofen results show a higher safety profile. Ibuprofen is associated with fewer clinical gastrointestinal and renal side effects with respect to Indomethacin even if subclinical potential effects are reported. When administered as prophylaxis, Ibuprofen has no effects on prevention of intraventricular haemorrhage unlike Indomethacin. Considering the potential adverse effects of both these drugs, a careful monitoring during and after the treatment period is highly recommended.
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Affiliation(s)
- Costantino Romagnoli
- Department of Paediatrics and Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy.
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De Carolis MP, Bersani I, De Rosa G, Cota F, Romagnoli C. Ibuprofen Lysinate and sodium ibuprofen for prophylaxis of patent ductus arteriosus in preterm neonates. Indian Pediatr 2011; 49:47-9. [DOI: 10.1007/s13312-012-0006-8] [Citation(s) in RCA: 4] [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] [Received: 01/12/2011] [Accepted: 03/28/2011] [Indexed: 11/29/2022]
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Ferrazzani S, Luciano R, Garofalo S, D'Andrea V, De Carolis S, De Carolis MP, Paolucci V, Romagnoli C, Caruso A. Neonatal outcome in hypertensive disorders of pregnancy. Early Hum Dev 2011; 87:445-9. [PMID: 21497462 DOI: 10.1016/j.earlhumdev.2011.03.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [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: 11/30/2010] [Revised: 03/08/2011] [Accepted: 03/17/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertensive disorders in pregnancy account for increased perinatal morbidity and mortality when compared to uneventful gestations. AIMS To analyze perinatal outcome of pregnancies complicated by different kinds of hypertension to uncomplicated pregnancies in a series of Italian women and to compare our data with series from other countries. STUDY DESIGN The sample was divided into four groups of hypertensive women: chronic hypertension (CH), gestational hypertension (GH), preeclampsia (PE), and chronic hypertension complicated by preeclampsia (CHPE). One thousand normal pregnancies served as controls. SUBJECTS Neonatal features of the offspring of 965 Italian women with hypertension in pregnancy were evaluated. MEASURES Gestational age, birthweight and the rate of small for gestational age were the outcomes. Perinatal asphyxia and mortality were also assessed. RESULTS Gestational age, the mean of birth weight and birth percentile were significantly lower in all groups with hypertensive complications when compared with controls. The rate of very early preterm delivery (<32 weeks) was 7.8% in CH, 5.9% in GH, 21.2% in PE and 37.2% in CHPE while it was to 1.2% in the control group. The rate of SGA was globally 16.2% in CH, 22.8% in GH, 50.7% in PE, 37.2% in CHPE and 5% in controls. The rate of SGA in PE was much higher than reported in series from other countries. CONCLUSION Comparing our data with those reported from other countries, it is evident that the rate of fetal growth restriction in PE we found in our center, is significantly higher even in the presence of a global lower incidence of PE.
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Affiliation(s)
- Sergio Ferrazzani
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Costa S, De Carolis MP, Fusco FP, Savarese I, Tesfagabir MG, Romagnoli C. Skin Ulceration in a Preterm Infant: A Warning Sign of a Percutaneous Long Line Complication. ACTA ACUST UNITED AC 2011; 147:512-4. [DOI: 10.1001/archdermatol.2011.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bersani I, De Carolis MP, Lacerenza S, De Rosa G, Fusco FP, Cota F, Romagnoli C. Is the prophylaxis of patent ductus arteriosus useful in extremely premature infants? Turk J Pediatr 2011; 53:187-193. [PMID: 21853657] [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: 05/31/2023]
Abstract
This study was aimed to verify the efficacy and safety of ibuprofen prophylaxis of patent ductus arteriosus in very preterm infants, in order to select infants receiving higher benefits from this intervention. Two hundred neonates with gestational age (GA) < or = 28 weeks receiving ibuprofen within the first two hours of life were included. Ductus closure rate was 68%, and results were significantly dependent on GA (48.8% among neonates with GA < 26 weeks vs 73.2% among those with GA > or = 26 weeks, p < 0.01). Neonates with GA < 26 weeks showed a lower ductus closure after the primary course of therapy (20% vs 57.5%, p < 0.01), as well as higher reopening rate (16.2% vs 3.8%, p < 0.05) and need for surgical ligation (38.8% vs 5.8%, p < 0.01). During the prophylaxis period, 11 neonates (5.5%) showed pulmonary hypertension. Considering risks/benefits, we recommend prophylaxis only in infants with GA < 26 weeks.
