1
|
Rizzi M, Avellis V, Messina A, Germano C, Tavella E, Dodaro V, Vitale R, Revelli A, Zola P, Picone S, Paolillo PM, Mondì V, Masturzo B, Manzoni P, Sainaghi PP. Vitamin D Supplementation in Neonatal and Infant MIS-C Following COVID-19 Infection. Int J Mol Sci 2024; 25:3712. [PMID: 38612523 PMCID: PMC11011671 DOI: 10.3390/ijms25073712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
To date, the SARS-CoV-2 pandemic still represents a great clinical challenge worldwide, and effective anti-COVID-19 drugs are limited. For this reason, nutritional supplements have been investigated as adjuvant therapeutic approaches in disease management. Among such supplements, vitamin D has gained great interest, due to its immunomodulatory and anti-inflammatory actions both in adult and pediatric populations. Even if there is conflicting evidence about its prevention and/or mitigation effectiveness in SARS-CoV-2 infection, several studies demonstrated a strict correlation between hypovitaminosis D and disease severity in acute COVID-19 and MIS-C (multisystem inflammatory syndrome in children). This narrative review offers a resume of the state of the art about vitamin D's role in immunity and its clinical use in the context of the current pandemic, specially focusing on pediatric manifestations and MIS-C. It seems biologically reasonable that interventions aimed at normalizing circulating vitamin D levels could be beneficial. To help clinicians in establishing the correct prophylaxis and/or supportive therapy with vitamin D, well-designed and adequately statistically powered clinical trials involving both adult and pediatric populations are needed. Moreover, this review will also discuss the few other nutraceuticals evaluated in this context.
Collapse
Affiliation(s)
- Manuela Rizzi
- Department of Health Sciences (DiSS), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Vincenzo Avellis
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Alessandro Messina
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Chiara Germano
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| | - Elena Tavella
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Valentina Dodaro
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Raffaele Vitale
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Alberto Revelli
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Paolo Zola
- School of Medicine, University of Turin, 10124 Turin, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
| | - Simonetta Picone
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, 00169 Rome, Italy
| | - Pier Michele Paolillo
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, 00169 Rome, Italy
| | - Vito Mondì
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, 00169 Rome, Italy
| | - Bianca Masturzo
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| | - Paolo Manzoni
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy (B.M.)
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| | - Pier Paolo Sainaghi
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| |
Collapse
|
2
|
Mondì V, Tzialla C, Aversa S, Merazzi D, Martinelli S, Araimo G, Massenzi L, Cavallaro G, Gagliardi L, Piersigilli F, Giuffrè M, Lozzi S, Manzoni P, Mosca F, Cetin I, Trojano V, Valensise H, Colacurci N, Orfeo L, Auriti C. Antibiotic prophylaxis for ophthalmia neonatorum in Italy: results from a national survey and the Italian intersociety new position statements. Ital J Pediatr 2023; 49:117. [PMID: 37697419 PMCID: PMC10494339 DOI: 10.1186/s13052-023-01507-7] [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: 04/18/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Ophthalmia neonatorum is an acute conjunctivitis that occurs in newborns within the first month of life. The most serious infections are due to Chlamydia trachomatis and Neisseria gonorrhoeae, that may cause permanent damages. The use of ophthalmic prophylaxis varies widely around the world, according to the different health and socio-economic contexts. To date in Italy there is no a clear legislation regarding ophthalmia neonatorum prophylaxis at birth. METHODS We invited all birth centers in Italy to carry out a retrospective survey relating the last three years. We collected data regarding demographics of neonates, drugs used for ophthalmic prophylaxis and results of the screening of pregnant women for Chlamydia trachomatis and Neisseria gonorrhoeae vaginal infections. RESULTS Among 419 birth centers, 302 (72,1%) responded to the survey. Overall 1041384 neonates, 82,3% of those born in the three years considered, received ophthalmic prophylaxis. Only 4,585 (0,4%) of them received one of the drugs recommended by the WHO. The Centers that participated to the survey reported 12 episodes of Chlamydial conjunctivitis and no Gonococcal infection in the three years. Only 38% of the Centers performed vaginal swabs to pregnant women: 2,6% screened only for Neisseria, 9,6% only for Chlamydia and 25,8% for both germs. CONCLUSIONS The data obtained from the survey showed a low incidence of neonatal conjunctivitis due to either Neisseria gonorrhoeae or Chlamydia trachomatis in Italy. Due to the lack of legislation regulating the prophylaxis of ophthalmia neonatorum in newborns, the Italian Society of Neonatology, the Italian Society of Obstetrics and Gynecology and the Italian Society of Perinatal Medicine have recently issued new recommendations on this topic.
Collapse
Affiliation(s)
- Vito Mondì
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, Via Casilina 1049, Rome, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, ASST Pavia, Via Volturno 14, Voghera, Italy.
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy
| | - Daniele Merazzi
- Division of Neonatology, 'Valduce' Hospital, Via Dante Alighieri 11, Como, Italy
| | - Stefano Martinelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore 3, Milan, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy
| | - Luca Massenzi
- Division of Neonatology, Central Teaching Hospital of Bolzano, Via Lorenz Böhler 5, Bolzano, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Versilia Hospital, Azienda USL Toscana Nord Ovest, SS1 335, ViareggioPisa, Italy
| | - Fiammetta Piersigilli
- Section of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, Belgium
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, A.U.O.P. 'P. Giaccone,' Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 129, Palermo, Italy
| | - Simona Lozzi
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS,, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | - Paolo Manzoni
- Department of Maternal, Neonatal and Infant Medicine, University Hospital "Degli Infermi", Via Dei Ponderanesi 2, Ponderano, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Della Commenda 19, Milan, Italy
| | - Irene Cetin
- Department of BioMedical and Clinical Sciences, University of Milan, Via Givan Battista Grassi 74, Milan, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Via Lodovico Castelvetro 32, Milan, Italy
| | - Vito Trojano
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Via Samuel F. Hahnemann 10, Bari, Italy
| | - Herbert Valensise
- Department of Surgical Sciences, University of Rome Tor Vergata, Via Montpellier, 1, Rome, Italy
- Obstetrics and Gynecology, Policlinico Casilino, Via Casilina 1049, Rome, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, Naples, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, Fatebenefratelli Isola Tiberina - Gemelli Isola, Via Di Ponte Quattro Capi 39, Rome, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS,, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
- Villa Margherita Private Clinic, Via Di Villa Massimo 48, 00161, Rome, Italy
| |
Collapse
|
3
|
Keary IP, Ravasio R, Fullarton JR, Manzoni P, Lanari M, Paes BA, Carbonell-Estrany X, Baraldi E, Tarride JÉ, Rodgers-Gray B. A new cost-utility analysis assessing risk factor-guided prophylaxis with palivizumab for the prevention of severe respiratory syncytial virus infection in Italian infants born at 29-35 weeks' gestational age. PLoS One 2023; 18:e0289828. [PMID: 37561741 PMCID: PMC10414677 DOI: 10.1371/journal.pone.0289828] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
Since the last Italian cost-utility assessment of palivizumab in 2009, new data on the burden of respiratory syncytial virus (RSV) and an International Risk Scoring Tool (IRST) have become available. The objective of this study was to provide an up-to-date cost-utility assessment of palivizumab versus no prophylaxis for the prevention of severe RSV infection in otherwise healthy Italian infants born at 29-31 weeks' gestational age (wGA) infants and those 32-35wGA infants categorized as either moderate- or high-risk of RSV-hospitalization (RSVH) by the IRST. A decision tree was constructed in which infants received palivizumab or no prophylaxis and then could experience: i) RSVH; ii) emergency room medically-attended RSV-infection (MARI); or, iii) remain uninfected/non-medically attended. RSVH cases that required intensive care unit admission could die (0.43%). Respiratory morbidity was considered in all surviving infants up to 18 years of age. Hospitalization rates were derived from Italian data combined with efficacy from the IMpact-RSV trial. Palivizumab costs were calculated from vial prices (50mg: €490.37 100mg: €814.34) and Italian birth statistics combined with a growth algorithm. A lifetime horizon and healthcare and societal costs were included. The incremental cost-utility ratio (ICUR) was €14814 per quality-adjusted life year (QALY) gained in the whole population (mean: €15430; probability of ICUR being <€40000: 0.90). The equivalent ICURs were €15139 per QALY gained (€15915; 0.89) for 29-31wGA infants and €14719 per QALY gained (€15230; 0.89) for 32-35wGA infants. The model was most sensitive to rates of long-term sequelae, utility scores, palivizumab cost, and palivizumab efficacy. Palivizumab remained cost-effective in all scenario analyses, including a scenario wherein RSVH infants received palivizumab without a reduction in long-term sequelae and experienced a 6-year duration of respiratory morbidity (ICUR: €27948 per QALY gained). In conclusion, palivizumab remains cost-effective versus no prophylaxis in otherwise healthy Italian preterm infants born 29-35wGA. The IRST can help guide cost-effective use of palivizumab in 32-35wGA infants.
Collapse
Affiliation(s)
- Ian P. Keary
- Violicom Medical Limited, Aldermaston, Berkshire, United Kingdom
| | | | | | - Paolo Manzoni
- Department of Public Health and Pediatric Sciences, University of Torino School of Medicine, Turin, Piedmont, Italy
- Division of Paediatrics and Neonatology, Degli Infermi Hospital, Ponderano, Italy
| | - Marcello Lanari
- Paediatric Emergency Unit, IRCCS-Policlinico Ospedaliero-Universitario di Bologna, Bologna, Italy
| | - Bosco A. Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | | | - Eugenio Baraldi
- Department of Women’s and Children’s Health, University Hospital of Padova, Veneto, Italy
- Institute of Pediatric Research, "Città della Speranza", Padova, Veneto, Italy
| | - Jean-Éric Tarride
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | | |
Collapse
|
4
|
Uccella S, Manzoni P, Militello MA, Bosco M, Porcari I, Lanzo G, Maraucci F, Violino C, Lo Cicero T, Biancotto G, Carlo Zorzato P, Franchi MP, Garzon S. Neonatal Outcomes of Water Delivery versus Land Delivery: A Retrospective Propensity Score Weighted Study. Am J Perinatol 2023. [PMID: 37207659 DOI: 10.1055/s-0043-1768961] [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: 05/21/2023]
Abstract
OBJECTIVE Recent evidence has shown that water delivery is safe for the mother, but high-quality evidence is not available for the newborn. Therefore, obstetric guidelines do not support it. This retrospective study aimed to contribute to the available evidence on maternal and neonatal outcomes associated with water delivery. STUDY DESIGN Retrospective cohort study from prospectively collected birth registry data from 2015 to 2019. A total of 144 consecutive water deliveries and 265 land deliveries eligible for waterbirth were identified. The inverse probability of treatment weighting (IPTW) method was applied to address for confounders. RESULTS We identified 144 women who delivered in water (water group) and 265 women who delivered on land (land group). One (0.7%) neonatal death was observed in the water delivery group. After IPTW adjustment, water delivery was significantly associated with a higher risk of maternal fever in puerperium (odds ratio [OR]: 4.98; 95% confidence interval [CI]: 1.86-17.02; p = 0.004), of neonatal cord avulsion (OR: 20.73; 95% CI: 2.63-2,674; p = 0.001), and of positive neonatal C-reactive protein (CRP > 5 mg/L; OR: 2.59; 95% CI: 1.05-7.24; p = 0.039); delivering in water was associated with lower maternal blood loss (mean difference: 110.40 mL; 95% CI: 191.01-29.78; p = 0.007), a lower risk of major (≥1,000 mL) postpartum hemorrhage (OR: 0.96; 95% CI: 0.92-0.99; p = 0.016), lower risk of manual placenta delivery (OR: 0.18; 95% CI: 0.03-0.67; p = 0.008) and curettage (OR: 0.24; 95% CI: 0.08-0.60; p = 0.002), lower use of episiotomy (OR: 0.02; 95% CI: 0-0.12; p < 0.001), and lower risk of neonatal ward admission (OR: 0.35; 95% CI: 0.25-0.48; p < 0.001). CONCLUSION The present study showed that differences are present between water and land delivery, and among them is the risk of cord avulsion, a severe and potentially fatal event. In women choosing to deliver in water, a trained staffmust be present and immediate recognition of cord avulsion is key for a prompt management to avoid possible serious complications. KEY POINTS · High-quality evidence is not available for neonatal safety of waterbirth; therefore, retrospective studies still represent the main body of evidence.. · Differences are present between water and land delivery, and among them, the increased risk of cord avulsion is a potentially fatal event.. · A trained staff must assist women who chose to deliver in water and cord avulsion must be promptly recognized and managed to avoid severe neonatal complications..
Collapse
Affiliation(s)
- Stefano Uccella
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Paolo Manzoni
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Maria A Militello
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Irene Porcari
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Gabriele Lanzo
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Francesca Maraucci
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Chiara Violino
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Tiziana Lo Cicero
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Giulia Biancotto
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| |
Collapse
|
5
|
Matino E, Tavella E, Rizzi M, Avanzi GC, Azzolina D, Battaglia A, Becco P, Bellan M, Bertinieri G, Bertoletti M, Casciaro GF, Castello LM, Colageo U, Colangelo D, Comolli D, Costanzo M, Croce A, D’Onghia D, Della Corte F, De Mitri L, Dodaro V, Givone F, Gravina A, Grillenzoni L, Gusmaroli G, Landi R, Lingua A, Manzoni R, Marinoni V, Masturzo B, Minisini R, Morello M, Nelva A, Ortone E, Paolella R, Patti G, Pedrinelli A, Pirisi M, Ravizzi L, Rizzi E, Sola D, Sola M, Tonello N, Tonello S, Topazzo G, Tua A, Valenti P, Vaschetto R, Vassia V, Zecca E, Zublena N, Manzoni P, Sainaghi PP. Effect of Lactoferrin on Clinical Outcomes of Hospitalized Patients with COVID-19: The LAC Randomized Clinical Trial. Nutrients 2023; 15:nu15051285. [PMID: 36904283 PMCID: PMC10005739 DOI: 10.3390/nu15051285] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
As lactoferrin is a nutritional supplement with proven antiviral and immunomodulatory abilities, it may be used to improve the clinical course of COVID-19. The clinical efficacy and safety of bovine lactoferrin were evaluated in the LAC randomized double-blind placebo-controlled trial. A total of 218 hospitalized adult patients with moderate-to-severe COVID-19 were randomized to receive 800 mg/die oral bovine lactoferrin (n = 113) or placebo (n = 105), both given in combination with standard COVID-19 therapy. No differences in lactoferrin vs. placebo were observed in the primary outcomes: the proportion of death or intensive care unit admission (risk ratio of 1.06 (95% CI 0.63-1.79)) or proportion of discharge or National Early Warning Score 2 (NEWS2) ≤ 2 within 14 days from enrollment (RR of 0.85 (95% CI 0.70-1.04)). Lactoferrin showed an excellent safety and tolerability profile. Even though bovine lactoferrin is safe and tolerable, our results do not support its use in hospitalized patients with moderate-to-severe COVID-19.
