1
|
Stringari G, Nai Fovino L, Naselli A, Tota F, Capogna M, Graziani S, Soffiati M. Neonatal severe COVID-19 infection complicated by Staphilococcus aureus could be misinterpreted as MIS-C?: case report and review of literature. New Microbiol 2024; 46:390-394. [PMID: 38252050] [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] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 01/23/2024]
Abstract
At 23 days of life a neonate presented to the emergency room with crying and decreased oral intake. His parents were positive to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), but he turned out negative. After one week he was admitted to NICU (neonatal intensive care unit) for respiratory failure, and nasopharyngeal swab (PCR test: polymerase chain reaction test) was positive for SARS-CoV-2. On examination the child had fever, tachy-dyspnea, reduced oxygen saturation, tachycardia, abdominal distension and tenderness, irritability and hypertonia. Blood exam showed respiratory acidosis, lymphocytopenia, hypoalbuminemia and coagulopathy; CRP (C reactive protein), procalcitonin, D-dimer, ferritin and NT-proBNP (N-terminal prohormone of brain natriuretic peptide) were elevated. Chest X-ray revealed bilateral interstitial infi ltration and abdomen ultrasound a thin fl uid effusion; echocardiography was normal. SARS-CoV-2 PCR tests on CSF (cerebrospinal fluid) and stool were also positive. He was started on non-invasive intermittent positive pressure respiratory ventilation, treated with antibiotic therapy, methylprednisolone, intravenous immunoglobulins, and antiplatelet therapy. Rapid clinical improvement was seen with remission of fever after eight days. The child complicated with bacterial super-infection presenting as pleural empyema. As presented in our case, it is not always easy to differentiate between severe forms of COVID-19 and MIS-C. Due to the rarity of these presentations in neonates, multicentric collaboration is needed to identify the specifi c characteristics of the two forms, better defi ne diagnostic criteria, and treatment options.
Collapse
Affiliation(s)
| | - Laura Nai Fovino
- Neonatal Intensive Care Unit, S. Chiara Hospital of Trento, Italy
| | - Aldo Naselli
- Neonatal Intensive Care Unit, S. Chiara Hospital of Trento, Italy
| | - Francesca Tota
- Neonatal Intensive Care Unit, S. Chiara Hospital of Trento, Italy
| | - Michela Capogna
- Neonatal Intensive Care Unit, S. Chiara Hospital of Trento, Italy
| | - Silvia Graziani
- Neonatal Intensive Care Unit, S. Chiara Hospital of Trento, Italy
| | - Massimo Soffiati
- Neonatal Intensive Care Unit, S. Chiara Hospital of Trento, Italy
| |
Collapse
|
2
|
Maines E, Urru SAM, Leonardi L, Fancellu E, Campomori A, Piccoli G, Maiorana A, Soffiati M, Franceschi R. Drug-induced hyperinsulinemic hypoglycemia: An update on pathophysiology and treatment. Rev Endocr Metab Disord 2023; 24:1031-1044. [PMID: 37552352 DOI: 10.1007/s11154-023-09828-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
The initial step for the differential diagnosis of hypoglycemia is to determine whether it is hyperinsulinemic or non hyperinsulinemic. Existing literature discusses drug-related hypoglycemia, but it misses a focus on drug-induced hyperinsulinemic hypoglycemia (DHH). Here we reviewed the association existing between drugs and hyperinsulinemic hypoglycemia. We primarily selected on the main electronic databases (MEDLINE, EMBASE, Web of Science, and SCOPUS) the reviews on drug-induced hypoglycemia. Among the drugs listed in the reviews, we selected the ones linked to an increase in insulin secretion. For the drugs missing a clear association with insulin secretion, we investigated the putative mechanism underlying hypoglycemia referring to the original papers. Our review provides a list of the most common agents associated with hyperinsulinemic hypoglycemia (HH), in order to facilitate both the recognition and the prevention of DHH. We also collected data about the responsiveness of DHH to diazoxide or octreotide.
Collapse
Affiliation(s)
- Evelina Maines
- Department of Women's and Children's Health, Pediatric Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy.
| | - Silvana Anna Maria Urru
- Hospital Pharmacy Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
| | - Letizia Leonardi
- Department of Women's and Children's Health, Pediatric Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
| | | | - Annalisa Campomori
- Hospital Pharmacy Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
| | - Giovanni Piccoli
- CIBIO - Department of Cellular, Computational and Integrative Biology, Università degli Studi di Trento, Trento, Italy
| | - Arianna Maiorana
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Soffiati
- Department of Women's and Children's Health, Pediatric Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
| | - Roberto Franceschi
- Department of Women's and Children's Health, Pediatric Unit, Azienda Provinciale per i Servizi Sanitari APSS, Largo Medaglie d'oro 9, Trento, Italy
| |
Collapse
|
3
|
Maines E, Cardellini MC, Stringari G, Leonardi L, Piccoli G, Urru SAM, Maiorana A, Soffiati M, Franceschi R. Drug-Induced Hypoglycemia in Neonates Born to Nondiabetic Women Treated with Medications during the Pregnancy or the Labor: A Systematic Review of the Literature. Am J Perinatol 2023. [PMID: 37848046 DOI: 10.1055/s-0043-1776061] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The prompt identification of at-risk newborns for drug-induced hypoglycemia can minimize the risk for adverse side effects, inappropriate investigations, and considerable unnecessary costs. Existing literature discusses drug-induced hypoglycemia, but a systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing. We reviewed the association between neonatal hypoglycemia and maternal medications. We systematically searched the literature according to the PICOS model on drug-induced hypoglycemia in neonates born to nondiabetic women treated with medications during the pregnancy or the labor. The main outcomes of the review were: (1) prevalence of hypoglycemia, (2) risk factors and potential confounders, (3) time at onset and severity of hypoglycemia, (4) dose-response gradient, (5) metabolic features of hypoglycemia, (6) modalities to treat hypoglycemia, and (7) quality of the studies. We included 69 studies in this review and we identified 11 groups of maternal drugs related to neonatal hypoglycemia. Results were classified for each outcome. Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia and in the differential diagnosis of neonatal hypoglycemia. Further studies are necessary to assess the risk of neonatal hypoglycemia associated with common maternal medications. KEY POINTS: · A systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing.. · In our review we identified 11 groups of maternal drugs related to neonatal hypoglycemia.. · Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia..
Collapse
Affiliation(s)
- Evelina Maines
- Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | | | - Giovanna Stringari
- Division of Neonatology, S. Chiara General Hospital, APSS, Trento, Italy
| | - Letizia Leonardi
- Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | - Giovanni Piccoli
- CIBIO - Department of Cellular, Computational and Integrative Biology, Università degli Studi di Trento, Trento, Italy
| | | | - Arianna Maiorana
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
- Division of Neonatology, S. Chiara General Hospital, APSS, Trento, Italy
| | | |
Collapse
|
4
|
Maines E, Rizzardi C, Bolognani M, Soli F, Piccoli G, Soffiati M, Franceschi R. Prenatal Diagnosis of a Case of Severe DGUOK Deficiency Did Not Affect the Postnatal Outcomes. Gene Expr 2023; 000:000-000. [DOI: 10.14218/ge.2023.00023] [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: 03/15/2024]
|
5
|
Franceschi R, Maines E, Petrone A, Bilato S, Trentini I, Di Spazio L, Leonardi L, Soffiati M, Francesconi A. Pediatric unit spending in the North of Italy during the COVID-19 pandemic. Ital J Pediatr 2023; 49:82. [PMID: 37443042 DOI: 10.1186/s13052-023-01486-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, accesses to pediatric health care services decreased, as well as the consumption of traditional drugs, while the median cost per patient at the emergency department slightly increased and the cost of pediatric COVID-19 admissions to the pediatric ward too. Overall spending of a secondary level Pediatric Unit in the last two years has not been previously reported. METHODS This is a retrospective study conducted by the Pediatric Unit of S. Chiara Hospital of Trento, North of Italy. We collected data on consumption and spending before and during the COVID-19 pandemic (between January 2018 and December 2022). RESULTS The total spending ranged from 2.141.220 to 2.483.931 euros between 2018 and 2022. COVID-19 spending accounted only for 5-8% of the overall budget, while two macro-areas of spending were identified: (i) biologic drugs for inherited metabolic diseases (IMDs), that impacted for 35.4-41.3%, and (ii) technology devices for type 1 diabetes (T1D), that accounted for 41.6-32.8% of the overall budget, in 2021 and 2022, respectively. Analysis of costs along with the different health care services revealed that: (i) the spending for COVID-19 antigen tests and personal protective equipment had a major impact on the Emergency room budget (from 54 to 68% in the two years); (ii) biological drugs accounted mainly on the Pediatric Ward (for 57%), Day Hospital (for 74%) and rare disease center budget (for 95% of the spending); (iii) the cost for T1D devices was mainly due to continuous glucose monitoring, and impacted for the 97% of the outpatient clinic budget. CONCLUSIONS The main impact on the budget was not due to COVID-19 pandemic related costs, but to the costs for biologic drugs and T1D devices. Therefore, cost savings could be mainly achieved through generic and biosimilars introduction and with inter-regionals calls for technology devices. We emphasize how the control of spending in pediatric hospital care has probably moved from the bedside (savings on traditional drugs as antibiotics) to the bench of national or inter-regional round tables, to obtain discounts on the costs of biologic drugs and medical devices. Here we provide for the first-time in literature, data for bench-marking between secondary level Pediatric Units before and during the COVID-19 pandemic.
Collapse
Affiliation(s)
| | - Evelina Maines
- Pediatric Unit, S.Chiara Hospital of Trento, APSS, Trento, Italy
| | | | - Simone Bilato
- Planning and management control Service, Azienda Provinciale per i Servizi Sanitari, APSS, Trento, Italy
| | - Ilaria Trentini
- Planning and management control Service, Azienda Provinciale per i Servizi Sanitari, APSS, Trento, Italy
| | - Lorenzo Di Spazio
- Hospital Pharmacy Department, S. Chiara Hospital of Trento, Trento, Italy
| | - Luca Leonardi
- Drug policy service and pharmaceutical assistance, Azienda Provinciale per i Servizi Sanitari, APSS, Trento, Italy
| | - Massimo Soffiati
- Pediatric Unit, S.Chiara Hospital of Trento, APSS, Trento, Italy
| | - Andrea Francesconi
- Department of Economics and Management, University of Trento, Trento, Italy
| |
Collapse
|
6
|
Franceschi R, Rivieri F, Novelli A, Ferretti D, Anesi A, Soffiati M, Porretti G, Maines E, Mucciolo M, Radetti G. Mosaicism of a novel variant in the ANKRD11 gene in a child with a mild KBG phenotype: A case report. World J Med Genet 2023; 11:21-27. [DOI: 10.5496/wjmg.v11.i2.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND KBG syndrome is likely underdiagnosed because of mild and non-specific features in some affected patients especially before the upper permanent central incisors eruption at about the age of 7-8 years. Somatic mosaicisms are usually recognized in the parents only after a typically affected son is diagnosed with KBG syndrome. We describe for the first time the mosaicism of a novel variant in a child with a mild KBG phenotype.