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Affiliation(s)
- Iliana Bersani
- Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
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De Rosa G, De Carolis MP, Pardeo M, Bersani I, Tempera A, De Nisco A, Caforio L, Romagnoli C, Piastra M. Neonatal Emergencies Associated with Cardiac Rhabdomyomas: An 8-Year Experience. Fetal Diagn Ther 2011; 29:169-77. [DOI: 10.1159/000320483] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 08/20/2010] [Indexed: 11/19/2022]
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De Carolis MP, Bersani I, Sindico P, Fusco FP, Costa S, Lacerenza S, Romagnoli C. Postoperative chylous ascites: increased scrotal volume as "alarm bell". Turk J Pediatr 2010; 52:645-647. [PMID: 21428199] [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: 05/30/2023]
Abstract
Chylous ascites has been reported only rarely as a possible consequence of congenital diaphragmatic hernia (CDH) surgical treatment. The present report regards a case of chylous ascites that developed after surgical treatment of CDH and was interestingly anticipated by increased scrotal volume. The aim was to alert neonatologists and pediatric surgeons about the potential usefulness of this clinical sign as a precocious "alarm bell" for chylous ascites development.
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Affiliation(s)
- Maria Pia De Carolis
- Division of Neonatology, Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy
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De Carolis MP, Bersani I, Frassanito L, Fusco FP, De Carolis S, Romagnoli C. Peripheral blockade as treatment of arm ischaemia at birth. Eur J Pediatr 2010; 169:1267-9. [PMID: 20339869 DOI: 10.1007/s00431-010-1182-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 01/28/2010] [Accepted: 02/23/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Limbs ischaemia represents a rare event during the neonatal period. The present paper reports an unusual case of precocious arm ischemia that occurred immediately after birth and successfully treated with a peripheral nerve blockade. CONCLUSIONS Peripheral nerve blockade resulted in an effective and safe therapeutic approach able to allow the salvaging of the limbs.
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Affiliation(s)
- Maria Pia De Carolis
- Division of Neonatology, Department of Paediatrics, Catholic University of Sacred Heart, Rome, Italy.
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Costa S, Maggio L, Sindico P, Cota F, De Carolis MP, Romagnoli C. Preterm small for gestational age infants are not at higher risk for parenteral nutrition-associated cholestasis. J Pediatr 2010; 156:575-9. [PMID: 20036379 DOI: 10.1016/j.jpeds.2009.10.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [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] [Received: 02/23/2009] [Revised: 09/29/2009] [Accepted: 10/28/2009] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess if being small for gestational age impacts parenteral nutrition-associated cholestasis (PNAC) development. STUDY DESIGN We reviewed all the very low-birth weight infants exposed to parenteral nutrition for >14 days from 1996 to 2006, comparing auxological and clinical data, as well as nutritional history, during the first 4 weeks of life of infants with cholestasis and control subjects. RESULTS Of 445 very low-birth weight infants, 55 had development of PNAC. Infants with cholestasis had lower birth weight and gestational age but similar birth weight z-score compared with infants without cholestasis, and they received a lower amount of enteral feeds (25.8 +/- 20.7 vs 67.9 +/- 33.0 mL/kg, P < .001), a greater amount of intravenous glucose (10.6 +/- 1.3 vs 7.5 +/- 2.5 g/kg, P < .0001), lipids (1.8 +/- 0.4 vs 1.3 +/- 0.5, P < .0001) and proteins (2.7 +/- 0.5 vs 1.9 +/- 0.7, P < .0001), and needed a higher number of days of fasting (13.2 +/- 6.7 vs 6.5 +/- 4.8, P < .001). Enteral intake between 0 and 21 days of life (OR 0.66; 95% CI 0.53, 0.81, P < .0001) and oxygen therapy (OR 1.05; 95% CI 1.01, 1.09; P = .030) were identified as the best independent predictors of PNAC. CONCLUSIONS Enteral feeding remains the main factor for the prevention of PNAC, whereas small for gestational age infants do not have a higher risk of PNAC.