Collapse
Affiliation(s)
- Erica Matino
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Elena Tavella
- Department of Maternal-Infant Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
- Internal Medicine, Department of Medical Sciences, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, University of Turin School of Medicine, 10126 Turin, Italy
| | - Manuela Rizzi
- Department of Health Sciences, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Danila Azzolina
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Antonio Battaglia
- Division of Dermatology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Paolo Becco
- Division of Oncology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Giovanni Bertinieri
- Division of Internal Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | | | - Giuseppe Francesco Casciaro
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Division of Internal Medicine, Azienda Ospedaliera “SS. Antonio e Biagio e Cesare Arrigo”, 15121 Alessandria, Italy
| | - Umberto Colageo
- Intensive Care Unit, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Donato Colangelo
- Department of Health Sciences, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Davide Comolli
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Martina Costanzo
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Alessandro Croce
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Davide D’Onghia
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Francesco Della Corte
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Anesthesia and Intensive Care Medicine, AOU “Maggiore della Carità”, 28100 Novara, Italy
| | - Luigi De Mitri
- Division of Diabetology and Endocrinology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Valentina Dodaro
- Internal Medicine, Department of Medical Sciences, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, University of Turin School of Medicine, 10126 Turin, Italy
| | - Filippo Givone
- Division of Pneumology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Alessia Gravina
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Luca Grillenzoni
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | | | - Raffaella Landi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Anna Lingua
- Division of Infectious Disease, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Roberto Manzoni
- Division of Dermatology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Vito Marinoni
- Division of Geriatric Care, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Marina Morello
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Anna Nelva
- Division of Diabetology and Endocrinology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Elena Ortone
- Division of Geriatric Care, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Rita Paolella
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Medical Department, Division of Cardiology, AOU “Maggiore della Carità”, 28100 Novara, Italy
| | - Anita Pedrinelli
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Lidia Ravizzi
- Division of Pneumology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Eleonora Rizzi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Daniele Sola
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Mariolina Sola
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Nadir Tonello
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Stelvio Tonello
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Gigliola Topazzo
- Division of Diabetology and Endocrinology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Aldo Tua
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, University of Rome, La Sapienza, 00185 Rome, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Anesthesia and Intensive Care Medicine, AOU “Maggiore della Carità”, 28100 Novara, Italy
| | - Veronica Vassia
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Nicoletta Zublena
- Division of Palliative Care, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Paolo Manzoni
- Department of Maternal-Infant Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
- Internal Medicine, Department of Medical Sciences, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, University of Turin School of Medicine, 10126 Turin, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Correspondence:
| |
Collapse
|
6
|
Manti S, Staiano A, Orfeo L, Midulla F, Marseglia GL, Ghizzi C, Zampogna S, Carnielli VP, Favilli S, Ruggieri M, Perri D, Di Mauro G, Gattinara GC, D’Avino A, Becherucci P, Prete A, Zampino G, Lanari M, Biban P, Manzoni P, Esposito S, Corsello G, Baraldi E. UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants. Ital J Pediatr 2023; 49:19. [PMID: 36765418 PMCID: PMC9912214 DOI: 10.1186/s13052-022-01392-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 02/12/2023] Open
Abstract
Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The document addresses care in both hospitals and primary care. The diagnosis of bronchiolitis is based on the clinical history and physical examination. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Evidence suggests no benefit with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of effective treatment, the reduction of morbidity must rely on preventive measures. De-implementation of non-evidence-based interventions is a major goal, and educational interventions for clinicians should be carried out to promote high-value care of infants with bronchiolitis. Well-prepared implementation strategies to standardize care and improve the quality of care are needed to promote adherence to guidelines and discourage non-evidence-based attitudes. In parallel, parents' education will help reduce patient pressure and contribute to inappropriate prescriptions. Infants with pre-existing risk factors (i.e., prematurity, bronchopulmonary dysplasia, congenital heart diseases, immunodeficiency, neuromuscular diseases, cystic fibrosis, Down syndrome) present a significant risk of severe bronchiolitis and should be carefully assessed. This revised document, based on international and national scientific evidence, reinforces the current recommendations and integrates the recent advances for optimal care and prevention of acute bronchiolitis.
Collapse
Affiliation(s)
- Sara Manti
- grid.10438.3e0000 0001 2178 8421University of Messina, Messina, Italy
| | - Annamaria Staiano
- grid.4691.a0000 0001 0790 385XSIP “Società Italiana di Pediatria”, University “Federico II”, Naples, Italy
| | - Luigi Orfeo
- grid.476687.c0000 0001 0944 2874SIN “Società Italiana di Neonatologia”, Hospital San Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Fabio Midulla
- grid.7841.aSIMRI ”Società Italiana per le Malattie Respiratorie Infantili”, University of Rome “La Sapienza”, Rome, Italy
| | - Gian Luigi Marseglia
- grid.419425.f0000 0004 1760 3027SIAIP “Società Italiana di Allergologia e Immunologia Pediatrica”, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Ghizzi
- AMIETIP ”Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica”, Major Hospital Polyclinic: Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Bologna, Italy
| | - Stefania Zampogna
- SIMEUP “Società Italiana di Medicina di Emergenza ed Urgenza Pediatrica”, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Virgilio Paolo Carnielli
- SIMP “Società Italiana di Medicina Perinatale”, University Hospital of Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Favilli
- SICP “Società Italiana di Cardiologia Pediatrica”, University Hospital Meyer, Firenze, Italy
| | - Martino Ruggieri
- grid.8158.40000 0004 1757 1969SINP “Società Italiana di Neurologia Pediatrica”, University of Catania, Catania, Italy
| | - Domenico Perri
- grid.415069.f0000 0004 1808 170XSIPO “Società Italiana Pediatria Ospedaliera”, San Giuseppe Moscati Hospital, Aversa, Italy
| | - Giuseppe Di Mauro
- SIPPS “Società Italiana di Pediatria Preventiva e Sociale”, Local Health Authority Caserta, Caserta, Italy
| | - Guido Castelli Gattinara
- grid.414125.70000 0001 0727 6809SITIP “Società Italiana di Infettivologia Pediatrica”, Bambino Gesu Pediatric Hospital, Rome, Italy
| | - Antonio D’Avino
- FIMP “Federazione Italiana Medici Pediatri”, Local Health Authority Naples 1 Centre, Naples, Italy
| | - Paolo Becherucci
- SICuPP “Società Italiana delle Cure Primarie Pediatriche”, Florence City Council, Florence, Italy
| | - Arcangelo Prete
- grid.412311.4AIEOP “Società Italiana di Ematologia e Oncologia Pediatrica”, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giuseppe Zampino
- grid.411075.60000 0004 1760 4193SIMGePeD “Società Italiana Malattie Genetiche Pediatriche e Disabilità Congenite”, University Hospital Agostino Gemelli, Rome, Italy
| | - Marcello Lanari
- grid.6292.f0000 0004 1757 1758Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Paolo Biban
- grid.411475.20000 0004 1756 948XUniversity Hospital of Verona, Verona, Italy
| | - Paolo Manzoni
- grid.417165.00000 0004 1759 6939Ospedale Degli Infermi, Biella, Italy ,grid.7605.40000 0001 2336 6580University of Turin, Turin, Italy
| | - Susanna Esposito
- grid.10383.390000 0004 1758 0937University of Parma, Parma, Italy
| | - Giovanni Corsello
- grid.10776.370000 0004 1762 5517University of Palermo, Palermo, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padova, Padova, Italy.
| |
Collapse
|
7
|
Pruccoli G, Castagno E, Raffaldi I, Denina M, Barisone E, Baroero L, Timeus F, Rabbone I, Monzani A, Terragni GM, Lovera C, Brach del Prever A, Manzoni P, Barbaglia M, Roasio L, De Franco S, Calitri C, Lupica M, Felici E, Marciano C, Santovito S, Militerno G, Abrigo E, Curtoni A, Quarello P, Bondone C, Garazzino S. The Importance of RSV Epidemiological Surveillance: A Multicenter Observational Study of RSV Infection during the COVID-19 Pandemic. Viruses 2023; 15:v15020280. [PMID: 36851494 PMCID: PMC9963567 DOI: 10.3390/v15020280] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
The restrictive measures adopted worldwide against SARS-CoV-2 produced a drastic reduction in respiratory pathogens, including RSV, but a dramatic rebound was thereafter reported. In this multicenter retrospective observational study in 15 Pediatric Emergency Departments, all children <3 years old with RSV infection admitted between 1 September and 31 December 2021 were included and compared to those admitted in the same period of 2020 and 2019. The primary aim was to evaluate RSV epidemiology during and after the COVID-19 pandemic peak. The secondary aims were to evaluate the clinical features of children with RSV infection. Overall, 1015 children were enrolled: 100 in 2019, 3 in 2020 and 912 in 2021. In 2019, the peak was recorded in December, and in 2021, it was recorded in November. Comparing 2019 to 2021, in 2021 the median age was significantly higher and the age group 2-3 years was more affected. Admissions were significantly higher in 2021 than in 2020 and 2019, and the per-year hospitalization rate was lower in 2021 (84% vs. 93% in 2019), while the duration of admissions was similar. No difference was found in severity between 2019-2020-2021. In conclusion, after the COVID-19 pandemic, an increase in RSV cases in 2021 exceeding the median seasonal peak was detected, with the involvement of older children, while no difference was found in severity.
Collapse
Affiliation(s)
- Giulia Pruccoli
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Denina
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Elisa Barisone
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-0113135396
| | - Luca Baroero
- Department of Pediatrics, Martini Hospital, 10141 Turin, Italy
| | - Fabio Timeus
- Pediatrics Department, Chivasso Hospital, 10034 Chivasso (TO), Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Alice Monzani
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | | | - Cristina Lovera
- Department of Pediatrics, A.O. S.Croce e Carle, 12100 Cuneo, Italy
| | | | - Paolo Manzoni
- Department of Pediatrics, Ospedale Degli Infermi di Ponderano, University of Turin, 13900 Biella, Italy
| | | | - Luca Roasio
- Department of Pediatrics, Edoardo Agnelli Hospital, 10064 Pinerolo (TO), Italy
| | - Simona De Franco
- Department of Pediatrics, Ospedale di Borgomanero, 28021 Borgomanero (NO), Italy
| | - Carmelina Calitri
- Department of Pediatrics, Ospedale di Rivoli, 10098 Rivoli (TO), Italy
| | - Maddalena Lupica
- Department of Pediatrics, Ospedale di Rivoli, 10098 Rivoli (TO), Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children’s Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy
| | - Cinzia Marciano
- Pediatric and Pediatric Emergency Unit, Children’s Hospital, AO SS Antonio e Biagio e C. Arrigo, 15121 Alessandria, Italy
| | - Savino Santovito
- Department of Pediatrics, Ospedale Maria Vittoria, ASL Città di Torino, 10143 Turin, Italy
| | - Gaia Militerno
- Department of Pediatrics, Ospedale Cardinal Massaia, 14100 Asti, Italy
| | - Enrica Abrigo
- Department of Pediatrics, Ospedale Cardinal Massaia, 14100 Asti, Italy
| | - Antonio Curtoni
- Microbiology and Virology Unit, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Paola Quarello
- Department of Pediatric Onco-Hematology, University of Turin, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children’s Hospital, A.O.U. Città Della Salute e della Scienza di Torino, 10126 Turin, Italy
| |
Collapse
|
8
|
De Luca D, Vauloup-Fellous C, Benachi A, Masturzo B, Manzoni P, Vivanti A. The Essentials about Neonatal Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Coronavirus Disease: A Narrative Review. Am J Perinatol 2022; 39:S18-S22. [PMID: 36356589 DOI: 10.1055/s-0042-1758487] [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: 11/12/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can occur in neonates as the virus can be transmitted both horizontally (from the environment) and vertically (during the pregnancy or at the delivery). Compared to the adult outbreak, neonatal infections do not represent a public health problem. Nonetheless, severe and life-threatening cases may rarely occur and both obstetricians and neonatologists should have a good knowledge of perinatal SARS-CoV-2 infection and related consequences. A high suspicion index must be applied and ruling out neonatal SARS-CoV-2 infection must become a part of the routine clinical workout. Moreover, neonates may be affected by the multisystem inflammatory syndrome, due to a dysregulated host response in the absence of any SARS-CoV-2 infection. We performed a narrative review to summarize here the available literature describing the essentials that should be known by every neonatologist and obstetrician, starting from what has been discovered in 2020 and adding what has been learned in the following years. The paper describes the mechanisms of transmission, clinical features, diagnostic tools, and criteria, as well as possible treatment and prevention strategies. The goal is to provide the practical points to be remembered at the bedside while caring for a pregnant woman or a neonate with suspected or proven coronavirus disease 2019 or multisystem inflammatory syndrome. KEY POINTS: · SARS-CoV-2 neonatal infections occur both vertically (30%) and horizontally (70%).. · Approximately, half of patients do not have clinical manifestations; clinical and laboratory signs are similar to those of adults but usually milder.. · Remdesivir and steroids can be used as a treatment..