CASE SUMMARY Our patient presented at 24 mo of age with short stature, hand abnormalities, facial dysmorphism and mild developmental delay. Pituitary hypoplasia and central hypothyroidism were also detected. By next generation sequencing (NGS) analysis we found a novel deletion in the ANKRD11 gene (c.4880_4893del.), that can be classified as likely pathogenic for the syndrome, with the percentage of mutated allele of 36%. We considered this finding as causative of the mild and non-specific phenotype for KBG syndrome in our patient, as previously reported in adults. A heterozygous variant in HESX1 gene, classified as variant of uncertain significance, but suspected of causing pituitary hypoplasia and hormonal deficiency, was also found. The patient started levothyroxine and growth hormone treatment.
CONCLUSION The increased use of NGS analysis may expand the phenotypic spectrum of KBG syndrome because it allows genetic diagnosis of somatic mosaicisms also in children.
Collapse
Affiliation(s)
- Roberto Franceschi
- Department of Pediatrics, S. Chiara Hospital of Trento, APSS, Trento 38122, Italy
| | - Francesca Rivieri
- Genetic Unit, Laboratory of Clinical Pathology, Department of Laboratories, APSS, Trento 38122, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Ospedale Pediatrico Bambino Gesù, Rome 00165, Italy
| | - Daniele Ferretti
- Human Genetics Laboratory, Ospedale Pediatrico Bambino Gesù, Rome 00165, Italy
| | - Adriano Anesi
- Genetic Unit, Laboratory of Clinical Pathology, Department of Laboratories, APSS, Trento 38122, Italy
| | - Massimo Soffiati
- Department of Pediatrics, S. Chiara General Hospital, APSS, Trento 38122, Italy
| | - Giulia Porretti
- Department of Radiology, S. Chiara General Hospital, APSS, Trento 38122, Italy
| | - Evelina Maines
- Department of Pediatrics, S. Chiara General Hospital, APSS, Trento 38122, Italy
| | - Mafalda Mucciolo
- Human Genetics Laboratory, Ospedale Pediatrico Bambino Gesù, Rome 00165, Italy
| | - Giorgio Radetti
- Department of Pediatrics, General Hospital Bolzano, Marienklinik, Bolzano 39100, Italy
| |
Collapse
|
7
|
Maines E, Moretti M, Vitturi N, Gugelmo G, Fasan I, Lenzini L, Piccoli G, Gragnaniello V, Maiorana A, Soffiati M, Burlina A, Franceschi R. Understanding the Pathogenesis of Cardiac Complications in Patients with Propionic Acidemia and Exploring Therapeutic Alternatives for Those Who Are Not Eligible or Are Waiting for Liver Transplantation. Metabolites 2023; 13:563. [PMID: 37110221 PMCID: PMC10143878 DOI: 10.3390/metabo13040563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The guidelines for the management of patients affected by propionic acidemia (PA) recommend standard cardiac therapy in the presence of cardiac complications. A recent revision questioned the impact of high doses of coenzyme Q10 on cardiac function in patients with cardiomyopathy (CM). Liver transplantation is a therapeutic option for several patients since it may stabilize or reverse CM. Both the patients waiting for liver transplantation and, even more, the ones not eligible for transplant programs urgently need therapies to improve cardiac function. To this aim, the identification of the pathogenetic mechanisms represents a key point. Aims: This review summarizes: (1) the current knowledge of the pathogenetic mechanisms underlying cardiac complications in PA and (2) the available and potential pharmacological options for the prevention or the treatment of cardiac complications in PA. To select articles, we searched the electronic database PubMed using the Mesh terms "propionic acidemia" OR "propionate" AND "cardiomyopathy" OR "Long QT syndrome". We selected 77 studies, enlightening 12 potential disease-specific or non-disease-specific pathogenetic mechanisms, namely: impaired substrate delivery to TCA cycle and TCA dysfunction, secondary mitochondrial electron transport chain dysfunction and oxidative stress, coenzyme Q10 deficiency, metabolic reprogramming, carnitine deficiency, cardiac excitation-contraction coupling alteration, genetics, epigenetics, microRNAs, micronutrients deficiencies, renin-angiotensin-aldosterone system activation, and increased sympathetic activation. We provide a critical discussion of the related therapeutic options. Current literature supports the involvement of multiple cellular pathways in cardiac complications of PA, indicating the growing complexity of their pathophysiology. Elucidating the mechanisms responsible for such abnormalities is essential to identify therapeutic strategies going beyond the correction of the enzymatic defect rather than engaging the dysregulated mechanisms. Although these approaches are not expected to be resolutive, they may improve the quality of life and slow the disease progression. Available pharmacological options are limited and tested in small cohorts. Indeed, a multicenter approach is mandatory to strengthen the efficacy of therapeutic options.
Collapse
Affiliation(s)
- Evelina Maines
- Division of Pediatrics, Santa Chiara General Hospital, APSS, 38122 Trento, Italy
| | - Michele Moretti
- Division of Cardiology, Santa Chiara General Hospital, APSS, 38122 Trento, Italy
| | - Nicola Vitturi
- Division of Metabolic Diseases, Department of Medicine-DIMED, University Hospital, 35128 Padova, Italy
| | - Giorgia Gugelmo
- Division of Clinical Nutrition, Department of Medicine-DIMED, University Hospital, 35128 Padova, Italy
| | - Ilaria Fasan
- Division of Clinical Nutrition, Department of Medicine-DIMED, University Hospital, 35128 Padova, Italy
| | - Livia Lenzini
- Emergency Medicine Unit, Department of Medicine-DIMED, University Hospital, 35128 Padova, Italy
| | - Giovanni Piccoli
- CIBIO, Department of Cellular, Computational and Integrative Biology, Italy & Dulbecco Telethon Institute, Università degli Studi di Trento, 38123 Trento, Italy
| | - Vincenza Gragnaniello
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Women’s and Children’s Health, University Hospital, 35128 Padova, Italy
| | - Arianna Maiorana
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children’s Hospital-IRCCS, 00165 Rome, Italy
| | - Massimo Soffiati
- Division of Pediatrics, Santa Chiara General Hospital, APSS, 38122 Trento, Italy
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Women’s and Children’s Health, University Hospital, 35128 Padova, Italy
| | - Roberto Franceschi
- Division of Pediatrics, Santa Chiara General Hospital, APSS, 38122 Trento, Italy
| |
Collapse
|
8
|
Franceschi R, Maines E, Bellizzi M, Rivieri F, Bacca A, Filippi A, Valente EM, Plumari M, Soffiati M, Vincenzi M, Teofoli F, Camilot M. A young boy with ventricular arrhythmias and thyroid dysgenesis: two genes are not enough? Arch Endocrinol Metab 2023; 67:143-149. [PMID: 36468928 PMCID: PMC9983796 DOI: 10.20945/2359-3997000000546] [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] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Congenital hypothyroidism (CH) may be caused by biallelic variants in the TSHR gene. CH due to thyroid dysgenesis has also been linked to pathogenic variants of the nucleotide kinase 2, homeobox 5 (NKX2-5) gene, which can also cause sudden cardiac death from ventricular arrhythmia. In particular, the NKX2-5 p.Arg25Cys missense variant has been repeatedly reported in patients with congenital heart defects and, more rarely, with hypogonadism. We report the case of a 7 year old boy with ventricular arrhythmias, thyroid dysgenesis and intellectual disability, born from consanguineous Tunisian parents. Exome sequencing and segregation analysis revealed two potentially relevant variants: the NKX2-5 p.Arg25Cys variant (maternally inherited), as well as a single heterozygous TSHR p.Gln90Pro variant (paternally inherited). Of note, a male sibling of the proband, presenting with intellectual disability only, carried the same two variants. No other TSHR variants, or other potentially relevant variants were identified. In this proband, despite the identification of variants in two genes potentially correlated to the phenotype, a definite genetic diagnosis could not be reached. This case report highlights the complexity of exome data interpretation, especially when dealing with families presenting complex phenotypes and variable expression of clinical traits.
Collapse
Affiliation(s)
| | - Evelina Maines
- Pediatric Department, S. Chiara Hospital of Trento, Trento, Italy
| | - Maria Bellizzi
- Pediatric Department, S. Chiara Hospital of Trento, Trento, Italy
| | | | - Andrea Bacca
- Cardiology Unit, S. Chiara Hospital of Trento, Trento, Italy
| | - Alessandra Filippi
- Pediatric Neuropsychology Unit, Azienda Provinciale per i Servizi Sanitari del Trentino, Trento, Italy
| | - Enza Maria Valente
- Neurogenetics Research Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Massimo Plumari
- Neurogenetics Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Massimo Soffiati
- Pediatric Department, S. Chiara Hospital of Trento, Trento, Italy
| | - Monica Vincenzi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesca Teofoli
- Department of Surgical, Odontostomatological, Mother and Child Sciences, University of Verona, Verona, Italy
| | - Marta Camilot
- Department of Surgical, Odontostomatological, Mother and Child Sciences, University of Verona, Verona, Italy
| |
Collapse
|
9
|
Maines E, Maiorana A, Leonardi L, Piccoli G, Soffiati M, Franceschi R. A narrative review on pathogenetic mechanisms of hyperinsulinemic hypoglycemia in Kabuki syndrome. Endocr Regul 2023; 57:128-137. [PMID: 37285460 DOI: 10.2478/enr-2023-0016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Objective. Kabuki syndrome (KS) is associated with hyperinsulinemic hypoglycemia (HH) in 0.3-4% of patients, thus exceeding the prevalence in the general population. HH association is stronger for KS type 2 (KDM6A-KS, OMIM #300867) than KS type 1 (KMT2D-KS, OMIM #147920). Both the disease-associated genes, KMD6A and KMT2D, modulate the chromatin dynamic. As such, KS is considered to be the best characterized pediatric chromatinopathy. However, the exact pathogenetic mechanisms leading to HH in this syndrome remain still unclear. Methods. We selected on the electronic database PubMed all articles describing or hypothesizing the mechanisms underlying the dysregulated insulin secretion in KS. Results. The impact on the gene expression due to the KDM6A or KMT2D function loss may lead to a deregulated pancreatic β-cell differentiation during embryogenesis. Moreover, both KMT2D gene and KDM6A gene are implicated in promoting the transcription of essential pancreatic β-cell genes and in regulating the metabolic pathways instrumental for insulin release. Somatic KMT2D or KDM6A mutations have also been described in several tumor types, including insulinoma, and have been associated with metabolic pathways promoting pancreatic cell proliferation. Conclusions. The impact of pathogenic variants in KDM6A and KDM2D genes on β-cell insulin release remains to be fully clarified. Understanding this phenomenon may provide valuable insight into the physiological mechanisms of insulin release and into the pathological cascade causing hyperinsulinism in KS. The identification of these molecular targets may open new therapeutic opportunities based on epigenetic modifiers.