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Affiliation(s)
- Simonetta Costa
- Division of Neonatology, Department of Paediatrics, Catholic University Sacred Heart, Rome, Italy.
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35
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Zuppa AA, Sindico P, Perrone S, Carducci C, Antichi E, Alighieri G, Cota F, Papacci P, De Carolis MP, Romagnoli C, Cardiello V. Different fetal-neonatal outcomes in siblings born to a mother with Graves-Basedow disease after total thyroidectomy: a case series. J Med Case Rep 2010; 4:59. [PMID: 20170485 PMCID: PMC2845141 DOI: 10.1186/1752-1947-4-59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 02/19/2010] [Indexed: 11/25/2022] Open
Abstract
Introduction We describe three different fetal or neonatal outcomes in the offspring of a mother who had persistent circulating thyrotropin receptor antibodies despite having undergone a total thyroidectomy several years before. Case presentation The three different outcomes were an intrauterine death, a mild and transient fetal and neonatal hyperthyroidism and a severe fetal and neonatal hyperthyroidism that required specific therapy. Conclusions The three cases are interesting because of the different outcomes, the absence of a direct correlation between thyrotropin receptor antibody levels and clinical signs, and the persistence of thyrotropin receptor antibodies several years after a total thyroidectomy.
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Affiliation(s)
- Antonio Alberto Zuppa
- Department of Pediatrics, Division of Neonatology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Fusco FP, Sindico P, Pia De Carolis M, Costa S, Cota F, De Rosa G, Romagnoli C. Hypertrabecular aspect of left ventricular myocardium: a possible complication of congenital hypothyroidism in a preterm infant. J Matern Fetal Neonatal Med 2010; 23:732-5. [PMID: 20121390 DOI: 10.3109/14767050903410649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a case of hypertrabeculated left ventricular myocardium associated with congenital hypothyroidism in a preterm infant. The myocardical anomalies and long QT interval, absent at birth, appeared simultaneously to abnormal thyroid hormones and progressively improved until complete recovery during Levo-Thyroxine treatment. We speculate that thyroid dysfunction could be the potential cause of transient hypertrabecular aspect of the left ventricle.
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Affiliation(s)
- Francesca Paola Fusco
- Division of Neonatology, Department of Paediatrics, Catholic University of Sacred Heart, Largo Gemelli 8, Rome, Italy
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37
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De Carolis MP, Lacerenza S, De Luca D, Bersani I, Costa S, Romagnoli C. Is neonatal antiretroviral therapy a risk factor for NEC occurrence? Turk J Pediatr 2010; 52:108-110. [PMID: 20402079] [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: 05/29/2023]
Abstract
An association between maternal human immunodeficiency virus (HIV) infection and increased necrotizing enterocolitis (NEC) risk has been reported. Viral exposure and maternal antiretroviral therapy have been described as mediators of this risk. We report a preterm patient with delayed meconium passage and subsequent NEC, in which both the above-mentioned mechanisms were excluded, suggesting that neonatal antiretroviral therapy could be the most relevant risk factor for NEC in a susceptible preterm gut.