Collapse
Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Le Plessis Robinson, France
| | - Christelle Vauloup-Fellous
- Division of Virology, "Paul Brousse" Hospital, Paris Saclay University Hospitals, APHP, Villejuif, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Paolo Manzoni
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Alexandre Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| |
Collapse
|
9
|
Bonadies L, Moschino L, Valerio E, Giordano G, Manzoni P, Baraldi E. Early Biomarkers of Bronchopulmonary Dysplasia: A Quick Look to the State of the Art. Am J Perinatol 2022; 39:S26-S30. [PMID: 36470296 DOI: 10.1055/s-0042-1758867] [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: 12/12/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is one of the most common pulmonary sequelae of extreme preterm birth, with long-lasting respiratory symptoms and reduced lung function. A reliable predictive tool of BPD development is urgent and its search remains one of the major challenges for neonatologists approaching the upcoming arrival of possible new preventive therapies. Biomarkers, identifying an ongoing pathogenetic pathway, could allow both the selection of preterm infants with an evolving disease and potentially the therapeutic targets of the indicted pathogenesis. The "omic" sciences represent well-known promising tools for this objective. In this review, we resume the current laboratoristic, metabolomic, proteomic, and microbiomic evidence in the prediction of BPD. KEY POINTS: · The early prediction of BPD development would allow the targeted implementation of new preventive therapies.. · BPD is a multifactorial disease consequently it is unlikely to find a single disease biomarker.. · "Omic" sciences offer a promising insight in BPD pathogenesis and its development's fingerprints..
Collapse
Affiliation(s)
- Luca Bonadies
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy.,Department of Woman's and Child's Health, Institute of Pediatric Research "Città della Speranza," Padova, Italy
| | - Laura Moschino
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy.,Department of Woman's and Child's Health, Institute of Pediatric Research "Città della Speranza," Padova, Italy
| | - Enrico Valerio
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy.,Department of Woman's and Child's Health, Institute of Pediatric Research "Città della Speranza," Padova, Italy
| | - Giuseppe Giordano
- Department of Woman's and Child's Health, Institute of Pediatric Research "Città della Speranza," Padova, Italy.,Department of Woman's and Child's Health, Mass Spectrometry and Metabolomic Laboratory, University of Padova, Padova, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital "Degli Infermi," Ponderano, Italy.,Department of Sciences of Public Health and Pediatrics, University of Turin School of Medicine, Turin, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy.,Department of Woman's and Child's Health, Institute of Pediatric Research "Città della Speranza," Padova, Italy.,Department of Woman's and Child's Health, Mass Spectrometry and Metabolomic Laboratory, University of Padova, Padova, Italy
| |
Collapse
|
10
|
Manzoni P, Baraldi E, Luna MS, Tzialla C. Real-World Studies of Respiratory Syncytial Virus Hospitalizations among Moderate/Late Preterm Infants Exposed to Passive Immunoprophylaxis with Palivizumab. Am J Perinatol 2022; 39:S7-S13. [PMID: 36307092 DOI: 10.1055/s-0042-1757279] [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: 01/28/2023]
Abstract
This article aims to assess the real-world effectiveness of palivizumab immunoprophylaxis against respiratory syncytial virus (RSV)-associated hospitalization (RSVH) rates in otherwise healthy moderate/late preterm infants and discuss the role of palivizumab in preventing acute and long-term outcomes. We identified studies in the PubMed and Embase databases that reported patient-level data on (1) exposure to palivizumab in preterm infants born between 29 and 35 weeks of gestational age (or subsets within this range) ≤ 2 years of chronological age, and (2) the outcome of RSVH. Six studies assessed RSVH in infants this gestational age who had been exposed or not to palivizumab and reported patient-level data. Exposure was associated with a reduction in RSVH rates that was comparable to the reduction seen in controlled clinical trials (weighed mean 4.0-fold reduction). RSV immunoprophylaxis in preterm infants within 29 to 35 weeks of gestational age is associated with a considerably lower burden of RSVH. KEY POINTS: · RSV is the leading cause of lower respiratory tract infection hospitalization in infants.. · Palivizumab prevents RSVH in a real-world scenario.. · Immunoprophylaxis should be used in high-risk infants..
Collapse
Affiliation(s)
- Paolo Manzoni
- Department of Maternal Infant Medicine, Degli Infermi Hospital, Biella, Italy.,University of Torino, Turin, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Manuel Sánchez Luna
- Neonatology Division and NICU, University Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, Italy
| |
Collapse
|
11
|
Auriti C, De Rose D, Santisi A, Martini L, Ronchetti M, Ravà L, Antenucci V, Bernaschi P, Serafini L, Catarzi S, Fiorini P, Betta P, Scuderi M, Di Benedetto V, Ferrari S, Maino M, Cavigioli F, Cocchi I, Giuffré M, Bonanno E, Tzialla C, Bua J, Pugni L, Della Torre B, Nardella G, Mazzeo D, Manzoni P, Capolupo I, Ciofi degli Atti M, Dotta A, Stronati M, Raponi M, Mosca F, Bagolan P. Incidence and risk factors of bacterial sepsis and invasive fungal infection in neonates and infants requiring major surgery: an Italian multicentre prospective study. J Hosp Infect 2022; 130:122-130. [DOI: 10.1016/j.jhin.2022.09.018] [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] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
|
12
|
Bagagiolo D, Priolo CG, Favre EM, Pangallo A, Didio A, Sbarbaro M, Borro T, Daccò S, Manzoni P, Farina D. A Randomized Controlled Trial of Osteopathic Manipulative Therapy to Reduce Cranial Asymmetries in Young Infants with Nonsynostotic Plagiocephaly. Am J Perinatol 2022; 39:S52-S62. [PMID: 36451623 DOI: 10.1055/s-0042-1758723] [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: 12/05/2022]
Abstract
OBJECTIVE This study aimed to compare the efficacy of osteopathic manipulative therapy (OMTh) versus light touch therapy (LTT) in reducing cranial asymmetries in infants with nonsynostotic plagiocephaly (NSP). STUDY DESIGN A prospective, parallel-group, single-center, LTT-controlled randomized clinical trial was conducted in the Department of Neonatology of Sant'Anna Hospital in Turin, Italy, from September 6, 2016 to February 20, 2020. We enrolled infants of 1 to 6 months of age with NSP, who were then randomly assigned to the study group (repositioning therapy plus six sessions of OMTh) or the control group (repositioning therapy plus six sessions of LTT). The outcome was the reduction of the oblique diameter difference index (ODDI) score <104%, which was assessed at the end of the intervention protocol (at 3 months) and at 1 year of age. RESULTS A total of 96 infants were randomized, 48 in the OMTh group and 48 in the LTT group, with mean ages of 3.1 versus 3.2 months, and baseline ODDI score of 110.2 versus 108.7%. In the OMTh group, a significant reduction of the ODDI score <104%, compared with the LTT group, was observed in the intension-to-treat (ITT) and per-protocol (PP) analyses. The ITT analysis revealed an ODDI score <104% in the OMTh group at 3 months (risk difference: 0.41; 95% confidence interval [CI]: 0.25-0.53; p < 0.001) and at the follow-up at 1 year of age (risk difference: 0.47; 95% CI: 0.31-0.64; p < 0.001). The PP analysis at 3 months reported a risk difference of 0.44 (95% CI: 0.27-0.60; p < 0.001), and at 1 year of age, a risk difference of 0.54 (95% CI: 0.36-0.72; p < 0.001). CONCLUSION In infants with NSP, a course of six OMTh sessions significantly reduced cranial asymmetries at both the 3-month and 1-year follow-up assessments, compared with LTT. This study is registered with ClinicalTrial.gov (identifier: NCT03970395; www. CLINICALTRIALS gov ). KEY POINTS · OMTh plus repositioning therapy significantly decreased the risk and severity of NSP compared with LTT.. · OMTh reduced mild and moderate cranial asymmetries.. · The role of OMTh in severe cranial asymmetries should be investigated in a multicenter trial..
Collapse
Affiliation(s)
- Donatella Bagagiolo
- Department of Research, Scuola Superiore di Osteopatia Italiana, Turin, Italy
| | - Claudio G Priolo
- Division of Neonatology and NICU, Sant'Anna Hospital, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy
| | - Elena M Favre
- Department of Research, Scuola Superiore di Osteopatia Italiana, Turin, Italy
| | - Antonella Pangallo
- Department of Research, Scuola Superiore di Osteopatia Italiana, Turin, Italy
| | - Alessia Didio
- Department of Research, Scuola Superiore di Osteopatia Italiana, Turin, Italy
| | - Marco Sbarbaro
- Department of Research, Scuola Superiore di Osteopatia Italiana, Turin, Italy
| | - Tiziana Borro
- Division of Neonatology and NICU, Sant'Anna Hospital, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy
| | - Silvia Daccò
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Albese con Cassano, Como, Italy
| | - Paolo Manzoni
- Division of Neonatology and NICU, Sant'Anna Hospital, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy.,Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Ponderano, Italy
| | - Daniele Farina
- Division of Neonatology and NICU, Sant'Anna Hospital, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy
| |
Collapse
|
13
|
Masturzo B, Delogu G, Germano C, Ghi T, Rizzo G, Puppo A, Attini R, Revelli A, Manzoni P. Vacuum delivery in all-fours position: is it a valuable, brand-new option? Am J Obstet Gynecol MFM 2022; 4:100691. [PMID: 35843544 DOI: 10.1016/j.ajogmf.2022.100691] [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: 03/27/2022] [Revised: 06/15/2022] [Accepted: 07/09/2022] [Indexed: 11/15/2022]
Abstract
Since all-fours birth position is considered to decrease the rate of failure of vaginal birth and the risk of negative maternal and fetal outcomes, we wondered if all-fours would be favorable in case of operative vaginal delivery with obstetrical vacuum. We performed a simulation of vacuum application on a mannequin settled in all-fours position and we filmed this new application for diffusion among clinicians. We suggest that the all-fours position be considered and investigated in further studies as a possible way of delivery in case of operative vaginal delivery.
Collapse
Affiliation(s)
- Bianca Masturzo
- Department of Obstetrics and Gynaecology, Ospedale degli Infermi, Biella, University of Turin, Turin, Italy (Drs Masturzo, Delogu, and Germano)
| | - Giuseppe Delogu
- Department of Obstetrics and Gynaecology, Ospedale degli Infermi, Biella, University of Turin, Turin, Italy (Drs Masturzo, Delogu, and Germano)
| | - Chiara Germano
- Department of Obstetrics and Gynaecology, Ospedale degli Infermi, Biella, University of Turin, Turin, Italy (Drs Masturzo, Delogu, and Germano).
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy (Dr Ghi)
| | - Giuseppe Rizzo
- Università di Roma Tor Vergata, Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Roma, Italy (Dr Rizzo)
| | - Andrea Puppo
- Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy (Dr Puppo)
| | - Rossella Attini
- Obstetrics and Gynaecology 2U, Sant'Anna Hospital, University of Turin, Turin, Italy (Drs Attini and Revelli)
| | - Alberto Revelli
- Obstetrics and Gynaecology 2U, Sant'Anna Hospital, University of Turin, Turin, Italy (Drs Attini and Revelli)
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Ospedale Degli Infermi, Biella, University of Turin, Turin, Italy (Dr Manzoni)
| |
Collapse
|
14
|
Germano C, Messina A, Tavella E, Vitale R, Avellis V, Barboni M, Attini R, Revelli A, Zola P, Manzoni P, Masturzo B. Fetal Brain Damage during Maternal COVID-19: Emerging Hypothesis, Mechanism, and Possible Mitigation through Maternal-Targeted Nutritional Supplementation. Nutrients 2022; 14:nu14163303. [PMID: 36014809 PMCID: PMC9414753 DOI: 10.3390/nu14163303] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
The recent outbreak of the novel Coronavirus (SARS-CoV-2 or CoV-2) pandemic in 2019 and the risk of CoV-2 infection during pregnancy led the scientific community to investigate the potential negative effects of Coronavirus infection on pregnancy outcomes and fetal development. In particular, as CoV-2 neurotropism has been demonstrated in adults, recent studies suggested a possible risk of fetal brain damage and fetal brain development impairment, with consequent psychiatric manifestations in offspring of mothers affected by COronaVIrus Disease (COVID) during pregnancy. Through the understanding of CoV-2’s pathogenesis and the pathways responsible for cell damage, along with the available data about neurotropic virus attitudes, different strategies have been suggested to lower the risk of neurologic disease in newborns. In this regard, the role of nutrition in mitigating fetal damages related to oxidative stress and the inflammatory environment during viral infection has been investigated, and arginine, n3PUFA, vitamins B1 and B9, choline, and flavonoids were found to be promising in and out of pregnancy. The aim of this review is to provide an overview of the current knowledge on the mechanism of fetal brain damage and the impact of nutrition in reducing inflammation related to worse neurological outcomes in the context of CoV-2 infections during pregnancy.
Collapse
Affiliation(s)
- Chiara Germano
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Correspondence:
| | - Alessandro Messina
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Elena Tavella
- Sant’Anna Hospital, Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Raffaele Vitale
- Sant’Anna Hospital, Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Vincenzo Avellis
- Sant’Anna Hospital, Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Martina Barboni
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Rossella Attini
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Alberto Revelli
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Paolo Zola
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Paolo Manzoni
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| | - Bianca Masturzo
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| |
Collapse
|
15
|
Baraldi E, Checcucci Lisi G, Costantino C, Heinrichs JH, Manzoni P, Riccò M, Roberts M, Vassilouthis N. RSV disease in infants and young children: Can we see a brighter future? Hum Vaccin Immunother 2022; 18:2079322. [PMID: 35724340 DOI: 10.1080/21645515.2022.2079322] [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] [Indexed: 12/21/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a highly contagious seasonal virus and the leading cause of Lower Respiratory Tract Infections (LRTI), including pneumonia and bronchiolitis in children. RSV-related LRTI cause approximately 3 million hospitalizations and 120,000 deaths annually among children <5 years of age. The majority of the burden of RSV occurs in previously healthy infants. Only a monoclonal antibody (mAb) has been approved against RSV infections in a restricted group, leaving an urgent unmet need for a large number of children potentially benefiting from preventive measures. Approaches under development include maternal vaccines to protect newborns, extended half-life monoclonal antibodies to provide rapid long-lasting protection, and pediatric vaccines. RSV has been identified as a major global priority but a solution to tackle this unmet need for all children has yet to be implemented. New technologies represent the avenue for effectively addressing the leading-cause of hospitalization in children <1 years old.