Collapse
Affiliation(s)
- Evelina Maines
- 1Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | - Arianna Maiorana
- 2Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Letizia Leonardi
- 1Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | - Giovanni Piccoli
- 3CIBIO - Department of Cellular, Computational and Integrative Biology, Università degli Studi di Trento, Italy
| | - Massimo Soffiati
- 1Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | - Roberto Franceschi
- 1Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| |
Collapse
|
10
|
Girardi M, Assalone C, Maines E, Genovese A, Naselli A, Nai Fovino L, Soffiati M, Franceschi R. Disease Characteristics and Psychiatric Comorbidities in Adolescents with Anorexia Nervosa Hospitalized During COVID-19 Pandemic. Front Biosci (Schol Ed) 2022; 14:28. [PMID: 36575838 DOI: 10.31083/j.fbs1404028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Since the beginning of COVID-19 pandemic, an increase in new diagnoses and pediatric hospital admission for anorexia nervosa (AN) or atypical AN in adolescents have been reported, suggesting an adverse effect of COVID-19 on youth mental health. We hypothesized possible differences in prevalence of hospitalization and/or disease severity, related to socio-economic status and/or ethnicity. METHODS Retrospectively, patients were divided into two subgroups and compared according to the date of first hospital admission: "pre SARS-COV2 era" group (n. 45, 8th March 2016-8th March 2020) and "SARS-COV2 era" group (n. 43, 9th March 2020-8th March 2022). RESULTS During the two years of the SARS-COV2 era, we reported an increase in hospital admission incidence more than doubled respect to the "pre-SARS-COV2 era". The "SARS-COV2 era group" showed a more rapid weight loss (p = 0.005), a minor duration of weight loss from lifetime maximum to admission (p = 0.019) and needed most frequently treatments with intravenous fluids (p < 0.0001), oral dietetic supplements (p <0.001) and enteral nutrition by nasogastric tube (p = 0.002). The same group presented higher prevalence of psychiatric comorbidities (63% vs. 22%, p < 0.0001) and required most frequently treatments with psychotropic drugs (56% vs. 24%, p = 0.002). We found higher family socioeconomic status (SES) in our patients with AN in both the periods and we did not find a shift in social class distribution over time. CONCLUSIONS Our study confirms a significant increase in incidence of hospitalization and of psychiatric comorbidity in the pediatric population with AN during the second year of COVID-19 pandemic, regardless of SES or ethnic background. Further studies are needed to understand potential mechanisms that during COVID-19 pandemic trigger eating disorder symptoms.
Collapse
Affiliation(s)
- Martina Girardi
- Pediatric Department, S. Chiara General Hospital, 38122 Trento, Italy
| | | | - Evelina Maines
- Pediatric Department, S. Chiara General Hospital, 38122 Trento, Italy
| | - Aldo Genovese
- Provincial Centre for Eating Disorders, 38122 Trento, Italy
| | - Aldo Naselli
- Pediatric Department, S. Chiara General Hospital, 38122 Trento, Italy
| | - Laura Nai Fovino
- Pediatric Department, S. Chiara General Hospital, 38122 Trento, Italy
| | - Massimo Soffiati
- Pediatric Department, S. Chiara General Hospital, 38122 Trento, Italy
| | | |
Collapse
|
11
|
Franceschi R, Canale M, Piras EM, Galvagni L, Vivori C, Cauvin V, Soffiati M, Maines E. Influence of Parental Health Locus of Control on Behavior, Self-Management and Metabolic Control, in Pediatric Patients with Type 1 Diabetes. J Pers Med 2022; 12:jpm12101590. [PMID: 36294729 PMCID: PMC9604908 DOI: 10.3390/jpm12101590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Precision medicine in type 1 diabetes (T1D) treatment considers context and environmental data to subclassify patients. Parental Health Locus of Control PHLOC) could influence behavior, self-management, and metabolic control of children with T1D. Methods: No. 135 pediatric patients with T1D (No. 57 with HbA1c ≤ 7.0%, “optimal” group, and No. 78 with >7.0%, “sub-optimal” group) were enrolled in the study. History, anthropometric and diabetes management data were collected, as well as caregiver’s data about socioeconomic status (SES). The PHLOC scale questionnaire and a semi-structured interview were administered. Results: Access to technology was lower in the “sub-optimal” group and, in particular, in the ethnic minority subgroup, only 8% used them. In the “sub-optimal” group ethnic minority status was higher (24%), the caregiver had a lower SES and showed lower internal HLOC. Conclusions: New care models have to be implemented to ensure equity in diabetes care and precision treatment, particularly for ethnic minority groups, because SES and external PHLOC are still an important barrier to “optimal” diabetes control. In the “sub-optimal” group, we have to implement strategies aimed at increasing self-efficacy, while in the “optimal” one, a personalised approach should be considered to facilitate the shifting of responsibilities within the family, avoiding psychological distress.
Collapse
Affiliation(s)
- Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, Santa Chiara Hospital of Trento, 38122 Trento, Italy
- Correspondence: ; Tel.: +39-0461-903538
| | - Marta Canale
- Pediatric Diabetology Unit, Pediatric Department, Santa Chiara Hospital of Trento, 38122 Trento, Italy
| | - Enrico Maria Piras
- Center for Information and Communication Technology, eHealth Unit, Fondazione “Bruno Kessler”, 38123 Trento, Italy
| | - Lucia Galvagni
- Center for Religious Studies, Bruno Kessler Foundation, 38123 Trento, Italy
| | - Cinzia Vivori
- Hygiene and Public Prevention Department, Azienda Provinciale per i Servizi Sanitari, 38100 Trento, Italy
| | - Vittoria Cauvin
- Pediatric Diabetology Unit, Pediatric Department, Santa Chiara Hospital of Trento, 38122 Trento, Italy
| | - Massimo Soffiati
- Pediatric Diabetology Unit, Pediatric Department, Santa Chiara Hospital of Trento, 38122 Trento, Italy
| | - Evelina Maines
- Pediatric Diabetology Unit, Pediatric Department, Santa Chiara Hospital of Trento, 38122 Trento, Italy
| |
Collapse
|
12
|
Franceschi R, Radetti G, Soffiati M, Maines E. Forearm Fractures in Overweight-Obese Children and Adolescents: A Matter of Bone Density, Bone Geometry or Body Composition? Calcif Tissue Int 2022; 111:107-115. [PMID: 35316361 DOI: 10.1007/s00223-022-00971-3] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/10/2022] [Indexed: 01/06/2023]
Abstract
Forearm fractures in children and adolescents are associated with increased body mass index (BMI). This bone site is non-weight-bearing and therefore is appropriate to explore the effect of BMI on bone mineral density (BMD) and bone geometry, avoiding the confounding effect of increased weight-associated mechanical loading. The aim of this review was to summarize available evidence on bone indices and body composition assessed by peripheral quantitative computed tomography (pQCT) or dual X-ray absorptiometry (DXA) at the forearm level in overweight (Ow) or obese (Ob) subjects. We conducted a review of the literature according to the PICOS model. A total of 46 studies were identified following the literature search. A final number of 12 studies were included in this review. pQCT studies evidenced that Ow and Ob children typically have normal or increased volumetric BMD (vBMD), total bone area and cortical area, with normal or reduced cortical thickness at the forearm. Outcomes from DXA evaluations are less conclusive. In almost all the studies fat mass and lean mass area at the forearm are increased. A higher fat-to-lean mass ratio has been observed in few studies. Bone strength was reported as normal or increased compared to normal weight peers. In Ow or Ob children-adolescents, vBMD, bone size and bone strength are not reduced compared to normal weight peers. The local higher fat-to-lean mass ratio may give a mismatch between bone strength and the load experienced by the distal forearm during a fall, resulting in increased risk of forearm fractures.
Collapse
Affiliation(s)
- Roberto Franceschi
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Giorgio Radetti
- Division of Pediatrics, General Hospital Bolzano, Bolzano, Italy
| | - Massimo Soffiati
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Evelina Maines
- Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| |
Collapse
|
13
|
Franceschi R, Scotton C, Leonardi L, Cauvin V, Maines E, Angriman M, Pertile R, Valent F, Soffiati M, Faraguna U. Impact of intermittently scanned continuous glucose monitoring with alarms on sleep and metabolic outcomes in children and adolescents with type 1 diabetes. Acta Diabetol 2022; 59:911-919. [PMID: 35397650 DOI: 10.1007/s00592-022-01882-3] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/13/2022] [Indexed: 11/01/2022]
Abstract
AIMS Data about sleep quality and quantity are not available in patients with type 1 diabetes (T1D) using intermittently scanned continuous glucose monitoring (isCGM). We questioned whether the isCGM with alarms could fragment sleep in patients and parents, compared to isCGM without alarms. METHODS A prospective, observational study including 47 child-adolescents with T1D who had experience with isCGM without alarms (Freestyle Libre 1-FSL1). They were asked to wear the isCGM with alarms (Freestyle Libre 2-FSL2) for 14 days. Patients enrolled and their caregiver (s), during a 14 day period with FSL1 and the following 14 days with FSL2, completed psychosocial and sleep-related questionnaires. Furthermore they wore an actigraph that was downloaded to a web platform and processed by the validated and certified algorithm "Dormi®." RESULTS By the switch to the alarmed FSL2 we found about a 5% increase in Time In Range (from 62.5 to 67.8%), a reduction in time spent in hypoglycemia, number of weekly hypoglycemic events, and coefficient of variation. We did not find significant differences in sleep parameters in patients and their parents; therefore, alarms did not worsen the duration and quality of sleep. A significant improvement in the Quality of Life was perceived by parents using FSL2. CONCLUSIONS Introduction of alarms in isCGM systems gives, in the short term, an improvement in metabolic control in terms of time in range and reduction in hypoglycemia, without worsening duration and quality of sleep, measured by actigraphy, in children-adolescent and their parents.