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MESH Headings
- Anti-HIV Agents/adverse effects
- Enterocolitis, Necrotizing/chemically induced
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/physiopathology
- Female
- Gastrointestinal Transit/drug effects
- Gastrointestinal Transit/physiology
- HIV Infections/drug therapy
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/chemically induced
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/physiopathology
- Peristalsis
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Risk Factors
- Zidovudine/adverse effects
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Affiliation(s)
- Maria Pia De Carolis
- Division of Neonatology, Department of Pediatrics, University Hospital "A. Gemelli" Catholic University of the Sacred Heart, Rome, Italy
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38
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Piastra M, Pietrini D, Massimi L, Caldarelli M, De Luca D, Del Lungo LM, De Carolis MP, Di Rocco C, Conti G, Zecca E. Severe subdural hemorrhage due to minimal prenatal trauma. J Neurosurg Pediatr 2009; 4:543-6. [PMID: 19951041 DOI: 10.3171/2009.7.peds08223] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 11/06/2022]
Abstract
The authors report a case of minimal prenatal trauma producing a large subdural hematoma in the fetus, which was diagnosed in utero by MR imaging. The occurrence of such a complication is extremely rare in the absence of significant maternal trauma. Prenatally diagnosed intracranial hemorrhages, particularly those that are subdural in origin, have a poor prognosis in most cases. After birth, brain compression required a complex neurosurgical intervention because simple hematoma evacuation was not possible. The clinical and neurological outcome at 6 months was excellent, as confirmed by the neuroimaging findings.
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Affiliation(s)
- Marco Piastra
- Paediatric Intensive Care Unit, Catholic University Medical School, A.Gemelli Hospital, L.go Gemelli 8, 00168 Rome, Italy.
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Abstract
OBJECTIVE The aim of this study was to investigate whether ibuprofen exposure was associated with increased hyperbilirubinemia in preterm infants. METHODS Since 2000, ibuprofen has been administered to all infants at <30 weeks of gestation who are admitted to our unit, to prevent patent ductus arteriosus. We retrospectively compared data for 418 infants subjected to ibuprofen prophylaxis (2000-2007) and 288 infants not exposed to ibuprofen (1993-1999). RESULTS The ibuprofen group had a significantly higher peak total serum bilirubin level (9.0 +/- 2.5 mg/dL vs 7.3 +/- 3.3 mg/dL), more need for phototherapy (398 infants [95%] vs 254 infants [87.6%]), and a longer phototherapy duration (94.3 +/- 43.6 hours vs 87.2 +/- 38.6 hours). Groups did not differ with respect to gestational age, birth weight, gender ratio, glucose-6-phosphate dehydrogenase deficiency incidence, or hypoalbuminemia (<2.5 g/dL) incidence. Hemolytic isoimmunization was diagnosed with similar incidences (no-ibuprofen group: 7 of 288 infants; ibuprofen group: 8 of 418 infants). The rates of exchange-transfusion also were similar between the groups (no-ibuprofen group: 14 infants [4.8%]; ibuprofen group: 19 infants [4.5%]). CONCLUSIONS Ibuprofen administration was associated with higher peak total serum bilirubin levels, and the more-pronounced hyperbilirubinemia led to longer phototherapy. The potential role of competition between ibuprofen and bilirubin in the hepatic glucuronidation pathway is discussed.
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Affiliation(s)
- Enrico Zecca
- Division of Neonatology, Department of Pediatrics, University Hospital A Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
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40
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Costa S, De Carolis MP, Savarese I, Manzoni C, Lacerenza S, Romagnoli C. An unusual complication of umbilical catheterisation. Eur J Pediatr 2008; 167:1467-9. [PMID: 18347811 DOI: 10.1007/s00431-008-0691-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 01/16/2008] [Accepted: 02/06/2008] [Indexed: 10/22/2022]
Abstract
We report the first case of perforated Meckel's diverticulum in a 1-day-old pre-term infant as a consequence of umbilical vein catheterisation. The clinical course consisted of abdominal distension and pneumoperitoneum that occurred after 12 h of life. Perforated Meckel's diverticulum was found at laparotomy. Neither inflammatory phenomena nor ectopic mucosa were found at microscopical examination. Perforation of the diverticulum was a complication of umbilical catheter insertion through a narrow lumen in the umbilical cord mistaken for an umbilical vein and connected to Meckel's diverticulum through a very short fibrous band. A search of the literature did not reveal any similar cases.