Collapse
Affiliation(s)
- Eugenio Baraldi
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | | | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Paolo Manzoni
- Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
| | - Matteo Riccò
- Dipartimento di Sanità Pubblica, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | |
Collapse
|
16
|
Hill LF, Clements MN, Turner MA, Donà D, Lutsar I, Jacqz-Aigrain E, Heath PT, Roilides E, Rawcliffe L, Alonso-Diaz C, Baraldi E, Dotta A, Ilmoja ML, Mahaveer A, Metsvaht T, Mitsiakos G, Papaevangelou V, Sarafidis K, Walker AS, Sharland M, Clements M, Turner MA, Donà D, Lutsar I, Jacqz-Aigrain E, Heath PT, Roilides E, Rawcliffe L, Bafadal B, Alarcon Allen A, Alonso-Diaz C, Anatolitou F, Baraldi E, Del Vecchio A, Dotta A, Giuffrè M, Ilmoja ML, Karachristou K, Mahaveer A, Manzoni P, Martinelli S, Metsvaht T, Mitsiakos G, Moriarty P, Nika A, Papaevangelou V, Roehr C, Sanchez Alcobendas L, Sarafidis K, Siahanidou T, Tzialla C, Bonadies L, Booth N, Catalina Morales-Betancourt P, Cordeiro M, de Alba Romero C, de la Cruz J, De Luca M, Farina D, Franco C, Gialamprinou D, Hallik M, Ilardi L, Insinga V, Iosifidis E, Kalamees R, Kontou A, Molnar Z, Nikaina E, Petropoulou C, Reyné M, Tataropoulou K, Triantafyllidou P, Vontzalidis A, Walker AS, Sharland M. Optimised versus standard dosing of vancomycin in infants with Gram-positive sepsis (NeoVanc): a multicentre, randomised, open-label, phase 2b, non-inferiority trial. Lancet Child Adolesc Health 2022; 6:49-59. [PMID: 34843669 DOI: 10.1016/s2352-4642(21)00305-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vancomycin is the most widely used antibiotic for neonatal Gram-positive sepsis, but clinical outcome data of dosing strategies are scarce. The NeoVanc programme comprised extensive preclinical studies to inform a randomised controlled trial to assess optimised vancomycin dosing. We compared the efficacy of an optimised regimen to a standard regimen in infants with late onset sepsis that was known or suspected to be caused by Gram-positive microorganisms. METHODS NeoVanc was an open-label, multicentre, phase 2b, parallel-group, randomised, non-inferiority trial comparing the efficacy and toxicity of an optimised regimen of vancomycin to a standard regimen in infants aged 90 days or younger. Infants with at least three clinical or laboratory sepsis criteria or confirmed Gram-positive sepsis with at least one clinical or laboratory criterion were enrolled from 22 neonatal intensive care units in Greece, Italy, Estonia, Spain, and the UK. Infants were randomly assigned (1:1) to either the optimised regimen (25 mg/kg loading dose, followed by 15 mg/kg every 12 h or 8 h dependent on postmenstrual age, for 5 ± 1 days) or the standard regimen (no loading dose; 15 mg/kg every 24 h, 12 h, or 8 h dependent on postmenstrual age for 10 ± 2 days). Vancomycin was administered intravenously via 60 min infusion. Group allocation was not masked to local investigators or parents. The primary endpoint was success at the test of cure visit (10 ± 1 days after the end of actual vancomycin therapy) in the per-protocol population, where success was defined as the participant being alive at the test of cure visit, having a successful outcome at the end of actual vancomycin therapy, and not having a clinically or microbiologically significant relapse or new infection requiring antistaphylococcal antibiotics for more than 24 h within 10 days of the end of actual vancomycin therapy. The non-inferiority margin was -10%. Safety was assessed in the intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT02790996). FINDINGS Between March 3, 2017, and July 29, 2019, 242 infants were randomly assigned to the standard regimen group (n=122) or the optimised regimen group (n=120). Primary outcome data in the per-protocol population were available for 90 infants in the optimised group and 92 in the standard group. 64 (71%) of 90 infants in the optimised group and 73 (79%) of 92 in the standard group had success at test of cure visit; non-inferiority was not confirmed (adjusted risk difference -7% [95% CI -15 to 2]). Incomplete resolution of clinical or laboratory signs after 5 ± 1 days of vancomycin therapy was the main factor contributing to clinical failure in the optimised group. Abnormal hearing test results were recorded in 25 (30%) of 84 infants in the optimised group and 12 (15%) of 79 in the standard group (adjusted risk ratio 1·96 [95% CI 1·07 to 3·59], p=0·030). There were six vancomycin-related adverse events in the optimised group (one serious adverse event) and four in the standard group (two serious adverse events). 11 infants in the intention-to-treat population died (six [6%] of 102 infants in the optimised group and five [5%] of 98 in the standard group). INTERPRETATION In the largest neonatal vancomycin efficacy trial yet conducted, no clear clinical impact of a shorter duration of treatment with a loading dose was demonstrated. The use of the optimised regimen cannot be recommended because a potential hearing safety signal was identified; long-term follow-up is being done. These results emphasise the importance of robust clinical safety assessments of novel antibiotic dosing regimens in infants. FUNDING EU Seventh Framework Programme for research, technological development and demonstration.
Collapse
Affiliation(s)
- Louise F Hill
- Institute for Infection and Immunity, St George's, University of London, London, UK.
| | - Michelle N Clements
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padova, Padova, Italy; Fondazione Penta, Padua, Italy
| | | | - Evelyne Jacqz-Aigrain
- Department of Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Paris, France
| | - Paul T Heath
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Emmanuel Roilides
- 3rd Department of Pediatrics, Aristotle University, Thessaloniki, Greece
| | | | | | - Eugenio Baraldi
- Azienda Ospedale-Universita' di Padova, Fondazione Istituto di Ricerca Pediatrica, Padova, Italy
| | | | | | | | | | | | | | | | - A Sarah Walker
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Michael Sharland
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Manzoni P, Messina A, Ceratto S, Tognato E, Stronati M, Auriti C. Early hyperglycaemia was linked to a risk of late-onset sepsis in very low birth weight preterm infants in a neonatal intensive care unit. Acta Paediatr 2021; 110:3272-3274. [PMID: 34173275 DOI: 10.1111/apa.16007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Paolo Manzoni
- Division of Pediatrics and Neonatology Department of Maternal, Neonatal and Infant Medicine Nuovo Ospedale Degli Infermi Biella Italy
- Neonatology and NICU, S. Anna Hospital. AOU Città della Salute e della Scienza Turin Italy
| | - Alessandro Messina
- Neonatology and NICU, S. Anna Hospital. AOU Città della Salute e della Scienza Turin Italy
| | - Simone Ceratto
- Division of Pediatrics and Neonatology Department of Maternal, Neonatal and Infant Medicine Nuovo Ospedale Degli Infermi Biella Italy
| | - Eleonora Tognato
- Division of Pediatrics and Neonatology Department of Maternal, Neonatal and Infant Medicine Nuovo Ospedale Degli Infermi Biella Italy
| | - Mauro Stronati
- UOC Neonatologia e Terapia Intensiva IRCCS Policlinico San Matteo Pavia Italy
| | - Cinzia Auriti
- Neonatology and NICU IRCSS Ospedale Pediatrico Bambino Gesù Rome
| | | |
Collapse
|
18
|
Lo Vecchio A, Garazzino S, Smarrazzo A, Venturini E, Poeta M, Berlese P, Denina M, Meini A, Bosis S, Galli L, Cazzato S, Nicolini G, Vergine G, Giacchero R, Ballardini G, Dodi I, Salvini FM, Manzoni P, Ferrante G, Quadri V, Campana A, Badolato R, Villani A, Guarino A, Gattinara GC. Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome. JAMA Netw Open 2021; 4:e2139974. [PMID: 34928354 PMCID: PMC8689385 DOI: 10.1001/jamanetworkopen.2021.39974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. OBJECTIVE To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged <18 years) with acute SARS-CoV-2 infection, confirmed by positive real-time reverse-transcriptase-polymerase chain reaction on nasopharyngeal swab or fulfilling the US Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children (MIS-C). The study was conducted by pediatricians working in primary care or hospitals in Italy participating in the COVID-19 Registry of the Italian Society of Pediatric Infectious Diseases. MAIN OUTCOMES AND MEASURES The occurrence of severe GI manifestations, defined by a medical and/or radiological diagnosis of acute abdomen, appendicitis (complicated or not by perforation and/or peritonitis), intussusception, pancreatitis, abdominal fluid collection, and diffuse adenomesenteritis requiring surgical consultation, occurring during or within 4 to 6 weeks after infection with SARS-CoV-2 infection. Logistic regression was used to estimate odds ratios (ORs) with 95% CIs of factors potentially associated with severe outcomes. RESULTS Overall, 685 children (386 boys [56.4%]; median age, 7.3 [IQR, 1.6-12.4] years) were included. Of these children, 628 (91.7%) were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C. The presence of GI symptoms was associated with a higher chance of hospitalization (OR, 2.64; 95% CI, 1.89-3.69) and intensive care unit admission (OR, 3.90; 95% CI, 1.98-7.68). Overall, 65 children (9.5%) showed severe GI involvement, including disseminated adenomesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6%). Twenty-seven of these 65 children (41.5%) underwent surgery. Severe GI manifestations were associated with the child's age (5-10 years: OR, 8.33; 95% CI, 2.62-26.5; >10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). CONCLUSIONS AND RELEVANCE In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications.
Collapse
Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | | | | | - Marco Poeta
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Paola Berlese
- Department of Paediatrics, Cà Foncello Hospital, Treviso, Italy
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Turin, Italy
| | - Antonella Meini
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children’s University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Salvatore Cazzato
- Paediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Gianluca Vergine
- Unità Operativa Complessa Pediatria, Ospedale degli Infermi di Rimini, Rimini, Italy
| | - Roberta Giacchero
- Unità Operativa Complessa Pediatria, Azienda Sanitaria Territoriale di Lodi, Lodi, Italy
| | | | - Icilio Dodi
- Emergency and General Paediatric Unit, Pietro Barilla Children’s Hospital, Parma, Italy
| | - Filippo Maria Salvini
- Paediatrics Division, Azienda Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Manzoni
- Division of Paediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, Azienda Sanitaria Locale Biella, Ponderano, Biella, Italy
| | - Giuliana Ferrante
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Vera Quadri
- Azienda Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Raffaele Badolato
- Department of Experimental and Clinical Sciences, Paediatric Clinic, University of Brescia, Brescia, Italy
| | | | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | | |
Collapse
|
19
|
Azzari C, Baraldi E, Bonanni P, Bozzola E, Coscia A, Lanari M, Manzoni P, Mazzone T, Sandri F, Checcucci Lisi G, Parisi S, Piacentini G, Mosca F. Epidemiology and prevention of respiratory syncytial virus infections in children in Italy. Ital J Pediatr 2021; 47:198. [PMID: 34600591 PMCID: PMC8487331 DOI: 10.1186/s13052-021-01148-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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: 05/31/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.
Collapse
Affiliation(s)
- Chiara Azzari
- Department of Health Sciences, Section of Pediatrics, University of Florence, Florence, Italy
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena Bozzola
- Pediatric Disease Unit, Bambino Gesù Children Hospital IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Alessandra Coscia
- Department of Public Health and Pediatric Sciences, Complex Structure Neonatology Unit, University of Turin, Turin, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studioru, University of Bologna, Bologna, Italy
| | - Paolo Manzoni
- Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
| | | | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Maggiore Hospital, Bologna, Italy
| | | | | | - Giorgio Piacentini
- Department of Pediatrics, Pediatric Division, University Hospital of Verona, Verona, Italy
| | - Fabio Mosca
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
20
|
Manzoni P, Militello MA, Fiorica L, Cappiello AR, Manzionna M. Impact of COVID-19 epidemics in paediatric morbidity and utilisation of Hospital Paediatric Services in Italy. Acta Paediatr 2021; 110:1369-1370. [PMID: 32573026 PMCID: PMC7361715 DOI: 10.1111/apa.15435] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Paolo Manzoni
- Department of Maternal‐Infant Medicine University Hospital ‘Degli Infermi’ Ponderano (Biella) Italy
| | - Maria Angela Militello
- Department of Maternal‐Infant Medicine University Hospital ‘Degli Infermi’ Ponderano (Biella) Italy
| | - Lorenzo Fiorica
- Department of Maternal‐Infant Medicine University Hospital ‘Degli Infermi’ Ponderano (Biella) Italy
| | | | - Mariano Manzionna
- UOC Pediatrics and Neonatology San Paolo Hospital, ASL Bari Bari Italy
| |
Collapse
|
21
|
Raffaldi I, Castagno E, Fumi I, Bondone C, Ricceri F, Besenzon L, Brach Del Prever A, Capalbo P, Cosi G, Felici E, Fusco P, Gallina MR, Garofalo F, Gianino P, Guala A, Haitink O, Manzoni P, Marra A, Rabbone I, Roasio L, Santovito S, Serra A, Tappi E, Terragni GM, Timeus FS, Torielli F, Vigo A, Urbino AF. Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study. Lancet Reg Health Eur 2021; 5:100081. [PMID: 34104902 PMCID: PMC7969147 DOI: 10.1016/j.lanepe.2021.100081] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background COVID-19 pandemic caused huge decrease of pediatric admissions to Emergency Department (ED), arising concerns about possible delays in diagnosis and treatment of severe disorders. Methods Impact of COVID-19 on Pediatric Emergency Room (ICOPER) was a retrospective multicentre observational study including 23 Italian EDs. All the children <18 years admitted, between March 9th and May 3rd 2020 stratified by age, priority code, cause of admission and outcome have been included and compared to those admitted in the same period of 2019. Our objectives were to assess the characteristics of pediatric admissions to EDs since COVID-19 outbreak until the end of lockdown, and to describe the features of critical children. Findings 16,426 children were admitted in 2020, compared to 55,643 in 2019 (-70·48%). Higher reduction was reported in hospitals without Pediatric Intensive Care Unit (PICU) (-73·38%) than in those with PICU (-64·08%) (P<0·0001). Admissions with low priority decreased more than critical ones (-82·77% vs. 44·17% respectively; P<0·0001). Reduction of discharged patients was observed both in hospitals with (-66·50%) and without PICU (-74·65%) (P<0·0001). No difference in the duration of symptoms before admission was reported between 2019 and 2020, with the majority of children accessing within 24 h (55·08% vs. 57·28% respectively; P = 0·2344). Interpretation Admissions with low priority decreased significantly more than those with high priority; we suppose that the fear of being infected in hospital maybe overcame the concerns of caregivers. Compared to 2019, no significant referral delay by caregivers was reported. Our data suggest the need of adaptation of EDs and primary care services to different needs of children during COVID-9 pandemic.