Collapse
Affiliation(s)
- Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Chiara Scotton
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Letizia Leonardi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Vittoria Cauvin
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Evelina Maines
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Marco Angriman
- Health Management, General Hospital of Bolzano, Bolzano, Italy
| | - Riccardo Pertile
- Clinical and Evaluative Epidemiology Unit, Department of Governance, APSS, Trento, Italy
| | - Francesca Valent
- Clinical and Evaluative Epidemiology Unit, Department of Governance, APSS, Trento, Italy
| | - Massimo Soffiati
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Ugo Faraguna
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCSS Stella Maris Foundation, Pisa, Italy
- SleepActa Srl, A spinoff company of the University of Pisa, Pisa, Italy
| |
Collapse
|
14
|
Naselli A, Venturini E, Oss M, Tota F, Graziani S, Collini L, Galli L, Soffiati M. Early-onset fulminant neonatal sepsis caused by Multi-Drug Resistant and ESBL producing E. coli (CTX-M gene) in a late-preterm neonate: case report and literature review. New Microbiol 2022; 45:223-226. [PMID: 35920879] [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] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Neonatal sepsis is a systemic condition characterized by haemodynamic changes and other clinical manifestations due to a presence of pathogenic microorganisms (bacteria, viruses, or fungi) in nor- mally sterile fluid that occurs in an infant younger than 90 days old. Neonatal sepsis may be divided into two types: early-onset neonatal sepsis (EOS) and late-onset neonatal sepsis (LOS). Gram-posi- tive microorganisms are the etiological agents in 62% of EOS, and in 43% of the total the identified microorganism is GBS. Gram-negative microorganisms comprise 37% of the etiological agents of EOS, of which 29% are caused by Escherichia coli. ESBL-producing Enterobacteriaceae represent a major worldwide threat among drug-resistant bacteria in both hospital and community settings. ESBLs are often located on large plasmids that also harbour genes resistant to other antimicrobial classes, resulting in multidrug-resistant isolates. Plasmid-encoded ESBLs of the CTX-M-type are increasingly reported worldwide in Gram-negative rods and now account for most of the ESBLs found in Enterobacteriaceae. We present one case of EOS by Multi Drug Resistant (MDR) and ESBL producing E. coli (CTX-M gene) in a neonate born to a mother recently immigrated from Africa. Maternal blood culture grew the same bacteria.
Collapse
Affiliation(s)
- Aldo Naselli
- Neonatal Intensive Care Unit, S. Chiara Hospital, Trento, Italy
| | - Elisabetta Venturini
- Division of Pediatric Infectious Disease, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Martina Oss
- Neonatal Intensive Care Unit, S. Chiara Hospital, Trento, Italy
| | - Francesca Tota
- Neonatal Intensive Care Unit, S. Chiara Hospital, Trento, Italy
| | - Silvia Graziani
- Neonatal Intensive Care Unit, S. Chiara Hospital, Trento, Italy
| | - Lucia Collini
- Microbiology and Virology Unit, S. Chiara Hospital, Trento, Italy
| | - Luisa Galli
- Division of Pediatric Infectious Disease, Anna Meyer Children’s University Hospital, Florence, Italy
| | | |
Collapse
|
15
|
Franceschi R, Iascone M, Maitz S, Marchetti D, Mariani M, Selicorni A, Soffiati M, Maines E. A missense mutation in DDRGK1 gene associated to Shohat-type spondyloepimetaphyseal dysplasia: Two case reports and a review of literature. Am J Med Genet A 2022; 188:2434-2437. [PMID: 35670300 DOI: 10.1002/ajmg.a.62857] [Citation(s) in RCA: 1] [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] [Received: 03/04/2022] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 12/17/2022]
Abstract
Spondylo-epi-metaphyseal dysplasia Shohat type (SEMDSH, OMIM # 602557) is a rare skeletal dysplasia. Until recently, only eight patients of five families have been reported. The disorder is characterized by severely disproportionate short stature with a short neck, small trunk with abdominal distension, and short lower limbs. Joint laxity and bowed legs are seen. The same homozygous splicing pathogenic variant in the DDRGK1 gene was found in four Iraqi families. Here we report a homozygous missense pathogenic variant in DDRGK1 in two children from unrelated two Moroccan families. The clinical and radiological phenotypes of the affected children were similar to those previously described.
Collapse
Affiliation(s)
| | - Maria Iascone
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Maitz
- Genetic Unit, Pediatric Clinic, Fondazione MBBM, S. Gerardo Hospital, Monza, Italy
| | - Daniela Marchetti
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Milena Mariani
- Pediatric Units, ASST Lariana, S.Fermo della Battaglia (CO), Italy
| | - Angelo Selicorni
- Pediatric Units, ASST Lariana, S.Fermo della Battaglia (CO), Italy
| | | | - Evelina Maines
- Pediatric Department, S. Chiara General Hospital, Trento, Italy
| |
Collapse
|
16
|
Rizzardi C, Franceschi R, Cauvin V, Bellizzi M, Liguori A, Longhi S, Lupi F, Soffiati M, Radetti G. Seronegative phenotype in a pediatric population with Hashimoto's thyroiditis. Hormones (Athens) 2022; 21:271-276. [PMID: 35377135 DOI: 10.1007/s42000-022-00355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim was to verify in a pediatric population with Hashimoto's thyroiditis whether there is a relationship between antithyroid antibodies and inflammatory status on thyroid ultrasound and thyroid function. SUBJECTS AND METHODS A total of 154 children and adolescents, aged 4 to 18 years, diagnosed with Hashimoto's thyroiditis with normal body weight were followed up for 1 year. RESULTS Patients with only antiperoxidase antibodies presented with higher TSH levels than subjects with only antithyroglobulin antibodies (p 0.027) but with similar FT4 levels and thyroid score. Prevalence of seronegative Hashimoto's thyroiditis in this cohort was 12.3% (19/154). At diagnosis, the seronegative group presented with lower prevalence of overt hypothyroidism, symptoms of hypothyroidism, and thyroid score, meaning less severe thyroid involvement. In contrast, similar TSH and FT4 values were found at diagnosis and during follow-up in both the seronegative and seropositive groups. A comparison between patients with seronegative Hashimoto's thyroiditis and an overweight/obese antibody-negative population, who presented superimposable altered parenchymal pattern on thyroid ultrasound without circulating antithyroid antibodies, presented similar clinical data. CONCLUSION We report for the first time in the literature that seronegative Hashimoto's thyroiditis in the pediatric age group has a less severe pattern. The seronegative group presents similar characteristics to those of overweight/obese children and adolescents with ultrasound changes, but, according to the established knowledge, the latter condition is reversible and does not need follow-up examinations.
Collapse
Affiliation(s)
- Caterina Rizzardi
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Roberto Franceschi
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy.
| | - Vittoria Cauvin
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Maria Bellizzi
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Alice Liguori
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Silvia Longhi
- Division of Paediatrics, General Hospital Bolzano, Bolzano, Italy
| | - Fiorenzo Lupi
- Division of Paediatrics, General Hospital Bolzano, Bolzano, Italy
| | - Massimo Soffiati
- Division of Paediatrics, S. Chiara General Hospital, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Giorgio Radetti
- Division of Paediatrics, General Hospital Bolzano, Bolzano, Italy
| |
Collapse
|
17
|
Franceschi R, Cauvin V, Stefani L, Berchielli F, Soffiati M, Maines E. Early Initiation of Intermittently Scanned Continuous Glucose Monitoring in a Pediatric Population With Type 1 Diabetes: A Real World Study. Front Endocrinol (Lausanne) 2022; 13:907517. [PMID: 35784525 PMCID: PMC9247237 DOI: 10.3389/fendo.2022.907517] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/18/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Use of Continuous Glucose Monitoring (CGM) systems early in the course of diabetes has the potential to help glycemic management and to improve quality of life (QoL). No previous research has examined these outcomes in children-adolescents with type 1 diabetes (T1D) who use intermittently scanned CGM (isCGM) starting within the first month after diagnosis. AIM To evaluate the impact of isCGM early after T1D diagnosis, on metabolic control and QoL, comparing a group who started the use of the device within one month from the onset with another one who started at least one year later. SUBJECTS AND METHODS Patients who used isCGM within 1 month from T1D diagnosis were enrolled in group A; those who didn't have the device during the first year were considered as control group (group B). HbA1c and total daily insulin were evaluated at 3 (T1), 6 (T2) and 12 (T3) months post-baseline (T0, diabetes onset), QoL after 1 year. In group A, isCGM glucose metrics were also recorded. RESULTS 85 patients were enrolled in group A and 67 patients in group B. In group A isCGM was well accepted during follow up: no patient dropped out; percentage of time with active sensor was in mean > 87%; number of scans/day remained stable. QoL was higher in group A than in group B both in children-adolescents (p<0.0001) and in parents (p 0.003). Group A presented lower HbA1c during the first year after diagnosis (p<0.001), and this data correlated with glucose management indicator (GMI), time in range (TIR) and mean glucose. The honeymoon period lasted more in group A than in B (p 0.028). Furthermore, the mean hypoglycemia duration decreased during follow-up (p 0.001) in group A. CONCLUSIONS Early use of isCGM, starting within the first month after diagnosis, improves metabolic control and QoL in pediatric patients with T1D.
Collapse
Affiliation(s)
- Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy
- *Correspondence: Roberto Franceschi,
| | - Vittoria Cauvin
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy
| | - Lorenza Stefani
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy
| | | | - Massimo Soffiati
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy
| | - Evelina Maines
- Pediatric Diabetology Unit, Pediatric Department, S. Chiara General Hospital, Trento, Italy
| |
Collapse
|
18
|
Assalone C, Leonardi L, Franceschi R, Fumanelli J, Maines E, Marini M, Quintarelli S, Genovese A, Soffiati M. Determinants of severe bradycardia in adolescents hospitalized for anorexia nervosa. Pediatr Int 2022; 64:e14967. [PMID: 34418241 DOI: 10.1111/ped.14967] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Severe bradycardia is an indication supporting hospitalization in adolescents with eating disorders. Some adolescents with anorexia nervosa (AN) and significant weight loss present with a normal pulse rate at admission, whereas others have severe bradycardia, suggesting that total weight loss is not the most important determinant of bradycardia. The aims of this study were to define the prevalence of severe bradycardia as the cause for hospital admission in adolescents with AN, to evaluate correlations between known determinants of severe bradycardia and pulse rate at admission, and to evaluate the average time required to recover from severe bradycardia after re-feeding. METHODS Ninety-nine hospitalized patients with AN were enrolled. Weight loss history, anthropometric, laboratory, and electrocardiogram data were collected at admission to and at discharge from hospital. Multivariate analysis was performed to detect the most important determinants of severe bradycardia. RESULTS Forty-eight percent of the AN patient admissions were due to severe bradycardia (AN-B+ group). Patients in this group had a higher maximum lifetime weight (P = 0.0045), greater premorbid weight loss (P = 0.0011), and more rapid weight loss (P = 0.0001). Multivariate analysis showed that recent weight loss is an independent predictor of bradycardia at hospital admission (R2 : 0.35, P = 0.0001). Severe bradycardia normalized after minimal weight gain of 0.25 ± 0.18 kg/day for 3-10 days. CONCLUSIONS This study confirms that recent weight loss is probably the most important determinant of severe bradycardia in adolescents with AN.