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Affiliation(s)
- Simonetta Costa
- Division of Neonatology, Department of Pediatrics, Catholic University of Sacred Heart, Largo A. Gemelli, 8, 00168, Rome, Italy.
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41
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Savarese I, De Carolis MP, Costa S, De Rosa G, De Carolis S, Lacerenza S, Romagnoli C. Atypical manifestations of congenital parvovirus B19 infection. Eur J Pediatr 2008; 167:1463-6. [PMID: 18309518 DOI: 10.1007/s00431-008-0688-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 11/30/2007] [Accepted: 02/06/2008] [Indexed: 11/24/2022]
Abstract
Parvovirus B19 infection in pregnancy is associated with fetal anemia, hydrops and fetal death. We report two unusual manifestations of vertical parvovirus B19 infection. The first patient developed hydrops as consequence of myocarditis with involvement of sino-atrial node. The other had pleural effusion reactive to the hepatic localization of the virus.
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Affiliation(s)
- Immacolata Savarese
- Division of Neonatology, Department of Pediatrics, Catholic University of Sacred Heart, Largo A. Gemelli, 8, 00168, Rome, Italy.
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42
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Ricci D, Cesarini L, Romeo DMM, Gallini F, Serrao F, Groppo M, De Carli A, Cota F, Lepore D, Molle F, Ratiglia R, De Carolis MP, Mosca F, Romagnoli C, Guzzetta F, Cowan F, Ramenghi LA, Mercuri E. Visual function at 35 and 40 weeks' postmenstrual age in low-risk preterm infants. Pediatrics 2008; 122:e1193-8. [PMID: 19047222 DOI: 10.1542/peds.2008-1888] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [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: 11/24/2022] Open
Abstract
OBJECTIVES The objectives of this study were to (1) assess visual function in low-risk preterm infants at 35 and 40 weeks' postmenstrual age, (2) compare preterm visual abilities at term-equivalent age with term-born infants, and (3) evaluate effects of preterm extrauterine life on early visual function. METHODS Visual function was assessed by using a validated test battery at 35 and 40 weeks' postmenstrual age in 109 low-risk preterm infants who were born at <31 weeks' gestation. The preterm findings were compared with data from term-born infants collected by using the same test protocol. RESULTS All preterm infants completed both assessments. The 35-week responses were generally less mature than those at 40 weeks. Preterm infants at both ages were significantly more mature than term-born infants for ocular movements and vertical and arc tracking and at 40 weeks for stripe discrimination. In contrast, tracking a colored stimulus, attention at distance, and stripe discrimination were more mature at term age (in both term-born and preterm infants) than at 35 weeks. CONCLUSIONS Our findings provide data for visual function at 35 and 40 weeks' postmenstrual age in low-risk preterm infants. The results suggest that early extrauterine experience may accelerate the maturation of aspects of visual function related to ocular stability and tracking but does not seem to affect other aspects that may be more cortically mediated.
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Affiliation(s)
- Daniela Ricci
- Catholic University, Pediatric Neurology Unit, Largo Gemelli 8, 00168 Rome, Italy
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43
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Costa S, De Carolis MP, De Luca D, Savarese I, Romagnoli C. Severe hyperbilirubinemia in a glucose-6-phosphate dehydrogenase-deficient preterm neonate: could prematurity be the main responsible factor? Fetal Diagn Ther 2008; 24:440-3. [PMID: 19023210 DOI: 10.1159/000174571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 11/28/2007] [Indexed: 11/19/2022]
Abstract
We report on a premature infant with glucose-6-phosphate dehydrogenase deficiency and severe hyperbilirubinemia. In this patient, all known potential hemolytic agents were excluded and no findings of hemolysis were observed. The crucial role of prematurity in the pathogenesis of this type of jaundice is discussed.