Collapse
Affiliation(s)
- Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Ilaria Fumi
- Department of Public Health and Pediatrics, University of Turin, Piazza Polonia 94, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano, TO, Italy.,Unit of Epidemiology, Regional Health Service, ASL TO3, Via Sabaudia 164, Grugliasco, TO, Italy
| | - Luigi Besenzon
- Division of Pediatrics and Neonatology, P.O. Savigliano, ASL CN1, Via Ospedali 9, Savigliano, CN, Italy
| | | | - Pina Capalbo
- Division of Pediatrics and Neonatology 3, P.O Martini, ASL Città di Torino, Via Tofane 71, Turin, Italy
| | - Gianluca Cosi
- Pediatric Unit, Sant'Andrea Hospital, ASL VC, Corso Mario Abbiate 21, Vercelli, Italy
| | - Enrico Felici
- Pediatrics and Pediatric Emergency Unit, The Children's Hospital, AO SS Antonio e Biagio e C. Arrigo, Via Spalto Marengo 46, Alessandria, Italy
| | - Patrizia Fusco
- Pediatric Unit, Montis Regalis Hospital, ASL CN1, Via San Rocchetto 99, Mondovì, CN, Italy
| | - Maria Rita Gallina
- Division of Pediatrics and Neonatology, Beauregard Hospital, Via L. Vaccari 5, Aosta, Italy
| | - Franco Garofalo
- Pediatric Unit, P.O. Rivoli, ASL TO3, Via Rivalta 29, Rivoli, TO, Italy
| | - Paola Gianino
- Division of Pediatrics, P.O. Cardinal Massaia, ASL AT, Corso Dante Alighieri 202, Asti, Italy
| | - Andrea Guala
- Division of Pediatrics, Ospedale Castelli, Via Fiume 18, Pallanza, Verbania, Italy
| | - Oscar Haitink
- Pediatric Department, SS Trinità Hospital, Viale Zoppis 10, Borgomanero, NO, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal-Infantile Medicine, Nuovo Ospedale Degli Infermi, Via dei Ponderanesi 2, Ponderano, BI, Italy
| | - Antonio Marra
- Pediatric Unit - NICU, S. Croce Hospital, ASLT TO5, Piazza Amedeo Ferdinando 3, Moncalieri, TO, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Corso G. Mazzini 18, Novara, Italy
| | - Luca Roasio
- Pediatric Department, E. Agnelli Hospital, Via Brigata Cagliari 39, Pinerolo, TO, Italy
| | - Savino Santovito
- Division of Pediatrics 1, Maria Vittoria Hospital, Via L. Cibrario 72, Turin, Italy
| | - Alberto Serra
- Division of Pediatrics, Ospedale Michele e Pietro Ferrero, P.O. Alba-Bra ASL CN2, Verduno, CN, Italy
| | - Eleonora Tappi
- Pediatric Unit, A.S.O. S. Croce e Carle, Via M. Coppino 26, Cuneo, Italy
| | - Gian Maria Terragni
- Division of Pediatrics, P.O. Chieri, ASL TO5, Via de Maria 1, Chieri, TO, Italy
| | - Fabio S Timeus
- Division of Pediatrics and Neonatology, P.O. Chivasso, ASL TO4, Corso G. Ferraris 3, Chivasso, TO, Italy
| | - Flaminia Torielli
- Division of Pediatrics, P.O. Novi Ligure, ASL AL, Via E. Raggio 12, Novi Ligure, AL, Italy
| | - Alessandro Vigo
- Division of Pediatrics and Neonatology, P.O. Ivrea, ASL TO4, Piazza Credenza 2, Ivrea, TO, Italy
| | - Antonio F Urbino
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Piazza Polonia 94, 10126 Turin, Italy
| | | |
Collapse
|
22
|
Prusakov P, Goff DA, Wozniak PS, Cassim A, Scipion CE, Urzúa S, Ronchi A, Zeng L, Ladipo-Ajayi O, Aviles-Otero N, Udeigwe-Okeke CR, Melamed R, Silveira RC, Auriti C, Beltrán-Arroyave C, Zamora-Flores E, Sanchez-Codez M, Donkor ES, Kekomäki S, Mainini N, Trochez RV, Casey J, Graus JM, Muller M, Singh S, Loeffen Y, Pérez MET, Ferreyra GI, Lima-Rogel V, Perrone B, Izquierdo G, Cernada M, Stoffella S, Ekenze SO, de Alba-Romero C, Tzialla C, Pham JT, Hosoi K, Consuegra MCC, Betta P, Hoyos OA, Roilides E, Naranjo-Zuñiga G, Oshiro M, Garay V, Mondì V, Mazzeo D, Stahl JA, Cantey JB, Monsalve JGM, Normann E, Landgrave LC, Mazouri A, Avila CA, Piersigilli F, Trujillo M, Kolman S, Delgado V, Guzman V, Abdellatif M, Monterrosa L, Tina LG, Yunis K, Rodriguez MAB, Saux NL, Leonardi V, Porta A, Latorre G, Nakanishi H, Meir M, Manzoni P, Norero X, Hoyos A, Arias D, Sánchez RG, Medoro AK, Sánchez PJ. A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study. EClinicalMedicine 2021; 32:100727. [PMID: 33554094 PMCID: PMC7848759 DOI: 10.1016/j.eclinm.2021.100727] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 09/25/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. METHODS We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. FINDINGS On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0·02). INTERPRETATION Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. FUNDING Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship.
Collapse
Affiliation(s)
- Pavel Prusakov
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Debra A. Goff
- Department of Pharmacy, The Ohio State University Wexner Medical Center, The Ohio State University College of Pharmacy, Columbus, OH, USA
| | | | - Azraa Cassim
- Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | | | - Soledad Urzúa
- Department of Neonatology, Pontificia Universidad Catolica, Santiago, Chile
| | - Andrea Ronchi
- Division of Neonatology and NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lingkong Zeng
- Department of Neonatology, Wuhan Children's Hospital Wuhan Maternal and Child Healthcare Hospital Tongji Medical College Huazhong University of Science & Technology, Wuhan, China
| | | | | | | | - Rimma Melamed
- Pediatric Infectious Diseases Unit and Faculty of Health Sciences, Ben Gurion University of the Negev, Soroka University Medical Center, Beer Sheva, Israel
| | - Rita C. Silveira
- Department of Pediatrics, Newborn Section, Universidade Federal do Rio Grande do Sul. Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Cinzia Auriti
- Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Elena Zamora-Flores
- Division of Neonatology, Hospital Materno Infantil Gregorio Marañon University Hospital, Madrid, Spain
| | - Maria Sanchez-Codez
- Division of Pediatric Infectious Diseases, Puerta del Mar University Hospital, Cadiz, Spain
| | - Eric S. Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Satu Kekomäki
- Division of Pediatric Infectious Diseases, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Jamalyn Casey
- Department of Pharmacy, St. Vincent Women's Hospital, Indianapolis, IN, United States
| | - Juan M. Graus
- Department of Neonatology, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Mallory Muller
- Department of Pharmacy, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Sara Singh
- University of Guyana, School of Medicine, Georgetown, Guyana
| | - Yvette Loeffen
- Division of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - María Eulalia Tamayo Pérez
- Coordinator of Neonatology Fellow Program, Head of Neonatal Intensive Care, University of Antioquia, Hospital San Vicente Fundacion, Medellin, Colombia
| | - Gloria Isabel Ferreyra
- Department of Neonatology, Instituto de Maternidad Ntra. Sra. de las Mercedes, San Miguel de Tucumán, Argentina
| | - Victoria Lima-Rogel
- Division of Neonatology, Hospital General Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
| | - Barbara Perrone
- Division of Neonatology and NICU, G. Salesi Children's Hospital, Ancona, Italy
| | - Giannina Izquierdo
- Division of Neonatology and Pediatric Infectious Diseases, Hospital Barros Luco Trudeau, Santiago, Chile
| | - María Cernada
- Division of Neonatology and Neonatal Research Group, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Sylvia Stoffella
- Department of Pharmacy, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - Jennifer T. Pham
- Department of Pharmacy, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Kenichiro Hosoi
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Pasqua Betta
- Division of Neonatology and NICU, AOU Policlinico G Rodolico, Catania, Italy
| | - O. Alvaro Hoyos
- Clínica Universitaria Bolivariana/Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Makoto Oshiro
- Department of Pediatrics, Nagoya Red Cross Daiichi Hospital, Nagoya, Japan
| | - Victor Garay
- Division of Neonatology, Alberto Sabogal Hospital, Lima, Peru
| | | | - Danila Mazzeo
- Division of Patology and Intensive Neonatal Care, A.O.U. Policlinico di Messina, Messina, Italy
| | - James A. Stahl
- Department of Pharmacy, Norton Children's Hospital, Louisville, KY, USA
| | - Joseph B. Cantey
- Department of Pediatrics, Division of Neonatology, University Hospital UT Health San Antonio, San Antonio, TX
| | | | - Erik Normann
- Department of Women's and Children's Health, Uppsala University, Uppsala University Children's Hospital, Uppsala, Sweden
| | | | - Ali Mazouri
- Iran University of Medical Sciences, Tehran, Iran
| | - Claudia Alarcón Avila
- Department of Perinatology and Neonatology, Central Military Hospital, Nueva Granada Military University, Bogotá, Colombia
| | | | - Monica Trujillo
- Program Coordinator Pediatric Infectious Diseases Clinica Universiraria Bolivariana, Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Sonya Kolman
- Department of Pharmacy, Nelson Mandela Children Hospital, Johannesburg, South Africa
| | - Verónica Delgado
- Head of Neonatal Intensive Care, Hospital de los Valles, Quito, Ecuador
| | - Veronica Guzman
- Pontificia Universidad Catolica del Ecuador, Hospital Metropolitano Quito, Quito, Ecuador
| | - Mohamed Abdellatif
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Luis Monterrosa
- Department of Pediatrics, Division of Neonatology, Saint John Regional Hospital, Saint John, Canada
| | | | - Khalid Yunis
- Division of Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Nicole Le Saux
- Division of Infectious Disease, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Valentina Leonardi
- Division of Neonatology and NICU, Careggi Univerisity Hospital, Florence, Italy
| | | | | | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Michal Meir
- Division of Pediatric Infectious Diseases, The Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Degli Infermi Hospital, Biella, Italy
| | | | - Angela Hoyos
- Division of Neonatology, Clínica del Country / Clínica La Colina, Bogotá, Colombia
| | | | | | - Alexandra K. Medoro
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Pablo J. Sánchez
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Corresponding author at: Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital - The Ohio State University College of Medicine, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, RB3, WB5245, Columbus, Ohio 43205-2664, United States.
| | | |
Collapse
|
23
|
Pastor N, Collado MC, Manzoni P. Phytonutrient and Nutraceutical Action against COVID-19: Current Review of Characteristics and Benefits. Nutrients 2021; 13:464. [PMID: 33573173 PMCID: PMC7910826 DOI: 10.3390/nu13020464] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022] Open
Abstract
The trend toward using phytonutrients and/or nutraceuticals (P/Ns) with the aim of impacting immune health has increased in recent years. The main reason is that properties of P/Ns are associated with possible immunomodulating effects in the prevention and complementary treatment of viral diseases, including COVID-19 and other respiratory infections. In the present review, we assess the scientific plausibility of specific P/Ns for this purpose of preventative and therapeutic interventions against COVID-19, with an emphasis on safety, validity, and evidence of efficacy against other viruses. Five potential candidates have been identified after reviewing available studies (in silico, in vitro, and in vivo) in which certain flavonoids have demonstrated a potential for use as adjuvant therapeutic agents against viral infections, including COVID-19. As these are often better tolerated than pharmacological treatments, their use could be more widely considered if additional detailed studies can validate the existing evidence.
Collapse
Affiliation(s)
- Nitida Pastor
- Department of Medical Affairs, Clinical Research, Mead Johnson Nutrition, Evansville, IN 47721, USA
| | - Maria Carmen Collado
- Department of Biotechnology, Institute of Agrochemistry and Food Technology-National Research Council (IATA-CSIC), Agustin Escardino 7, 46980 Paterna, Valencia, Spain;
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, 13875 Biella, Italy;
- Neonatology and NICU, Sant’Anna Hospital, AOU Città della Salute e della Scienza, 10136 Torino, Italy
| |
Collapse
|
24
|
Uccella S, Rosa M, Biletta E, Tinelli R, Zorzato PC, Botto-Poala C, Lanzo G, Gallina D, Franchi MP, Manzoni P. The Case of a Serous Borderline Ovarian Tumor in a 15-Year Old Pregnant Adolescent: Sonographic Characteristics and Surgical Management. Am J Perinatol 2020; 37:S61-S65. [PMID: 32898885 DOI: 10.1055/s-0040-1714080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to describe a rare case of a serous borderline ovarian tumor (BOT) diagnosed during pregnancy in a 15-year old adolescent. RESULTS The suspect of BOT was raised at a transvaginal ultrasound scan in early first trimester (at 5 weeks of amenorrhea), due to the presence of a moderately vascularized irregular papilla in the context of a unilocular low-level right ovarian cyst. The patient and her parents required termination of pregnancy, irrespective of the diagnosis of an ovarian lesion. After termination of pregnancy, the patient underwent laparoscopic enucleation of the ovarian mass, omentectomy, and peritoneal biopsies. No intra-abdominal spillage of the ovarian mass occurred, and the surgical specimens were put in an endobag and extracted transvaginally. Final pathological examination confirmed the diagnosis of a serous borderline ovarian tumor. The patient of free of disease after 8 months of follow-up. CONCLUSION Although rare, borderline ovarian tumors can be diagnosed in an adolescent during pregnancy. The combination of specific sonographic assessment and minimally invasive conservative surgery appears as a very effective approach in this type of patient. KEY POINTS · BOTs can occur in pregnant adolescents.. · Transvaginal ultrasound is crucial to suspect BOT.. · Laparoscopic conservative treatment is feasible..