Collapse
Affiliation(s)
- Chiara Assalone
- Division of Paediatrics, S. Chiara General Hospital, Trento, Italy.,Provincial Centre for Eating Disorders, Trento, Italy
| | - Letizia Leonardi
- Division of Paediatrics, S. Chiara General Hospital, Trento, Italy
| | | | | | - Evelina Maines
- Division of Paediatrics, S. Chiara General Hospital, Trento, Italy
| | | | | | - Aldo Genovese
- Provincial Centre for Eating Disorders, Trento, Italy
| | - Massimo Soffiati
- Division of Paediatrics, S. Chiara General Hospital, Trento, Italy
| |
Collapse
|
19
|
Maines E, Franceschi R, Martinelli D, Soli F, Lepri FR, Piccoli G, Soffiati M. Hypoglycemia due to PI3K/AKT/mTOR signaling pathway defects: two novel cases and review of the literature. Hormones (Athens) 2021; 20:623-640. [PMID: 33876391 DOI: 10.1007/s42000-021-00287-1] [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: 10/26/2020] [Accepted: 03/25/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The PI3K/AKT/mTOR signaling pathway is important for the regulation of multiple biological processes, including cellular growth and glucose metabolism. Defects of the PI3K/AKT/mTOR signaling pathway are not usually considered among the genetic causes of recurrent hypoglycemia in childhood. However, accumulating evidence links hypoglycemia with defects of this pathway. CASE REPORTS AND REVIEW We describe here two cases of macrocephaly and hypoglycemia bearing genetic defects in genes involved in the PI3K/AKT/mTOR pathway. The first patient was diagnosed with a PTEN hamartoma tumour syndrome (PTHS) due to the de novo germline missense mutation c.[492 + 1G > A] of the PTEN gene. The second patient presented the autosomal dominant mental retardation-35 (MDR35) due to the heterozygous missense mutation c.592G > A in the PPP2R5D gene. A review of the literature on hypoglycemia and PI3K/AKT/mTOR signaling pathway defects, with a special focus on the metabolic characterization of hypoglycemia, is included. CONCLUSIONS PI3K/AKT/mTOR pathway defects should be included in the differential diagnosis of patients with hypoglycemia and macrocephaly. Clinical suspicion and molecular confirmation are important, not just for an accurate genetic counselling but also for defining the follow-up management, including cancer surveillance. The biochemical profile of hypoglycemia varies among patients. While most patients are characterized by low plasmatic insulin levels, hyperinsulinemia has also been observed. Large patient cohorts are needed to gain a comprehensive profile of the biochemical patterns of hypoglycemia in such defects and eventually guide targeted therapeutic interventions.
Collapse
Affiliation(s)
- Evelina Maines
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'oro, 9, 38122, Trento, Italy.
| | - Roberto Franceschi
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'oro, 9, 38122, Trento, Italy
| | - Diego Martinelli
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fiorenza Soli
- Division of Medical Genetics, S. Chiara General Hospital, Trento, Italy
| | | | - Giovanni Piccoli
- CIBIO - Centre for Integrative Biology, Università Degli Studi Di Trento, Italy & Dulbecco Telethon Institute, Trento, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'oro, 9, 38122, Trento, Italy
| |
Collapse
|
20
|
Cavallin F, Doglioni N, Allodi A, Battajon N, Vedovato S, Capasso L, Gitto E, Laforgia N, Paviotti G, Capretti MG, Gizzi C, Villani PE, Biban P, Pratesi S, Lista G, Ciralli F, Soffiati M, Staffler A, Baraldi E, Trevisanuto D. Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study. Arch Dis Child Fetal Neonatal Ed 2021; 106:572-577. [PMID: 33597230 DOI: 10.1136/archdischild-2020-320567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/29/2020] [Accepted: 01/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed. OBJECTIVE To compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth. STUDY DESIGN AND SETTING Multicentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals. PARTICIPANTS Infants with estimated birth weight <1500 g and/or gestational age <30+6 weeks. INTERVENTION Thermal management with or without a thermal servo-controlled system during stabilisation in the delivery room. PRIMARY OUTCOME Proportion of normothermia at NICU admission (axillary temperature 36.5°C-37.5°C). RESULTS At NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36°C-36.4°C) (risk ratio 1.48, 95% CI 1.09 to 2.01). CONCLUSIONS In very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge. TRIAL REGISTRATION NUMBER NCT03844204.
Collapse
Affiliation(s)
| | - Nicoletta Doglioni
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | | | - Nadia Battajon
- Pediatric Department, Ospedale Regionale Ca Foncello Treviso, Treviso, Veneto, Italy
| | - Stefania Vedovato
- Pediatric Department, Ospedale San Bortolo di Vicenza, Vicenza, Veneto, Italy
| | - Letizia Capasso
- Translational Medical Sciences, University "Federico II", Napoli, Italy
| | - Eloisa Gitto
- Department of Pediatrics, University of Messina, Neonatal Intensive Care Unit, Messina, Italy
| | | | - Giulia Paviotti
- Department of Neonatology, Azienda Ospedaliera Universitaria Integrata di Udine, Udine, Italy
| | - Maria Grazia Capretti
- Department of Medical and Surgical Sciences, Operative Unit of Neonatology, University of Bologna, Bologna, Italy
| | - Camilla Gizzi
- NICU, "S. Giovanni Calibita" Hospital - Fatebenefratelli Isola Tiberina, Rome, Italy
| | | | - Paolo Biban
- Department of Pediatrics, PICU-NICU, University Hospital of Verona, Verona, Italy
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital, Florence, Italy
| | - Gianluca Lista
- Department of Pediatrics, Ospedale dei Bambini "V.Buzzi", Milano, Italy
| | - Fabrizio Ciralli
- Dipartimento Donna-Bambino-Neonato, Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
| | - Alex Staffler
- Division of Neonatology, Azienda Sanitaria dell'Alto Adige di Bolzano, Bolzano, Italy
| | - Eugenio Baraldi
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | | |
Collapse
|
21
|
Urru SAM, Maines E, Campomori A, Soffiati M. Safety of Sars-Cov-2 vaccines administration for adult patients with hereditary fructose intolerance. Hum Vaccin Immunother 2021; 17:4112-4114. [PMID: 34197272 DOI: 10.1080/21645515.2021.1943992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Silvana A M Urru
- Hospital Pharmacy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Evelina Maines
- Pediatric Unit, Department of Women's and Children's Health, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Annalisa Campomori
- Hospital Pharmacy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Massimo Soffiati
- Pediatric Unit, Department of Women's and Children's Health, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| |
Collapse
|
22
|
Bulfamante GP, Carpenito L, Bragantini E, Graziani S, Bellizzi M, Bagowski CP, Shoukier M, Rivieri F, Soffiati M, Barbareschi M. Generalized Arterial Calcification of Infancy Type 1 (GACI1): Identification of a Novel Pathogenic Variant (c.1715T>C (p.Leu572Ser)). Diagnostics (Basel) 2021; 11:diagnostics11061034. [PMID: 34199854 PMCID: PMC8229691 DOI: 10.3390/diagnostics11061034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/29/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022] Open
Abstract
Generalized Arterial Calcification of Infancy (GACI) is a rare disease inherited in a recessive manner, with severe and diffuse early onset of calcifications along the internal elastic lamina in large and medium size arteries. The diagnosis results are from clinical manifestations, imaging, histopathologic exams, and genetic tests. GACI is predominantly caused by biallelic pathogenic variant in the ENPP1 gene (GACI1, OMIM#208000) and, to a lesser extent, by pathogenic variants in the ABCC6 gene (GACI2, OMIM#614473). We present a novel variation in the ENPP1 gene identified in a patient clinically diagnosed with GACI and confirmed by genetic investigation and autopsy as GACI type 1. The sequence analysis of the patient's ENPP1 gene detected two heterozygous variants c.1412A>G (p.Tyr471Cys) and c.1715T>C (p.Leu572Ser). The variant c.1715T>C (p.Leu572Ser) has not been described yet in the literature and in mutation databases. A genetic analysis was also carried out for the parents of the newborn; the heterozygous pathogenic variant c.1412A>G (p.Tyr471Cys) was detected in the mother's ENPP1 gene, and a sequence analysis of the father's ENPP1 gene revealed the novel heterozygous variant c.1715T>C (p.Leu572Ser). Our results showed that the variant c.1715T>C (p.Leu572Ser) may have a pathogenic role in the development of GACI type1 (GACI1, OMIM#208000), at least when associated with the pathogenic c.1412A>G (p.Tyr471Cys) variant. The identification of novel mutations potentially enabled genotype/phenotype associations that will ultimately have an impact on clinical management and prognosis for the disease.