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Affiliation(s)
- Simonetta Costa
- Division of Neonatology, Department of Pediatrics, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
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44
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Fusco FP, De Carolis MP, Costa S, De Rosa G, Zambraro A, Romagnoli C. Cardiac complications in preterm infants with percutaneous long lines: the importance of early diagnosis. Resuscitation 2008; 79:506-8. [PMID: 18952360 DOI: 10.1016/j.resuscitation.2008.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 07/11/2008] [Accepted: 07/22/2008] [Indexed: 11/30/2022]
Abstract
Percutaneous long lines, routinely used in preterm infants, can be associated with several cardiac complications such as pericardial effusion and consequent cardiac tamponade. We report three patients with pericardial effusion highlighting the importance of cardiac ultrasound monitoring to both early diagnosis and treatment.
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Affiliation(s)
- Francesca Paola Fusco
- Division of Neonatology, Department of Paediatrics, Catholic University of Sacred Heart, Rome, Italy.
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45
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De Carolis MP, Polimeni V, Papacci P, Lacerenza S, Romagnoli C. Severe sepsis in a premature neonate: protein C replacement therapy. Turk J Pediatr 2008; 50:405-408. [PMID: 19014060] [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: 05/27/2023]
Abstract
Treatment with activated protein C has been shown to reduce mortality in adult patients with severe sepsis but also to increase risk of bleeding. In patients with predisposition to bleeding, as in preterm infants, the inactivated form of protein C could serve as a safe therapeutic option. We report the case of a preterm neonate who developed severe sepsis on the 28th day of life, who was successfully treated with the inactivated form of protein C for a period of 96 hours.
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Affiliation(s)
- Maria Pia De Carolis
- Division of Neonatal Intensive Care, Department of Pediatrics, Catholic University of Sacred Heart, Rome, Italy
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46
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Lacerenza S, De Carolis MP, Fusco FP, La Torre G, Chiaradia G, Romagnoli C. An Evaluation of a New Combined Spo2/PtcCO2 Sensor in Very Low Birth Weight Infants. Anesth Analg 2008; 107:125-9. [DOI: 10.1213/ane.0b013e3181733e47] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Costa S, De Carolis MP, Savarese I, Lacerenza S, Romagnoli C. Hepatic hematoma in a neonate with a high level of alpha-fetoprotein. Eur J Pediatr 2008; 167:591-3. [PMID: 17541634 DOI: 10.1007/s00431-007-0518-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 05/02/2007] [Indexed: 10/23/2022]
Abstract
Hepatic hematomas in neonates are uncommon lesions. When they are large or subcapsular in location, they can rupture with clinical signs of hemoperitoneum. We report a case of subcapsular hepatic hematoma (SHH) associated with a high level of alpha-fetoprotein (AFP), for which diagnosis was made with conservative management, following up with the reduction in size at ultrasound examination and the reduction of the level of AFP.
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Affiliation(s)
- Simonetta Costa
- Division of Neonatology, Department of Paediatrics, University Hospital Agostino Gemelli-Catholic University Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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De Luca D, De Carolis MP, Capelli A, Gallini F, Draisci G, Pinto R, Arena V. Tracheal agenesis without esophageal fistula: genetic, resuscitative, and pathological issues. J Pediatr Surg 2008; 43:e29-32. [PMID: 18206442 DOI: 10.1016/j.jpedsurg.2007.10.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
An exceptional case of tracheal agenesis with no communication with the esophagus is described. This malformation needs surgical airway approach and is hardly classifiable. We analyzed the literature and our institutional data: this resulted to be the first case of such anatomical variant. Genetic and pathological issues are reviewed: recent genetic data seem to explain this malformation. We also reviewed the available literature about prenatal presentation. Because prenatal diagnosis is difficult to achieve and current guidelines for neonatal resuscitation do not provide any recommendation, the resuscitative team may not be prepared for managing such a case. Usefulness of uncommon resuscitative maneuvers is discussed: a promptly performed surgical tracheotomy is the only mean to ventilate such a baby.