Collapse
Affiliation(s)
- Stefano Uccella
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Health, ASL (Azienda Sanitaria Locale) Biella, Italy.,Department of Obstetrics and Gynecology, AOUI (Azienda Ospedaliera Universitaria Integrata), University of Verona, Italy
| | - Manuela Rosa
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Health, ASL (Azienda Sanitaria Locale) Biella, Italy
| | | | - Raffaele Tinelli
- Presidio Ospedaliero Valle d'Itria, Martina Franca, Taranto, Italy
| | - Pier C Zorzato
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Health, ASL (Azienda Sanitaria Locale) Biella, Italy.,Department of Obstetrics and Gynecology, AOUI (Azienda Ospedaliera Universitaria Integrata), University of Verona, Italy
| | - Chiara Botto-Poala
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Health, ASL (Azienda Sanitaria Locale) Biella, Italy
| | - Gabriele Lanzo
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Health, ASL (Azienda Sanitaria Locale) Biella, Italy
| | - Davide Gallina
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Health, ASL (Azienda Sanitaria Locale) Biella, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, AOUI (Azienda Ospedaliera Universitaria Integrata), University of Verona, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Health, ASL Biella, Italy
| |
Collapse
|
25
|
Genoni G, Conio A, Binotti M, Manzoni P, Castagno M, Rabbone I, Monzani A. Management and Nutrition of Neonates during the COVID-19 Pandemic: A Review of the Existing Guidelines and Recommendations. Am J Perinatol 2020; 37:S46-S53. [PMID: 32898882 DOI: 10.1055/s-0040-1714675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/23/2022]
Abstract
OBJECTIVE We aimed at reviewing the currently available guidelines and scientific recommendations regarding the neonatal in-hospital management and feeding in the light of the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN We systematically searched the guideline databases, Medline, Embase, and nationale/international neonatal societies websites as of June 19, 2020, for guidelines on neonatal management and feeding during the COVID-19 pandemic, at the same time assessing the methodological quality using the Appraisal of Guidelines for Research and Evaluation II tool. RESULTS Eleven guidelines were included. The Chinese and American recommendations suggest separation of the mother and her neonate, whereas in French, Italian, UK, Canadian, and World Health Organization consensus documents the rooming-in is suggested, with Centers for Disease Control and Prevention guidelines suggesting to decide on a case-by-case basis. All the guidelines recommend breastfeeding or feeding with expressed maternal milk; the only exception is the Chinese recommendations, these last suggesting to avoid breastfeeding. CONCLUSION This review may provide a useful tool for clinicians and organizers, highlighting differences and similarities of the existing guidelines on the management and feeding strategies in the light of the COVID-19 pandemic. KEY POINTS · This study compares guidelines on management and nutrition of a newborn born to a mother with SARS-CoV-2 infection.. · Existing guidelines on neonatal management and nutrition during the SARS-CoV-2 pandemic show many differences.. · The majority of recommendations are mainly based on experts' opinion and are not evidence-based..
Collapse
Affiliation(s)
- Giulia Genoni
- Pediatric and Neonatal Intensive Care Unit, Maggiore Della Carità University Hospital, Novara, Italy
| | - Alessandra Conio
- Pediatric and Neonatal Intensive Care Unit, Maggiore Della Carità University Hospital, Novara, Italy
| | - Marco Binotti
- Pediatric and Neonatal Intensive Care Unit, Maggiore Della Carità University Hospital, Novara, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal Infant Medicine, Degli Infermi Hospital, Ponderano (Biella), Italy
| | - Matteo Castagno
- Pediatric Unit, Maggiore Della Carità University Hospital, Novara, Italy
| | - Ivana Rabbone
- Pediatric Unit, Maggiore Della Carità University Hospital, Novara, Italy.,Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Alice Monzani
- Pediatric Unit, Maggiore Della Carità University Hospital, Novara, Italy.,Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| |
Collapse
|
26
|
Affiliation(s)
- Riccardo Davanzo
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Anne Merewood
- Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal Infant Medicine, "Degli Infermi" Hospital, Pomderano, Biella, Italy
| |
Collapse
|
27
|
Tognato E, Ceratto S, Enrico G, Fiorica L, Spola R, Loperfido B, Cimminelli L, Militello MA, Eshraghy MR, Savino F, Giuliani F, Perona A, Manzoni P. Neonatal Adrenal Hemorrhage: A Case Series. Am J Perinatol 2020; 37:S57-S60. [PMID: 32898884 DOI: 10.1055/s-0040-1713407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neonatal adrenal hemorrhage (NAH) in newborn infants is a rare event that is associated with specific anatomical and vascular characteristics. It is more common in term infants and occurs more often in neonates who feature perinatal asphyxia. Symptoms that more frequently prompt to diagnosis are prolonged jaundice, detection of an abdominal mass, anemia, scrotal discoloration and/or swelling, hypotonia, lethargy, and hypertension. However, NAH may also occur without symptoms with its detection being occasional. Imaging through ultrasound scans is the cornerstone of diagnosis and follow-up monitoring over time. Here we report on a small NAH case series comprising three full-term, macrosomic infants who were born by vaginal delivery. The first and second ones showed clear signs of birth asphyxia, whereas the third was completely asymptomatic. In all three patients, only the right adrenal gland was involved, in line with what happens in 70% of cases. NAH is usually self-limiting and prone to a progressive resolution in a time ranging between 3 weeks and 6 months and so did in our three patients. KEY POINTS: · NAH is caused by perinatal asphyxia.. · It is diagnosed with addominal ultrasound.. · It is usually self-limiting..
Collapse
Affiliation(s)
- Eleonora Tognato
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Simone Ceratto
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy.,Postgraduate School of Pediatrics, University of Turin, Piazza, Polonia, Torino, Italy
| | - Giorgia Enrico
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy.,Postgraduate School of Pediatrics, University of Turin, Piazza, Polonia, Torino, Italy
| | - Lorenzo Fiorica
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Roberta Spola
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Bruna Loperfido
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Lina Cimminelli
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Maria A Militello
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Mohammad R Eshraghy
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Francesco Savino
- Dipartimento Patologia e Cura del Bambino, S.S.D, Subintesiva Allargata della Prima Infanzia, Ospedale Infantile Regina Margherita, A.U.O. Città della Salute e della Scienza, Torino, Italy
| | - Francesca Giuliani
- Dipartimento Patologia e Cura del Bambino, S.S.D, Subintesiva Allargata della Prima Infanzia, Ospedale Infantile Regina Margherita, A.U.O. Città della Salute e della Scienza, Torino, Italy
| | - Anna Perona
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, Ponderano, Biella, Italy
| |
Collapse
|
28
|
De Leo R, La Gamba DA, Manzoni P, De Lorenzi R, Torresan S, Franchi M, Uccella S. Vaginal Birth after Two Previous Cesarean Sections versus Elective Repeated Cesarean: A Retrospective Study. Am J Perinatol 2020; 37:S84-S88. [PMID: 32898889 DOI: 10.1055/s-0040-1714344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Trial of labor after cesarean delivery (TOLAC) is a common practice worldwide but the evidence is still scant regarding this practice in women who underwent 2 previous cesareans. The purpose of this study is to retrospectively review our experience with vaginal birth after two previous cesarean sections (VBA2C), with specific attention to the indications for previous cesarean and to the women's motivation for attempting trial of labor. STUDY DESIGN This was a retrospective cohort study conducted in a primary care hospital between January 2011 and December 2019. Inclusion criteria were: singleton pregnancies, absence of morphological abnormalities at ultrasonographic screening of the second trimester (or at any other stage of pregnancy), and two previous cesarean sections. RESULTS The final analysis included 114 cases for maternal and neonatal outcomes. In total, 40.4% of women chose trial of labor after two cesarean delivery (TOLA2C group). TOLA2C was associated with a success rate of 76.1%, a higher gestational age at birth, and a shorter hospital stay, compared with elective repeated cesarean delivery group. There were no significant differences in the rate of Apgar scores at 5 minutes <7 between both groups. The percentage of successful TOLA2C in women with prior vaginal delivery was 92.8%. Factors related to failed TOLA2C included failure to progress (3/11, 27.3%), nonreassuring fetal heart rate (3/11, 27.3%), and no onset of spontaneous labor after premature rupture of membranes (5/11, 45.4%). In the group of TOLA2C, more than 70% accepted to travel more than 45 minutes to reach our hospital, with the aim to attempt VBA2C. CONCLUSION TOLA2C is a possible option for both mothers and neonates in selected cases. Adequate counseling about pros and cons of TOLA2C is mandatory. The woman's motivation represents a key element to determine the success of VBA2C. KEY POINTS · Selection of candidates and motivation of the patients represent key elements for successful TOLA2C.. · A careful record of obstetrical history and previous deliveries can provide clinicians useful information.. · Mode of delivery in women with two previous cesareans is strongly associated with doctor's counseling..
Collapse
Affiliation(s)
- Rossella De Leo
- Obstetrics and Gynecology Department, San Giacomo Apostolo Hospital-ULSS 2, Castelfranco Veneto, Italy
| | - Domenico Antonio La Gamba
- Obstetrics and Gynecology Department, San Giacomo Apostolo Hospital-ULSS 2, Castelfranco Veneto, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, ASL Biella, Ponderano, Biella, Italy
| | - Raffaella De Lorenzi
- Obstetrics and Gynecology Department, San Giacomo Apostolo Hospital-ULSS 2, Castelfranco Veneto, Italy
| | - Sonia Torresan
- Obstetrics and Gynecology Department, San Giacomo Apostolo Hospital-ULSS 2, Castelfranco Veneto, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI, University of Verona, Verona, Italy.,Division of Obstetrics and Gynecology, Department of Maternal, Neonatal, and Infant Health, Ospedale degli Infermi, ASL Biella, Ponderano, Biella, Italy
| |
Collapse
|
29
|
Abstract
In spite of the increasing, accumulating knowledge on the novel pandemic coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), questions on the coronavirus disease-2019 (COVID-19) infection transmission from mothers to fetuses or neonates during pregnancy and peripartum period remain pending and have not been addressed so far. SARS-CoV-2, a RNA single-stranded virus, has been detected in the amniotic fluid, in the cord blood and in the placentas of the infected women. In the light of these findings, the theoretical risk of intrauterine infection for fetuses, or of peripartum infection occurring during delivery for neonates, has a biological plausibility. The extent of this putative risk might, however, vary during the different stages of pregnancy, owing to several variables (physiological modifications of the placenta, virus receptors' expression, or delivery route). This brief review provides an overview of the current evidence in this area. Further data, based on national and international multicenter registries, are needed not only to clearly assess the extent of the risk for vertical transmission, but also to ultimately establish solid guidelines and consistent recommendations. KEY POINTS: · Questions on the COVID-19 infection transmission from mothers to fetuses or neonates during pregnancy and peripartum period remain pending so far.. · The theoretical risk of intrauterine infection for fetuses, or of neonatal infection during delivery for neonates, has a biological plausibility.. · A caution is recommended in the interpretation of clinical and laboratory data in neonates..
Collapse
Affiliation(s)
- Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children's Hospital IRCCS, Rome, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children's Hospital IRCCS, Rome, Italy
| | - Chryssoula Tzialla
- Neonatal Intensive Care Unit, IRCCS Foundation Policlinico “San Matteo,” Pavia, Italy
| | - Leonardo Caforio
- Fetal Medicine and Surgery Unit, Department of Medical and Surgical Neonatology, “Bambino Gesù” Children's Hospital IRCCS, Rome, Italy
| | - Matilde Ciccia
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, Maggiore Hospital, Bologna, Italy
| | - Paolo Manzoni
- Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
| | - Mauro Stronati
- Neonatal Intensive Care Unit, IRCCS Foundation Policlinico “San Matteo,” Pavia, Italy
| |
Collapse
|
30
|
Baraldi E, Bonadies L, Manzoni P. Evidence on the Link between Respiratory Syncytial Virus Infection in Early Life and Chronic Obstructive Lung Diseases. Am J Perinatol 2020; 37:S26-S30. [PMID: 32772357 DOI: 10.1055/s-0040-1714345] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/13/2022]
Abstract
There is growing evidence in medical literature to support an association between early-life respiratory syncytial virus lower respiratory tract-lower respiratory tract infection (RSV-LRTI) and recurrent wheezing/asthma-like symptoms. It has been estimated that children with a history of RSV-LRTI have a 2- to 12-fold higher risk of developing asthma. The connection between RSV infection and a developmental trajectory of reduced lung function remains throughout adolescence and early adulthood, suggesting a possible role for RSV even in the inception of chronic obstructive pulmonary disease. That is why the postnatal period appears to offer a specific window of opportunity for early intervention to prevent chronic obstructive lung diseases. The mechanisms by which RSV contributes to the onset of wheezing/asthma and lung function impairment are not fully understood but appear to relate to injury caused directly by the virus and/or to pre-existing predisposing factors. While awaiting a deeper understanding of the association between RSV and chronic lung diseases, the crucial role of pediatricians and physicians is to develop strategies to prevent RSV infections to try and protect children's lifelong respiratory health. KEY POINTS: · Several evidence suggest a link between RSV infection in early life and wheezing/asthma development.. · RSV infection appears to have long term respiratory effects.. · The prevention of RSV infections could reduce the incidence of chronic obstructive respiratory diseases..
Collapse
Affiliation(s)
- Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Paolo Manzoni
- Department of Maternal-Infant Medicine, University Hospital "Degli Infermi," Ponderano, Biella, Italy
| |
Collapse
|
31
|
Griffin MP, Yuan Y, Takas T, Domachowske JB, Madhi SA, Manzoni P, Simões EAF, Esser MT, Khan AA, Dubovsky F, Villafana T, DeVincenzo JP. Single-Dose Nirsevimab for Prevention of RSV in Preterm Infants. N Engl J Med 2020; 383:415-425. [PMID: 32726528 DOI: 10.1056/nejmoa1913556] [Citation(s) in RCA: 296] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection in infants, and a need exists for prevention of RSV in healthy infants. Nirsevimab is a monoclonal antibody with an extended half-life that is being developed to protect infants for an entire RSV season with a single intramuscular dose. METHODS In this trial conducted in both northern and southern hemispheres, we evaluated nirsevimab for the prevention of RSV-associated lower respiratory tract infection in healthy infants who had been born preterm (29 weeks 0 days to 34 weeks 6 days of gestation). We randomly assigned the infants in a 2:1 ratio to receive nirsevimab, at a dose of 50 mg in a single intramuscular injection, or placebo at the start of an RSV season. The primary end point was medically attended RSV-associated lower respiratory tract infection through 150 days after administration of the dose. The secondary efficacy end point was hospitalization for RSV-associated lower respiratory tract infection through 150 days after administration of the dose. RESULTS From November 2016 through November 2017, a total of 1453 infants were randomly assigned to receive nirsevimab (969 infants) or placebo (484 infants) at the start of the RSV season. The incidence of medically attended RSV-associated lower respiratory tract infection was 70.1% lower (95% confidence interval [CI], 52.3 to 81.2) with nirsevimab prophylaxis than with placebo (2.6% [25 infants] vs. 9.5% [46 infants]; P<0.001) and the incidence of hospitalization for RSV-associated lower respiratory tract infection was 78.4% lower (95% CI, 51.9 to 90.3) with nirsevimab than with placebo (0.8% [8 infants] vs. 4.1% [20 infants]; P<0.001). These differences were consistent throughout the 150-day period after the dose was administered and across geographic locations and RSV subtypes. Adverse events were similar in the two trial groups, with no notable hypersensitivity reactions. CONCLUSIONS A single injection of nirsevimab resulted in fewer medically attended RSV-associated lower respiratory tract infections and hospitalizations than placebo throughout the RSV season in healthy preterm infants. (Funded by AstraZeneca and Sanofi Pasteur; ClinicalTrials.gov number, NCT02878330.).