Collapse
Affiliation(s)
- Gaetano Pietro Bulfamante
- Human Pathology and Medical Genetic Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, 20142 Milan, Italy;
| | - Laura Carpenito
- School of Pathology, University of Milan, 20122 Milan, Italy
- Correspondence:
| | - Emma Bragantini
- Department of Pathology, Santa Chiara Hospital, 38122 Trento, Italy; (E.B.); (M.B.)
| | | | - Maria Bellizzi
- Department of Pediatrics, Santa Chiara Hospital, 38122 Trento, Italy; (M.B.); (M.S.)
| | - Christoph Peter Bagowski
- Prenatal Medicine Münich, Department of Molecular Genetics, University Hospital, Aiblingerstr. 8, 80639 Münich, Germany; (C.P.B.); (M.S.)
| | - Moneef Shoukier
- Prenatal Medicine Münich, Department of Molecular Genetics, University Hospital, Aiblingerstr. 8, 80639 Münich, Germany; (C.P.B.); (M.S.)
| | - Francesca Rivieri
- Medical Genetic Service, Santa Chiara Hospital, 38122 Trento, Italy;
| | - Massimo Soffiati
- Department of Pediatrics, Santa Chiara Hospital, 38122 Trento, Italy; (M.B.); (M.S.)
| | - Mattia Barbareschi
- Department of Pathology, Santa Chiara Hospital, 38122 Trento, Italy; (E.B.); (M.B.)
| |
Collapse
|
23
|
Franceschi R, Rizzardi C, Maines E, Liguori A, Soffiati M, Tornese G. Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting. Ital J Pediatr 2021; 47:62. [PMID: 33691756 PMCID: PMC7945305 DOI: 10.1186/s13052-021-01017-4] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/02/2021] [Indexed: 12/05/2022] Open
Abstract
Background Failure to thrive is a common reason for referral to paediatric services. Malnutrition or inadequate caloric intake is the most common cause, while organic form is unlikely in children who are asymptomatic and healthy on examination. By this study we evaluate the application of a cost-effective flow chart that helps the clinician in a hospital setting discern accurately organic and non-organic failure to thrive. Methods Conduct a prospective single-center study in children up to 2 years of age with growth faltering. The pediatricians used a practical flow chart, took the medical history, created a growth chart, performed clinical examinations, and requested blood test and consultations in a step by step approach. Results Among the 74 subjects included in the study, the diagnosis of organic failure to thrive was reached by 42%. Gastrointestinal and genetic diagnoses were the most frequent. Patients with organic failure to thrive had significantly lower gestational age and birth weight. Age at diagnosis and Z-score weight were lower in organic than in non-organic forms. Most patients with non-organic forms (88%) did not undergo in-depth blood test or specialist advice. Conclusion The flow chart we presented was accurate for diagnosing children with failure to thrive in a hospital setting and distinct organic and non-organic forms. It was cost-effective to avoid unnecessary blood test or consultations in most non-organic diagnoses.
Collapse
Affiliation(s)
- Roberto Franceschi
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy.
| | - Caterina Rizzardi
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Evelina Maines
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Alice Liguori
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, Largo Medaglie d'Oro, 9, 38122, Trento, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| |
Collapse
|
24
|
Franceschi R, Micheli F, Mozzillo E, Cauvin V, Liguori A, Soffiati M, Giani E. Intermittently Scanned and Continuous Glucose Monitor Systems: A Systematic Review on Psychological Outcomes in Pediatric Patients. Front Pediatr 2021; 9:660173. [PMID: 34026692 PMCID: PMC8131655 DOI: 10.3389/fped.2021.660173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
Aim: To explore the impact of real-time continuous glucose monitoring (rtCGMs) or intermittently scanned/viewed CGM (isCGM) on psychological outcomes in children and caregivers, and to grade the level of evidence. Method: Systematic review of the literature from PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Nursing reference center, Up to date, Google Scholar, and PsycINFO databases. The studies selected used validated questionnaires for investigating the psychological outcomes. We applied GRADE (Grading of Recommendations Assessment, Development and Evaluation) to rank the quality of a body of evidence. Results: A total of 192 studies were identified in the initial search and after the process of evaluation 25 studies were selected as appropriate to be included in this systematic review. We found in moderate quality studies that isCGM in adolescents can improve diabetes related distress, family conflicts, fear of hypoglycemia, and quality of life, while depression, anxiety, and quality of sleep have not yet been evaluated by validated questionnaires. In moderate-high quality studies, rtCGM technology does not impact on diabetes burden, diabetes specific family conflict, and depressive symptoms. The effect on fear of hypoglycemia, sleep quality, and anxiety is still debated and RCT studies powered to find significant results in psychological outcomes are lacking. RtCGM increases satisfaction and quality of life in parents and patients wearing rtCGM. Conclusion: these data present an interesting point to consider when families are deciding whether or not to start CGM use, choosing between rtCGM to reach a tighter metabolic control, or isCGM which allows greater benefits on psychological outcomes.
Collapse
Affiliation(s)
| | | | - Enza Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | | | | | | | - Elisa Giani
- Humanitas Clinical and Research Center, Rozzano, Italy
| |
Collapse
|
25
|
Franceschi R, Rizzardi C, Cauvin V, Berchielli F, Liguori A, Soffiati M. Carbohydrate Restriction and Growth Failure in Two Children with Type 1 Diabetes: A Case Report. Dubai Diabetes Endocrinol J 2020. [DOI: 10.1159/000510819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Variety of media have popularized restrictive diets in diabetes mellitus reporting that carbohydrates are the cause of glycemic excursion, excessive insulin dosage, and weight gain. We report 2 cases of children with type 1 diabetes where adherence to restricted carbohydrate diets caused growth failure. Two prepubertal patients with type 1 diabetes presented at follow-up visit during the honeymoon period with no weight increase and low height velocity. Dietetic evaluation revealed a low-carbohydrate diet had been introduced in an attempt to achieve less postprandial excursions in the blood glucose readings. The 2 patients started to improve weight and height when the appropriate amount of carbohydrates was given. There are few published data to support not to restrict carbohydrate; therefore, we report 2 cases of children with type 1 diabetes where adherence to this diet caused growth failure. We want to emphasize the importance of educating families of children with type 1 diabetes on this aspect, particularly when they are in the honeymoon phase or this one is concluding.
Collapse
|
26
|
Bolognani M, Morelli PD, Scolari I, Dolci C, Fiorito V, Uez F, Graziani S, Stefani B, Zeni F, Gobber G, Bravi E, Tateo S, Soffiati M. Development of a Perinatal Palliative Care Model at a Level II Perinatal Center Supported by a Pediatric Palliative Care Network. Front Pediatr 2020; 8:574397. [PMID: 33520884 PMCID: PMC7845291 DOI: 10.3389/fped.2020.574397] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022] Open
Abstract
Objective: To describe the model build up to take care of fetuses and newborns eligible to perinatal palliative care (PnPC) followed in an Italian II level perinatal center. Methods: Retrospective chart review of all fetuses and newborn infants eligible to PnPC admitted to level II perinatal center within a 4 years period. Results: Forty-five of 848 infants (0.5%) referred to II level NICU were eligible to PnPC. Twenty-seven percentage had fetal diagnosis. Twenty percentage were preterm infants at the limit of viability, 35% were newborns with life limiting or life threatening disease diagnosed in utero or at the postnatal ward, 45% were newborns not responding to intensive care intervention with high health care needs or medical complexity. Fifty-seven percentage of neonates admitted to NICU died before discharge, while 16 (35% of population considered) were discharged home. Median age at death was 4 days after birth, and delivery room death immediately after birth occurred in six patients (13%). Conclusions: Despite the paucity of our population and the high variability in disease trajectories the perinatal palliative care program build up in our region provides a reproducible method for a structured taking in charge of fetuses and neonates eligible to PnPC and their families, from the time of diagnosis to bereavement, in both outpatient and inpatient settings.
Collapse
Affiliation(s)
- Marco Bolognani
- Department of Neonatology, Santa Chiara Hospital, Trento, Italy.,Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | | | - Isabella Scolari
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Cristina Dolci
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | | | - Francesca Uez
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Silvia Graziani
- Department of Neonatology, Santa Chiara Hospital, Trento, Italy
| | - Barbara Stefani
- Department of Neonatology, Santa Chiara Hospital, Trento, Italy.,Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Francesca Zeni
- Department of Neonatology, Santa Chiara Hospital, Trento, Italy.,Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Gino Gobber
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Elena Bravi
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Saverio Tateo
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | | |
Collapse
|
27
|
Ferretti P, Pasolli E, Tett A, Asnicar F, Gorfer V, Fedi S, Armanini F, Truong DT, Manara S, Zolfo M, Beghini F, Bertorelli R, De Sanctis V, Bariletti I, Canto R, Clementi R, Cologna M, Crifò T, Cusumano G, Gottardi S, Innamorati C, Masè C, Postai D, Savoi D, Duranti S, Lugli GA, Mancabelli L, Turroni F, Ferrario C, Milani C, Mangifesta M, Anzalone R, Viappiani A, Yassour M, Vlamakis H, Xavier R, Collado CM, Koren O, Tateo S, Soffiati M, Pedrotti A, Ventura M, Huttenhower C, Bork P, Segata N. Mother-to-Infant Microbial Transmission from Different Body Sites Shapes the Developing Infant Gut Microbiome. Cell Host Microbe 2018; 24:133-145.e5. [PMID: 30001516 PMCID: PMC6716579 DOI: 10.1016/j.chom.2018.06.005] [Citation(s) in RCA: 640] [Impact Index Per Article: 106.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/17/2018] [Accepted: 06/14/2018] [Indexed: 02/08/2023]
Abstract
The acquisition and development of the infant microbiome are key to establishing a healthy host-microbiome symbiosis. The maternal microbial reservoir is thought to play a crucial role in this process. However, the source and transmission routes of the infant pioneering microbes are poorly understood. To address this, we longitudinally sampled the microbiome of 25 mother-infant pairs across multiple body sites from birth up to 4 months postpartum. Strain-level metagenomic profiling showed a rapid influx of microbes at birth followed by strong selection during the first few days of life. Maternal skin and vaginal strains colonize only transiently, and the infant continues to acquire microbes from distinct maternal sources after birth. Maternal gut strains proved more persistent in the infant gut and ecologically better adapted than those acquired from other sources. Together, these data describe the mother-to-infant microbiome transmission routes that are integral in the development of the infant microbiome.