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Affiliation(s)
- Daniele De Luca
- Neonatal Intensive Care Unit, Department of Paediatrics, University Hospital A. Gemelli-Catholic University of the Sacred Heart, 00168 Rome, Italy.
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49
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De Carolis MP, Costa S, Polimeni V, Di Stasi C, Papacci P, Romagnoli C. Successful removal of catheter fragment from right atrium in a premature infant. Eur J Pediatr 2007; 166:617-8. [PMID: 17063348 DOI: 10.1007/s00431-006-0275-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 07/25/2006] [Indexed: 10/24/2022]
Abstract
A premature infant with rupture of percutaneous central catheter and subsequent migration of the fragment in the right atrium was reported. Umbilical venous catheterization was safely used to remove the fragment.
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Affiliation(s)
- Maria Pia De Carolis
- Division of Neonatology, Department of Pediatrics, Catholic University Sacred Heart, Rome, Italy.
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50
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Costa S, Zecca E, De Luca D, De Carolis MP, Romagnoli C. Efficacy of a single dose of antenatal corticosteroids on morbidity and mortality of preterm infants. Eur J Obstet Gynecol Reprod Biol 2007; 131:154-7. [PMID: 16797825 DOI: 10.1016/j.ejogrb.2006.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 02/18/2006] [Accepted: 05/09/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of an incomplete course of antenatal corticosteroids (ACS) on neonatal morbidity and mortality of preterm infants. METHODS Preterm infants born at 25-34 weeks' gestational age between January 1, 1998 and December 31, 2003 were included in this study. Studied infants were divided in two groups: the ACS group included those infants who had been exposed to a single 12-mg dose of betamethasone before delivery while the control group included those infants who had been delivered without any antenatal corticosteroids treatment. The most important neonatal outcomes were compared between the two groups. RESULTS One hundred and seventy neonates (41.4%) were exposed to one 12-mg dose of betamethasone before delivery, while 241 neonates (58.6%) did not receive any antenatal corticosteroids treatment. Mean gestational age at delivery (30.4+/-2.4 weeks versus 31.2+/-2.9 weeks, p=0.004) and mean birth weight (1375+/-454 g versus 1625+/-580 g, p<0.001) were lower in the ACS group. The univariate analysis showed that delivery room intubation and respiratory distress syndrome were more frequent in the ACS group and that the length of stay was also significantly longer in this group. No differences were found concerning survival, neonatal morbidity, need for and duration of mechanical ventilation and oxygen therapy. The incidence of major outcomes in survivors was also similar. Logistic regression adjusted for gestational age showed that the exposure to a single dose of betamethasone before delivery was not associated with a significant reduction in the rate of any neonatal outcome. We also compared the outcomes in function of gestational age subclasses. In the 25-27 weeks subgroup, delivery room intubation, surfactant treatment and patent ductus arteriosus (PDA) were less frequent in ACS infants; they had also shorter ventilation and oxygen duration. In the 30-31 weeks subgroup, ACS infants had a lower incidence of mechanical ventilation and a shorter duration of oxygen therapy. Finally, no differences were found in the 28-29 weeks subgroup and in the 32-34 weeks subgroup. CONCLUSION Effects of incomplete antenatal corticosteroids are variable: they give some benefits to infants of 25-27 weeks gestational age, fail to show any difference in outcomes in the 32-34 weeks subgroup and are doubtful between these extremes.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Betamethasone/therapeutic use
- Case-Control Studies
- Cohort Studies
- Dose-Response Relationship, Drug
- Ductus Arteriosus, Patent/mortality
- Ductus Arteriosus, Patent/prevention & control
- Female
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/prevention & control
- Logistic Models
- Male
- Pregnancy
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Respiratory Distress Syndrome, Newborn/mortality
- Respiratory Distress Syndrome, Newborn/prevention & control
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Simonetta Costa
- Division of Neonatology, Department of Paediatrics, Catholic University of the Sacred Heart, Rome, Italy.
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