Collapse
MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antiviral Agents/administration & dosage
- Antiviral Agents/adverse effects
- Female
- Hospitalization/statistics & numerical data
- Humans
- Incidence
- Infant
- Infant, Newborn
- Infant, Premature
- Injections, Intramuscular
- Kaplan-Meier Estimate
- Male
- Poisson Distribution
- Respiratory Syncytial Virus Infections/epidemiology
- Respiratory Syncytial Virus Infections/prevention & control
- Respiratory Syncytial Virus, Human
- Respiratory Tract Infections/epidemiology
- Respiratory Tract Infections/prevention & control
- Respiratory Tract Infections/virology
- Viral Fusion Proteins/antagonists & inhibitors
Collapse
Affiliation(s)
- M Pamela Griffin
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Yuan Yuan
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Therese Takas
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Joseph B Domachowske
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Shabir A Madhi
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Paolo Manzoni
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Eric A F Simões
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Mark T Esser
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Anis A Khan
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Filip Dubovsky
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Tonya Villafana
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - John P DeVincenzo
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| |
Collapse
|
32
|
Shalish W, Lakshminrusimha S, Manzoni P, Keszler M, Sant'Anna GM. COVID-19 and Neonatal Respiratory Care: Current Evidence and Practical Approach. Am J Perinatol 2020; 37:780-791. [PMID: 32359226 PMCID: PMC7356086 DOI: 10.1055/s-0040-1710522] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/23/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has urged the development and implementation of guidelines and protocols on diagnosis, management, infection control strategies, and discharge planning. However, very little is currently known about neonatal COVID-19 and severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infections. Thus, many questions arise with regard to respiratory care after birth, necessary protection to health care workers (HCW) in the delivery room and neonatal intensive care unit (NICU), and safety of bag and mask ventilation, noninvasive respiratory support, deep suctioning, endotracheal intubation, and mechanical ventilation. Indeed, these questions have created tremendous confusion amongst neonatal HCW. In this manuscript, we comprehensively reviewed the current evidence regarding COVID-19 perinatal transmission, respiratory outcomes of neonates born to mothers with COVID-19 and infants with documented SARS-CoV-2 infection, and the evidence for using different respiratory support modalities and aerosol-generating procedures in this specific population. The results demonstrated that to date, neonatal COVID-19 infection is uncommon, generally acquired postnatally, and associated with favorable respiratory outcomes. The reason why infants display a milder spectrum of disease remains unclear. Nonetheless, the risk of severe or critical illness in young patients exists. Currently, the recommended respiratory approach for infants with suspected or confirmed infection is not evidence based but should include all routinely used types of support, with the addition of viral filters, proper personal protective equipment, and placement of infants in isolation rooms, ideally with negative pressure. As information is changing rapidly, clinicians should frequently watch out for updates on the subject. KEY POINTS: · Novel coronavirus disease 2019 (COVID-19) pandemic urged development of guidelines.. · Neonatal COVID-19 disease is uncommon.. · Respiratory outcomes in neonates seems favorable.. · Current neonatal respiratory care should continue.. · Clinicians should watch frequently for updates..
Collapse
MESH Headings
- Airway Management/methods
- Airway Management/trends
- Betacoronavirus/isolation & purification
- COVID-19
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/therapy
- Evidence-Based Practice
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/prevention & control
- Infant, Newborn, Diseases/therapy
- Infant, Newborn, Diseases/virology
- Infection Control/methods
- Infection Control/organization & administration
- Infection Control/standards
- Infectious Disease Transmission, Vertical/prevention & control
- Pandemics/prevention & control
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/therapy
- Pregnancy
- SARS-CoV-2
Collapse
Affiliation(s)
- Wissam Shalish
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Paolo Manzoni
- Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
| | - Martin Keszler
- Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island
| | - Guilherme M. Sant'Anna
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| |
Collapse
|
33
|
Affiliation(s)
- Paolo Manzoni
- Head, Department of Maternal-Infant Medicine, University Hospital "Degli Infermi", Via dei Ponderanesi, 2, 31785 Ponderano (Biella). Italy.
| | - Cristina Milillo
- Board of Directors. Italian Society of Family Pediatricians (FIMP), Piedmont Section, Torino, Italy
| |
Collapse
|
34
|
Tarnow-Mordi WO, Abdel-Latif ME, Martin A, Pammi M, Robledo K, Manzoni P, Osborn D, Lui K, Keech A, Hague W, Ghadge A, Travadi J, Brown R, Darlow BA, Liley H, Pritchard M, Kochar A, Isaacs D, Gordon A, Askie L, Cruz M, Schindler T, Dixon K, Deshpande G, Tracy M, Schofield D, Austin N, Sinn J, Simes RJ. The effect of lactoferrin supplementation on death or major morbidity in very low birthweight infants (LIFT): a multicentre, double-blind, randomised controlled trial. Lancet Child Adolesc Health 2020; 4:444-454. [PMID: 32407710 DOI: 10.1016/s2352-4642(20)30093-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/06/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Very low birthweight or preterm infants are at increased risk of adverse outcomes including sepsis, necrotising enterocolitis, and death. We assessed whether supplementing the enteral diet of very low-birthweight infants with lactoferrin, an antimicrobial protein, reduces all-cause mortality or major morbidity. METHODS We did a multicentre, double-blind, pragmatic, randomised superiority trial in 14 Australian and two New Zealand neonatal intensive care units. Infants born weighing less than 1500 g and aged less than 8 days, were eligible and randomly assigned (1:1) using minimising web-based randomisation to receive once daily 200 mg/kg pasteurised bovine lactoferrin supplements or no lactoferrin supplement added to breast or formula milk until 34 weeks' post-menstrual age (or for 2 weeks, if longer), or until discharge from the study hospital if that occurred first. Designated nurses preparing the daily feeds were not masked to group assignment, but other nurses, doctors, parents, caregivers, and investigators were unaware. The primary outcome was survival to hospital discharge or major morbidity (defined as brain injury, necrotising enterocolitis, late-onset sepsis at 36 weeks' post-menstrual age, or retinopathy treated before discharge) assessed in the intention-to-treat population. Safety analyses were by treatment received. We also did a prespecified, PRISMA-compliant meta-analysis, which included this study and other relevant randomised controlled trials, to estimate more precisely the effects of lactoferrin supplementation on late-onset sepsis, necrotising enterocolitis, and survival. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12611000247976. FINDINGS Between June 27, 2014, and Sept 1, 2017, we recruited 1542 infants; 771 were assigned to the intervention group and 771 to the control group. One infant who had consent withdrawn before beginning lactoferrin treatment was excluded from analysis. In-hospital death or major morbidity occurred in 162 (21%) of 770 infants in the intervention group and in 170 (22%) of 771 infants in the control group (relative risk [RR] 0·95, 95% CI 0·79-1·14; p=0·60). Three suspected unexpected serious adverse reactions occurred; two in the lactoferrin group, namely unexplained late jaundice and inspissated milk syndrome, but were not attributed to the intervention and one in the control group had fatal inspissated milk syndrome. Our meta-analysis identified 13 trials completed before Feb 18, 2020, including this Article, in 5609 preterm infants. Lactoferrin supplements significantly reduced late-onset sepsis (RR 0·79, 95% CI 0·71-0·88; p<0·0001; I2=58%), but not necrotising enterocolitis or all-cause mortality. INTERPRETATION Lactoferrin supplementation did not improve death or major morbidity in this trial, but might reduce late-onset sepsis, as found in our meta-analysis of over 5000 infants. Future collaborative studies should use products with demonstrated biological activity, be large enough to detect moderate and clinically important effects reliably, and assess greater doses of lactoferrin in infants at increased risk, such as those not exclusively receiving breastmilk or infants of extremely low birthweight. FUNDING Australian National Health and Medical Research Council.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Kei Lui
- University of New South Wales, Kensington, NSW, Australia
| | | | - Wendy Hague
- University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | - Helen Liley
- University of Queensland, Brisbane, QLD, Australia
| | | | - Anu Kochar
- University of Adelaide, Adelaide, SA, Australia
| | | | | | - Lisa Askie
- University of Sydney, Sydney, NSW, Australia
| | - Melinda Cruz
- Miracle Babies Foundation, Chipping Norton, NSW, Australia
| | - Tim Schindler
- University of New South Wales, Kensington, NSW, Australia
| | - Kelly Dixon
- University of Queensland, Brisbane, QLD, Australia
| | | | - Mark Tracy
- University of Sydney, Sydney, NSW, Australia
| | | | | | - John Sinn
- University of Sydney, Sydney, NSW, Australia
| | | | | |
Collapse
|
35
|
Affiliation(s)
- Renato Soibelmann Procianoy
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Chief Editor of the Jornal de Pediatria, Porto Alegre, RS, Brazil.
| | - Rita C Silveira
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Paolo Manzoni
- Hospital Universitário Degli Infermi, Department of Maternal-Infant Medicine, Ponderano, Italy
| | | |
Collapse
|
36
|
Perrett KP, Halperin SA, Nolan T, Carmona Martínez A, Martinón-Torres F, García-Sicilia J, Virta M, Vanderkooi OG, Zuccotti GV, Manzoni P, Kostanyan L, Meyer N, Ceregido MA, Cheuvart B, Kuriyakose SO, Stranak Z, Merino Arribas JM, Cilleruelo Ortega MJ, Miranda-Valdivieso M, Arias Novas B, Ramos Amador JT, Omeñaca F, Baca M, Marchisio PG, Mesaros N. Impact of tetanus-diphtheria-acellular pertussis immunization during pregnancy on subsequent infant immunization seroresponses: follow-up from a large randomized placebo-controlled trial. Vaccine 2019; 38:2105-2114. [PMID: 31776027 DOI: 10.1016/j.vaccine.2019.10.104] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pertussis immunization during pregnancy results in high pertussis antibody concentrations in young infants but may interfere with infant immune responses to post-natal immunization. METHODS This phase IV, multi-country, open-label study assessed the immunogenicity and safety of infant primary vaccination with DTaP-HepB-IPV/Hib and 13-valent pneumococcal conjugate vaccine (PCV13). Enrolled infants (6-14 weeks old) were born to mothers who were randomized to receive reduced-antigen-content diphtheria-tetanus-three-component acellular pertussis vaccine (Tdap group) or placebo (control group) during pregnancy (270/7-366/7 weeks' gestation) with crossover immunization postpartum. All infants received 2 or 3 DTaP-HepB-IPV/Hib and PCV13 doses according to national schedules. Immunogenicity was assessed in infants pre- and 1 month post-primary vaccination. The primary objective was to assess seroprotection/vaccine response rates for DTaP-HepB-IPV/Hib antigens 1 month post-primary vaccination. RESULTS 601 infants (Tdap group: 296; control group: 305) were vaccinated. One month post-priming, seroprotection rates were 100% (diphtheria; tetanus), ≥98.5% (hepatitis B), ≥95.9% (polio) and ≥94.5% (Hib) in both groups. Vaccine response rates for pertussis antigens were significantly lower in infants whose mothers received pregnancy Tdap (37.5-77.1%) versus placebo (90.0-99.2%). Solicited and unsolicited adverse event rates were similar between groups. Serious adverse events occurred in 2.4% (Tdap group) and 5.6% (control group) of infants, none were vaccination-related. CONCLUSIONS Pertussis antibodies transferred during pregnancy may decrease the risk of pertussis infection in the first months of life but interfere with the infant's ability to produce pertussis antibodies, the clinical significance of which remains unknown. Safety and reactogenicity results were consistent with previous experience. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02422264.
Collapse
Affiliation(s)
- Kirsten P Perrett
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Scott A Halperin
- Dalhousie University, Canadian Center for Vaccinology, Halifax, Canada.
| | - Terry Nolan
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | | | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela and Genetics, Vaccines and Pediatrics Research Group, University of Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain.
| | | | - Miia Virta
- Tampere Vaccine Research Center, Tampere University, Tampere, Finland.
| | - Otto G Vanderkooi
- Alberta Children's Hospital, University of Calgary, Alberta, Calgary, Canada.
| | | | - Paolo Manzoni
- Ospedale Ostetrico Ginecologico Sant'Anna, Turin, Italy and Department of Maternal-Infant -Pediatric Health, Hospital "Degli Infermi", Biella, Italy
| | | | | | | | | | | | - Zbynek Stranak
- Institute for the Care of Mother and Child, Prague, Czech Republic.
| | | | | | | | | | | | | | - Manuel Baca
- Hospital Quiron Malaga, Andalucia, Malaga, Spain.
| | - Paola Giovanna Marchisio
- Unità Pediatrica di Cure Altamente Intensive, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Lombardia, Milano, Italy.
| | | |
Collapse
|
37
|
Tepedino V, Berrini A, Borromeo V, Gaggioli D, Cantoni C, Manzoni P, Secchi C. Identification of Commercial Fish Species Belonging to the Orders Pleuronectiformes and Gadiformes: Library of Isoelectric Focusing Patterns. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.5.1600] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Isoelectric focusing in polyacrylamide gel was used to establish an identification archive of fish species belonging to the orders Pleuronectiformes, or flat fish, and Gadiformes, or gadoid fish. The 2 orders include species of different commercial value and interest that are frequently requested in European fish markets, but are susceptible to substitution either because they are morphologically similar or because they arrive on the markets already filleted or sliced. The sarcoplasmic protein profiles are species-specific and reproducible. The use of densitometry and image analysis coupled with a simple computer program overcomes the subjective evaluation of the patterns, making it possible to identify species correctly.