Collapse
Affiliation(s)
- Pamela Ferretti
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy; European Molecular Biology Laboratory, Structural and Computational Biology Unit, 69117 Heidelberg, Germany
| | - Edoardo Pasolli
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | - Adrian Tett
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | - Francesco Asnicar
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | | | - Sabina Fedi
- Azienda Provinciale per i Servizi Sanitari, 38123 Trento, Italy
| | - Federica Armanini
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | - Duy Tin Truong
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | - Serena Manara
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | - Moreno Zolfo
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | - Francesco Beghini
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | - Roberto Bertorelli
- NGS Facility, Laboratory of Biomolecular Sequence and Structure Analysis for Health, Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | - Veronica De Sanctis
- NGS Facility, Laboratory of Biomolecular Sequence and Structure Analysis for Health, Centre for Integrative Biology, University of Trento, 38123 Trento, Italy
| | | | - Rosarita Canto
- Azienda Provinciale per i Servizi Sanitari, 38123 Trento, Italy
| | | | - Marina Cologna
- Azienda Provinciale per i Servizi Sanitari, 38123 Trento, Italy
| | - Tiziana Crifò
- Azienda Provinciale per i Servizi Sanitari, 38123 Trento, Italy
| | | | | | | | - Caterina Masè
- Azienda Provinciale per i Servizi Sanitari, 38123 Trento, Italy
| | - Daniela Postai
- Azienda Provinciale per i Servizi Sanitari, 38123 Trento, Italy
| | - Daniela Savoi
- Azienda Provinciale per i Servizi Sanitari, 38123 Trento, Italy
| | - Sabrina Duranti
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | - Gabriele Andrea Lugli
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | - Leonardo Mancabelli
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | - Francesca Turroni
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | - Chiara Ferrario
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | - Christian Milani
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | - Marta Mangifesta
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy; GenProbio srl, 43124 Parma, Italy
| | - Rosaria Anzalone
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | | | - Moran Yassour
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Hera Vlamakis
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Ramnik Xavier
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Carmen Maria Collado
- Institute of Agrochemistry and Food Technology, National Research Council, Paterna, 46980 Valencia, Spain
| | - Omry Koren
- Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
| | - Saverio Tateo
- Azienda Provinciale per i Servizi Sanitari, 38123 Trento, Italy
| | | | - Anna Pedrotti
- Azienda Provinciale per i Servizi Sanitari, 38123 Trento, Italy
| | - Marco Ventura
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | - Curtis Huttenhower
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Peer Bork
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, 69117 Heidelberg, Germany
| | - Nicola Segata
- Centre for Integrative Biology, University of Trento, 38123 Trento, Italy.
| |
Collapse
|
28
|
Pertile R, Pavanello L, Soffiati M, Manica L, Piffer S. Length of stay for childbirth in Trentino (North-East of Italy): the impact of maternal characteristics and organizational features of the maternity unit on the probability of early discharge of healthy, term infants. Eur J Pediatr 2018; 177:155-159. [PMID: 29116396 DOI: 10.1007/s00431-017-3035-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/20/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Early discharge (ED) of healthy term infants has become a common practice due to current social and economic needs. The primary objective of the present study was to evaluate trends in early discharge of healthy term neonates (≥ 37 gestational weeks) by delivery method (cesarean and vaginal) in maternity units in the Province of Trento. The secondary objective was to identify the socio-demographic characteristics (including the area of residence and distance from the designated hospital) and clinical characteristics of mothers whose infants were discharged early. This retrospective study reviewed records of live births from 2006 to 2016, for a total of 45, 314 healthy term infants. The trend for ED grew significantly during the period 2006-2016, for both cesarean and vaginal deliveries. The multiple logistic regression analysis shows how the determinants of ED are maternal age, birth order, citizenship of mother, maternal smoking, maternal employment status, and the number of births at the hospital on the day of birth. CONCLUSION The post-partum length of stay should be adjusted based on the characteristics and needs of the mother-infant dyad, identifying the criteria for safe discharge. In Trento, various procedures and programs are becoming more uniform today with the intention to provide family assistance service. What is Known: • Admission for childbirth is one of the primary causes of hospitalization in industrialized countries. • The length of stay for childbirth has been steadily declining in recent decades, with the aim of reducing costs while also demedicalizing pregnancy. What is New: • A higher rate of early discharge (ED) was recorded for neonates of women having foreign citizenship, < 30 years, pluriparous, smoked during pregnancy, housewife, and, if emplyed, entrepreneurs, self-employed professionals or managers. • ED was more common when the new mother gave birth on a day in which there was a higher number of births at the hospital, indicating overcrowding in the maternity unit.
Collapse
Affiliation(s)
- Riccardo Pertile
- Clinical and Evaluative Epidemiology Department, Trento Health Service, Viale Verona, 38123, Trento, Italy.
| | - Lucia Pavanello
- Neonatal Unit, Trento Health Service, Largo Medaglie d'Oro 9, 38122, Trento, Italy
| | - Massimo Soffiati
- Neonatal Unit, Trento Health Service, Largo Medaglie d'Oro 9, 38122, Trento, Italy
| | - Laura Manica
- Maternal and child health clinic of Rovereto, Trento Health Service, Via San Giovanni Bosco 10, 38068, Rovereto, TN, Italy
| | - Silvano Piffer
- Clinical and Evaluative Epidemiology Department, Trento Health Service, Viale Verona, 38123, Trento, Italy
| |
Collapse
|
29
|
Duranti S, Lugli GA, Mancabelli L, Armanini F, Turroni F, James K, Ferretti P, Gorfer V, Ferrario C, Milani C, Mangifesta M, Anzalone R, Zolfo M, Viappiani A, Pasolli E, Bariletti I, Canto R, Clementi R, Cologna M, Crifò T, Cusumano G, Fedi S, Gottardi S, Innamorati C, Masè C, Postai D, Savoi D, Soffiati M, Tateo S, Pedrotti A, Segata N, van Sinderen D, Ventura M. Maternal inheritance of bifidobacterial communities and bifidophages in infants through vertical transmission. Microbiome 2017; 5:66. [PMID: 28651630 PMCID: PMC5485682 DOI: 10.1186/s40168-017-0282-6] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/05/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND The correct establishment of the human gut microbiota represents a crucial development that commences at birth. Different hypotheses propose that the infant gut microbiota is derived from, among other sources, the mother's fecal/vaginal microbiota and human milk. RESULTS The composition of bifidobacterial communities of 25 mother-infant pairs was investigated based on an internal transcribed spacer (ITS) approach, combined with cultivation-mediated and genomic analyses. We identified bifidobacterial strains/communities that are shared between mothers and their corresponding newborns. Notably, genomic analyses together with growth profiling assays revealed that bifidobacterial strains that had been isolated from human milk are genetically adapted to utilize human milk glycans. In addition, we identified particular bacteriophages specific of bifidobacterial species that are common in the viromes of mother and corresponding child. CONCLUSIONS This study highlights the transmission of bifidobacterial communities from the mother to her child and implies human milk as a potential vehicle to facilitate this acquisition. Furthermore, these data represent the first example of maternal inheritance of bifidobacterial phages, also known as bifidophages in infants following a vertical transmission route.
Collapse
Affiliation(s)
- Sabrina Duranti
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 11a, 43124, Parma, Italy
| | - Gabriele Andrea Lugli
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 11a, 43124, Parma, Italy
| | - Leonardo Mancabelli
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 11a, 43124, Parma, Italy
| | | | - Francesca Turroni
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 11a, 43124, Parma, Italy
| | - Kieran James
- APC Microbiome Institute and School of Microbiology, Bioscience Institute, National University of Ireland, Cork, Ireland
| | - Pamela Ferretti
- Centre for Integrative Biology, University of Trento, Trento, Italy
| | | | - Chiara Ferrario
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 11a, 43124, Parma, Italy
| | - Christian Milani
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 11a, 43124, Parma, Italy
| | | | - Rosaria Anzalone
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 11a, 43124, Parma, Italy
| | - Moreno Zolfo
- Centre for Integrative Biology, University of Trento, Trento, Italy
| | | | - Edoardo Pasolli
- Centre for Integrative Biology, University of Trento, Trento, Italy
| | | | - Rosarita Canto
- Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | | | - Marina Cologna
- Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Tiziana Crifò
- Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | | | - Sabina Fedi
- Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | | | | | - Caterina Masè
- Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Daniela Postai
- Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Daniela Savoi
- Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | | | - Saverio Tateo
- Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Anna Pedrotti
- Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Nicola Segata
- Centre for Integrative Biology, University of Trento, Trento, Italy
| | - Douwe van Sinderen
- APC Microbiome Institute and School of Microbiology, Bioscience Institute, National University of Ireland, Cork, Ireland
| | - Marco Ventura
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 11a, 43124, Parma, Italy.
| |
Collapse
|
30
|
Zampieri N, Pietrobelli A, Biban P, Soffiati M, Dall'agnola A, Camoglio FS. Lactobacillus paracasei subsp. paracasei F19 in Bell's stage 2 of necrotizing enterocolitis. Minerva Pediatr 2013; 65:353-360. [PMID: 24051968] [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
AIM The aim of this trial is to evaluate the role Lactobacillus paracasei in Bell's stage 2 in order to prevent the clinical progression to stage 3. METHODS A prospective study was approved and started in December 2008. Patients were infants with birth weight 600 to 1500 g. One group received probiotic supplementation (L. paracasei susp.paracasei F-19) and the control group received only standard medical treatment. The primary outcome was the progression to stage 3 as defined by Bell's modified criteria. Inclusion and exclusion criteria were created and discussed with parents before treatment. RESULTS Thirty-two patients (stage 2 NEC) were considered eligible for the study. Group A: 18 patients and Group B: 14 patients. Three patients in group A and six patients in group B had a clinical history of Bell's stage 3 NEC (P<0.05); oral supplementation of L. paracasei reduced the clinical progression of NEC. It was considered that an improvement in intestinal motility might have contributed to this result. CONCLUSION The use of Lactobacillus paracasei subsp. paracasei F-19 is safe; the low progression rate to stage 3 NEC suggests that the use of this probiotic in stage 2 NEC could be a valuable therapeutic option.
Collapse
Affiliation(s)
- N Zampieri
- Department of Anesthetic and Surgical Sciences Pediatric Surgical Unit University of Verona, Verona, Italy -
| | | | | | | | | | | |
Collapse
|
31
|
Biban P, Serra A, Polese G, Soffiati M, Santuz P. Neurally adjusted ventilatory assist: a new approach to mechanically ventilated infants. J Matern Fetal Neonatal Med 2011; 23 Suppl 3:38-40. [PMID: 20828233 DOI: 10.3109/14767058.2010.510018] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neurally adjusted ventilator assist (NAVA) is a new mode of partial ventilatory support, in which neural inspiratory activity is monitored through the continuous esophageal recording of the electrical activity of the diaphragm. Assistance is triggered and cycled off in according to this signal and is delivered in proportion to its intensity. NAVA can improve patient-ventilator synchrony while maintaining spontaneous breathing. Small preliminary studies have shown that NAVA can be successfully used also in term and preterm infants, being safe and well tolerated. However, much additional work is still needed before NAVA can be recommended in the everyday practice of the neonatologist.
Collapse
Affiliation(s)
- Paolo Biban
- Neonatal and Paediatric Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | | | | | | | | |
Collapse
|
32
|
Soffiati M, Bonaldi A, Biban P. [Management of pleural drainage]. Minerva Pediatr 2010; 62:165-167. [PMID: 21090089] [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
In the neonatal population, pleural effusion and particularly tension pneumothorax can be a deadly situation. Pneumothorax occurs more often in the neonatal period that any other time of life. Tension pneumothorax can result in very high pressures within the pleural space, collapsing the lung on the involved side and resulting in immediate hypoxia, hypercapnia and subsequent circulatory collapse. For these reasons, the ability to recognize, understand and treat these pathologies is essential for neonatal health and a good outcome. Neonates have many factors that can contribute to. these problems. These include respiratory distress syndrome, mechanical ventilation, sepsis, pneumonia, aspiration of meconium, congentital malformation, hydrothorax, congenital or acquired chylothorax. The diagnosis can be made by clinical examination, transillumination (pneumothorax) and chest x-ray. Besides, lung ultrasound constitutes a visual medicine and provides a transparent approach to the acutely ill patient, newborn included, guiding diagnosis, management and care. Newborns with moderate to severe symptoms and those receiving positive pressure ventilation require tube thoracostomy. If a tension pneumothorax is suspected, emergency needle decompression in the second intercostal space in the midclavicular line is required. In this article, we describe the management of tube thoracostomy using trocar tubes or pigtail catheters. Besides, we pay attention to the use of pain control for neonates undergoing painful procedures such as chest tube insertion.
Collapse
Affiliation(s)
- M Soffiati
- Terapia Intensiva Pediatrica e Neonatale, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | | | | |
Collapse
|
33
|
Abstract
Cardiopulmonary resuscitation (CPR) is necessary in about 1-2% of all newly born infants in their first minutes of life. However, CPR may also be needed in newborns beyond the time of birth, particularly in high risk categories of infants admitted in the NICU or in other less specialised units. In all these scenarios, the role of nurses is essential for several aspects, including early recognition of a deteriorating infant, with the aim to prevent cardiac arrest, as well as the starting of immediate basic life support manoeuvres at the bedside, whenever needed. Furthermore, nurses have a special part in family care during cardiopulmonary resuscitation.
Collapse
Affiliation(s)
- Paolo Biban
- Neonatal and Paediatric Intensive Care Unit, Division of Paediatrics, Major City Hospital, Verona, Italy.
| | | | | |
Collapse
|
34
|
Furia S, Biban P, Benedetti M, Terzi A, Soffiati M, Calabrò F. Postpneumonectomy-like syndrome in an infant with right lung agenesis and left main bronchus hypoplasia. Ann Thorac Surg 2009; 87:e43-5. [PMID: 19379854 DOI: 10.1016/j.athoracsur.2009.02.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 02/05/2009] [Accepted: 02/09/2009] [Indexed: 11/15/2022]
Abstract
We report a 1-year-old child born with agenesis of the right lung who sustained an episode of acute respiratory failure related to a postpneumonectomy-like syndrome, with severe mediastinal shift and subsequent stretching and stenosis of the left main bronchus. The insertion of an expandable prosthesis in the right empty pleural space markedly improved the patient's clinical condition.
Collapse
Affiliation(s)
- Simone Furia
- Division of Thoracic Surgery, Major City Hospital, Verona, Italy
| | | | | | | | | | | |
Collapse
|
35
|
Santuz P, Soffiati M, Dorizzi RM, Benedetti M, Zaglia F, Biban P. Procalcitonin for the diagnosis of early-onset neonatal sepsis: A multilevel probabilistic approach. Clin Biochem 2008; 41:1150-5. [DOI: 10.1016/j.clinbiochem.2008.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 05/24/2008] [Accepted: 05/30/2008] [Indexed: 02/06/2023]
|
36
|
Santuz P, Soffiati M, Benedetti M, Biban P. Comment on "A new device for administration of continuous positive airway pressure in preterm infants" by Trevisanuto et al. Intensive Care Med 2005; 31:1732-3; author reply 1731. [PMID: 16283169 DOI: 10.1007/s00134-005-2840-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2005] [Indexed: 11/30/2022]
|
37
|
Biban P, Cavalli C, Santuz P, Soffiati M, Rugolotto S, Zangardi T. [Positioning of umbilical vein catheter with ECG-guided technique: randomized study]. Acta Biomed Ateneo Parmense 2001; 71 Suppl 1:647-50. [PMID: 11424822] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
GOAL To evaluate the effectiveness of electrocardiography-guided technique to aid in the correct positioning of umbilical vein catheters. DESIGN A prospective, randomized controlled study. METHODS Term and preterm newborns who required an umbilical venous catheter were managed by an ECG-guided technique (group A) or by a conventional method (group B). Correct positioning was defined by a chest-X-ray when the catheter tip was located above the diaphragm and outside the right atrium. For the ECG-guided technique we utilized a conductive device Vygocard (Medival, Padova) inserted in a 3-way stopcock connected with the catheter. The catheter was inserted under ECG observation until the appearance of a tall P-wave in lead III, which indicated the tip was within the right atrium. The catheter was then withdrawn until the P wave size returned to normal. RESULTS We enrolled 44 patients (16 F, 28 M). Median gestational age (GA) and birth weight (BW) were 34 weeks (range 26-41) and 2130 g. (590-3870), respectively. Sex distribution, GA, BW and Apgar scores were not different between patients in group A (n = 22) and group B (n = 22). Catheters could not be advanced till the estimated insertion depth in 11 patients (A = 5, B = 6). In the remaining 33 patients, correct tip placement was more frequent in group A (88%) compared with group B (50%) (p = 0.021 by Fisher's exact test). No side effects specific to the ECG-guided method were noted. CONCLUSIONS The ECG-guided technique seems to be a safe and effective method for the proper placement of umbilical vein catheters in newborns.
Collapse
Affiliation(s)
- P Biban
- Cattedra e Divisione di Pediatria, Ospedale Civile Maggiore, Università di Verona
| | | | | | | | | | | |
Collapse
|
38
|
Tosi G, Brunelli S, Mantero G, Magalini AR, Soffiati M, Pinelli L, Tridente G, Accolla RS. The complex interplay of the DQB1 and DQA1 loci in the generation of the susceptible and protective phenotype for insulin-dependent diabetes mellitus. Mol Immunol 1994; 31:429-37. [PMID: 8183282 DOI: 10.1016/0161-5890(94)90062-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 01/29/2023]
Abstract
IDDM patients of North East Italian region were molecularly typed for their HLA-DQB1 and DQA1 loci by using allele specific oligonucleotide probes and PCR amplified genomic DNA. IDDM status strongly correlated with DQB1 alleles carrying a non-aspartic acid residue in position 57 of DQ beta chain and DQA1 alleles with an arginine residue in position 52 of DQ alpha chain. Genotype analysis revealed that individuals with two DQB1 alleles having a non-aspartic residue in position 57 and two DQA1 alleles with an arginine residue in position 52 had the highest relative risk of disease: they constituted 41% of IDDM patients as compared to 0% of controls. Heterozygosity either at residue 57 of DQB1 or residue 52 of DQA1 was sufficient to abrogate statistical significance for disease association, although 43.6% of IDDM patients were included in these two groups as compared to 21.6% of normal controls. On the other hand the presence of two DQB1 alleles with aspartic acid in position 57 was sufficient to confer resistance to disease irrespective of the DQA1 genotype. Based on the number of possible susceptible heterodimers an individual can form, it was found that 85% of IDDM cases could form two or more heterodimers (two in cis and two in trans), but no IDDM case was found to form one susceptible heterodimer in cis. These results demonstrate that the complete HLA-DQ genotype, more than single DQB1 or DQA1 alleles or DQB1-DQA1 haplotypes, is associated with the highest risk of disease. Screening of the population for preventive purposes and/or early signs of IDDM should then take advantage of this result and "susceptible homozygous" individuals should be followed very closely and considered the first group of choice for possible new therapeutical trials.
Collapse
Affiliation(s)
- G Tosi
- Istituto di Immunologia e Malattie Infettive, Facoltà di Medicina e Chirurgia, Università di Verona, Italy
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Tosi G, Mantero G, Magalini AR, Primi D, Soffiati M, Pinelli L, Sartoris S, Tridente G, Accolla RS. HLA-DQB1 typing of north east Italian IDDM patients using amplified DNA, oligonucleotide probes and a rapid DNA-enzyme immunoassay (DEIA). Mol Immunol 1993; 30:69-76. [PMID: 8417376 DOI: 10.1016/0161-5890(93)90427-d] [Citation(s) in RCA: 9] [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: 01/30/2023]
Abstract
We report on HLA-DQB1 typing in IDDM patients of north east Italian region using an enzymatic method based on the detection of hybridization reaction between PCR amplified DNA from whole blood and allele specific oligonucleotides by an antibody directed against double stranded DNA (DNA-enzyme immunoassay or DEIA). The method is reliable, simple and sensitive as the classical radioactive method with the advantage of using a universal non radioactive detection reagent. Nineteen families, each including one subject with juvenile insulin-dependent diabetes mellitus (IDDM) were analyzed. A strong association between absence of an aspartic acid (Asp) in position 57 of DQB1 beta chain in homozygous conditions and susceptibility to IDDM was found. In contrast with some previous observations, however, no significant association was found between Asp/non-Asp heterozygous genotype and IDDM. No patients were found with an homozygous Asp/Asp genotype, known to be protective in caucasoid population. Of particular interest was the DQB1 allelic distribution in our population sample. The non-Asp allele most frequently found in IDDM subjects was the DQB1 0201 allele and this finding was statistically significant (Pc value < 0.05, relative risk = 5.01). No significant association was found for any other allele including the DQB1 0302 (Pc value = not significant although with relative risk = 3.28) previously reported as the most frequent allele in IDDM caucasoid patients.
Collapse
Affiliation(s)
- G Tosi
- Istituto di Scienze Immunologiche e Malattie Infettive, Policlinico Borgo Roma, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Blood levels of glucose, insulin (IRI), Calcium (Ca), phosphorus (P), alkaline phosphatase (AP), osteocalcin (OC), parathyroid hormone (PTH), calcitonin (CT), 25-hydroxyvitamin D3 (25OHD3), 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and urinary excretion of Ca (Ca/Cr), P (TmP/GFR), hydroxyproline (OH-P/Cr) and cyclic AMP (cAMP/GFR) were determined in 16 obese children, aged 8 to 11 years, on a diet rich in calories and carbohydrates and in 15 controls of the same age. Blood glucose, IRI, Ca, P, PTH and CT were also determined in both groups of subjects, during an oral glucose tolerance test (OGTT). In basal conditions glucose, IRI, AP, OC, PTH, CT and 1,25(OH)2D3 levels were significantly higher, and 25OHD3 levels lower, in obese children than in controls. Urinary Ca/Cr, TmP/GFR were lower in obese than in non obese children, while OH-P/Cr and cAMP/GFR were higher. Bone mineral content (BMC), measured by photon absorptiometry, and BMC/bone width ratio were lower in obese than in non obese children. During OGTT serum Ca and P decreased and serum PTH and CT increased less in obese than in non obese children. In obese children receiving a diet with high carbohydrate content, an alteration of mineral metabolism occurred, characterized by secondary increase of PTH and 1,25(OH)2D3. Ca decreased and PTH and CT increased less markedly during OGTT.
Collapse
Affiliation(s)
- G Zamboni
- Paediatric University Clinic, Verona, Italy
| | | | | | | |
Collapse
|