Collapse
Affiliation(s)
- Valentina Tepedino
- University of Milan, Istituto di Ispezione degli Alimenti di Origine Animale, Via Celoria 10, I-20133 Milan, Italy
| | - Anna Berrini
- University of Milan, Istituto di Fisiologia Veterinaria e Biochimica, Via Celoria 10, I-20133 Milan, Italy
| | - Vitaliano Borromeo
- University of Milan, Istituto di Fisiologia Veterinaria e Biochimica, Via Celoria 10, I-20133 Milan, Italy
| | - Daniela Gaggioli
- University of Milan, Istituto di Fisiologia Veterinaria e Biochimica, Via Celoria 10, I-20133 Milan, Italy
| | - Carlo Cantoni
- University of Milan, Istituto di Ispezione degli Alimenti di Origine Animale, Via Celoria 10, I-20133 Milan, Italy
| | - Paolo Manzoni
- ASL Provincia di Lecco, Veterinary Sector, Via Ghislanzoni 22, I-23900 Lecco, Italy
| | - Camillo Secchi
- University of Milan, Istituto di Fisiologia Veterinaria e Biochimica, Via Celoria 10, I-20133 Milan, Italy
| |
Collapse
|
38
|
Richard V, Detrée P, Frontczak A, Balssa L, Bernardini S, Chabannes E, Guichard G, David A, Manzoni P, Bittard H, Kleinclauss F. [Concordances and predictors of biopsies in renal tumors]. Prog Urol 2019; 29:955-961. [PMID: 31629660 DOI: 10.1016/j.purol.2019.08.275] [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: 06/04/2018] [Revised: 08/07/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
AIM Evaluate the concordance between the renal lesions biopsy's histology and the final histology of the surgical specimen according to histological subtype, and search for predictive factors of non-concordance. MATERIAL We performed a monocentric retrospective study that included 156 patients suffering from a renal tumor that benefited a lesion biopsy before surgical treatment. Sensibility and specificity of the renal lesion's biopsy for histological diagnostic of the different renal tumors where calculated. RESULTS One hundred and fifty-eight renal tumor biopsies were realized between 2001 and 2016. One hundred and forty-three renal cell carcinoma were found on the surgical piece, 135 were diagnosed on prior biopsy. Global concordance rate was 88%. For the establishment of the nuclear Fuhrmann grade, the concordance rate (low vs. high grade) was 72.9%. The cohort was divided into 2 groups according to the existence (group 1, n=139) or the absence (group 2, n=19) of concordance. Group 1 and 2 differed by the predominance of men in group 1 (66% vs. 37%, P=0.013), distance between the sinus and the tumor above 4mm (65% vs. 42%, P=0.05). CONCLUSION In renal tumor care, renal biopsy is a reliable testing. However, some factors most likely linked to the tumor anatomy (intra-sinusal tumor) and their histological composition were involved in the lack of non-contribution to the diagnosis. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- V Richard
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France.
| | - P Detrée
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France
| | - A Frontczak
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France
| | - L Balssa
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France
| | - S Bernardini
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France
| | - E Chabannes
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France
| | - G Guichard
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France
| | - A David
- Service de radiologie, CHRU de Besançon, 25000 Besançon, France
| | - P Manzoni
- Service de radiologie, CHRU de Besançon, 25000 Besançon, France
| | - H Bittard
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France
| | - F Kleinclauss
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France; Inserm URM 1098, 25000 Besançon, France
| |
Collapse
|
39
|
Priante E, Tavella E, Girardi E, Militello MA, Mardegan V, Maule MM, Dall'Agnola A, Baraldi E, Manzoni P. Restricted Palivizumab Recommendations and the Impact on RSV Hospitalizations among Infants Born at > 29 Weeks of Gestational Age: An Italian Multicenter Study. Am J Perinatol 2019; 36:S77-S82. [PMID: 31238365 DOI: 10.1055/s-0039-1691771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Premature infants have the highest risk of being hospitalized with respiratory syncytial virus (RSV) infections. Palivizumab is the only licensed agent for RSVhospitalization (RSVH) prophylaxis in infants born at < 35 weeks of gestational age (wGA). In 2016, the Italian Drug Agency (Agenzia Italiana del Farmaco [AIFA]) has restricted the eligibility for reimbursement to infants at high risk of RSVH, ruling out palivizumab administration for infants born at > 29 wGA. The aim of the present study was to compare the incidence of RSVH in two consecutive epidemic seasons (2015-2016 vs. 2016-2017), that is, before and after the new AIFA recommendations on palivizumab eligibility. STUDY DESIGN This was a noninterventional retrospective cohort study conducted at three neonatal intensive care units (NICUs) in northern Italy. Infants born at 29 and 35 wGA between March 15, 2015 and March 14, 2017 were enrolled for this study. Electronic medical charts were reviewed and parents were interviewed by telephone. Data were collected on neonatal course during NICU stay, palivizumab administration, and hospitalizations related to respiratory infections during the 1st year of life, comparing the infants born in season 1 with season 2. RESULTS Of 632 eligible infants, data were available for 536 (262 in season 1 and 274 in season 2). Overall, RSVH occurred 1.9 and 5.1% in infants in seasons 1 and 2, respectively (odds ratio [OR] = 2.77; 95% confidence interval [CI]: 0.98-7.8, p = 0.045). When the analysis was limited to patients not exposed to palivizumab, RSVHs were recorded for 1.8 and 5.9% infants in seasons 1 and 2, respectively (OR = 3.42; 95% CI: 0.96-12.20, p = 0.045). It is noteworthy that the incidence of hospital admissions for respiratory viruses other than RSV did not differ between the two seasons. CONCLUSION Restricting eligibility for palivizumab reimbursement led to a significant increase in RSVH but had no impact on hospitalizations for other respiratory viruses. Future decisions on palivizumab prescription and coverage rules should be driven by a careful assessment of the cost-benefit ratio.
Collapse
Affiliation(s)
- Elena Priante
- Department of Woman's and Child's Health, Unit of Neonatal Intensive Care, University of Padua, Padua, Italy
| | - Elena Tavella
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Nuovo Ospedale degli Infermi, ASL Biella, Italy
| | - Elisa Girardi
- Paediatrics and Neonatology, Hospital Villafranca di Verona, Italy
| | - Maria Angela Militello
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Nuovo Ospedale degli Infermi, ASL Biella, Italy
| | - Veronica Mardegan
- Department of Woman's and Child's Health, Unit of Neonatal Intensive Care, University of Padua, Padua, Italy
| | - Milena M Maule
- Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin, Turin, Italy
| | - Alberto Dall'Agnola
- Neonatology and Pediatric Infectious Disease, P. Pederzoli Hospital, Peschiera del Garda, Regione Veneto, Italy
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, Unit of Neonatal Intensive Care, University of Padua, Padua, Italy.,Respiratory Syncytial Virus Network (ReSViNET) Foundation, Zeist, The Netherlands
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Nuovo Ospedale degli Infermi, ASL Biella, Italy.,Respiratory Syncytial Virus Network (ReSViNET) Foundation, Zeist, The Netherlands
| |
Collapse
|
40
|
Manzoni P, Militello MA, Rizzollo S, Tavella E, Messina A, Pieretto M, Boano E, Carlino M, Tognato E, Spola R, Perona A, Maule MM, García Sánchez R, Meyer M, Stolfi I, Pugni L, Messner H, Cattani S, Betta PM, Memo L, Decembrino L, Bollani L, Rinaldi M, Fioretti M, Quercia M, Tzialla C, Laforgia N, Mosca F, Magaldi R, Mostert M, Farina D, Tarnow-Mordi W. Is Lactoferrin More Effective in Reducing Late-Onset Sepsis in Preterm Neonates Fed Formula Than in Those Receiving Mother's Own Milk? Secondary Analyses of Two Multicenter Randomized Controlled Trials. Am J Perinatol 2019; 36:S120-S125. [PMID: 31238372 DOI: 10.1055/s-0039-1691807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Lactoferrin is the major antimicrobial protein in human milk. In our randomized controlled trial (RCT) of bovine lactoferrin (BLF) supplementation in preterm neonates, BLF reduced late-onset sepsis (LOS). Mother's own milk (MM) contains higher concentrations of lactoferrin than donor milk or formula, but whether BLF is more effective in infants who receive formula or donor milk is uncertain. AIM To evaluate the incidence of LOS in preterm infants fed MM and in those fed formula and/or donor milk. STUDY DESIGN This is a (A) post hoc subgroup analysis, in our RCT of BLF, of its effects in preterm infants fed MM, with or without formula, versus those fed formula and/or donor milk (no-MM) and (B) post hoc meta-analysis, in our RCT of BLF and in the ELFIN (Enteral Lactoferrin in Neonates) RCT, of the effect of BLF in subgroups not exclusively fed MM. RESULTS (A) Of 472 infants in our RCT, 168 were randomized to placebo and 304 were randomized to BLF. Among MM infants, LOS occurred in 22/133 (16.5%) infants randomized to placebo and in 14/250 (5.6%) randomized to BLF (relative risk or risk ratio (RR): 0.34; relative risk reduction (RRR): 0.66; 95% confidence interval (95% CI) for RR: 0.18-0.64; p < 0.0008). Among no-MM infants, LOS occurred in 7/35 (20.0%) randomized to placebo and in 2/54 (3.7%) randomized to BLF (RR: 0.19; RRR: 0.81; 95% CI for RR: 0.16-0.96; p = 0.026). In multivariable logistic regression analysis, there was no interaction between BLF treatment effect and type of feeding (p = 0.628). (B) In 1,891 infants not exclusively fed MM in our RCT of BLF and in the ELFIN RCT, BLF reduced the RR of LOS by 18% (RR: 0.82; 95% CI: 0.71-0.96; p = 0.01). CONCLUSION Adequately powered studies should address the hypothesis that BLF is more effective in infants fed formula or donor milk than those fed MM. Such studies should evaluate whether a specific threshold of total lactoferrin intake can be identified to protect such patients from LOS.
Collapse
Affiliation(s)
- Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy.,Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Torino, Italy
| | - Maria Angela Militello
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Stefano Rizzollo
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Elena Tavella
- Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alessandro Messina
- Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Torino, Italy
| | - Marta Pieretto
- Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Torino, Italy
| | - Elena Boano
- Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Torino, Italy
| | - Martina Carlino
- Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Torino, Italy
| | - Eleonora Tognato
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Roberta Spola
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Anna Perona
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - Milena Maria Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Ruben García Sánchez
- Department of Neonatology and NICU, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Mike Meyer
- Department of Neonatology and NICU, Middlemore Hospital, Auckland, New Zealand
| | - Ilaria Stolfi
- Department of Neonatology, Azienda Ospedaliera Universitaria Policlinico Umberto I, Roma, Italy
| | - Lorenza Pugni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Hubert Messner
- Department of Neonatology and NICU, Ospedale Regionale, Bolzano/Bozen, Italy
| | - Silvia Cattani
- NICU, University of Modena and Reggio Emilia, Modena, Italy
| | - Pasqua Maria Betta
- NICU, Azienda Ospedaliera Universitaria Policlinico di Catania, Catania, Italy
| | - Luigi Memo
- U.O.C. di Pediatria e Patologia Neonatale, Ospedale San Martino, Belluno, Italy
| | - Lidia Decembrino
- UOC Neonatologia e Terapia Intensiva, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lina Bollani
- UOC Neonatologia e Terapia Intensiva, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Rinaldi
- Department of Neonatology, Ospedali Riuniti, Foggia, Italy
| | - Maria Fioretti
- Terapia Intensiva Neonatale, Ospedale Monaldi-Azienda Ospedaliera dei Colli, Napoli, Italy
| | - Michele Quercia
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Chryssoula Tzialla
- UOC Neonatologia e Terapia Intensiva, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicola Laforgia
- Terapia Intensiva Neonatale, Ospedale Monaldi-Azienda Ospedaliera dei Colli, Napoli, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Michael Mostert
- Department of Pediatrics, University of Turin, Torino, Italy
| | - Daniele Farina
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, Italy
| | - William Tarnow-Mordi
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | |
Collapse
|
41
|
Uccella S, Manzoni P, Cromi A, Marconi N, Gisone B, Miraglia A, Biasoli S, Zorzato PC, Ferrari S, Lanzo G, Bertoli F, Capozzi VA, Gallina D, Agosti M, Ghezzi F. Pregnancy after Endometriosis: Maternal and Neonatal Outcomes according to the Location of the Disease. Am J Perinatol 2019; 36:S91-S98. [PMID: 31238367 DOI: 10.1055/s-0039-1692130] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To systematically evaluate pregnancy and labor course, obstetrical complications, and maternal and neonatal outcomes in women with endometriosis, stratifying according to the specific location of the disease. STUDY DESIGN We retrospectively analyzed our prospectively maintained obstetrical database from January 2011 to August 2014 to identify all women with a previous histological diagnosis of endometriosis who delivered at our institution (cases). We divided the cases according to the specific location of the disease (deep infiltrating endometriosis, ovarian endometriosis, and peritoneal endometriosis). As controls, we identified all unaffected women who delivered in the year 2013. To avoid the confounding effect of parity, we limited our analysis to nulliparous women. RESULTS A total of 118 nulliparous women with endometriosis and 1,690 nulliparous controls were identified. Women with endometriosis were significantly older, had a lower body mass index, and had a higher incidence of assisted reproductive technology. The duration of pregnancy was significantly shorter among women with endometriosis. A higher incidence of placenta previa (3.4 vs. 0.5%; p = 0.006), hypertension (11 vs. 5.9%; p = 0.04), cesarean section (41.5 vs. 24.2%; p < 0.0001), and vacuum delivery (10.1 vs. 2.9%; p = 0.006) was found in women with endometriosis. Neonatal outcomes were similar between groups. The incidence of placenta previa in patients with deep endometriosis was 11.7 versus 0.5% among controls (p < 0.0001), whereas in women with ovarian and peritoneal endometriosis, it was similar to the controls. CONCLUSION Women with endometriosis have a higher incidence of vacuum delivery, cesarean section, and placenta previa compared with unaffected women. The higher risk of placenta previa is attributable exclusively to women with deep endometriosis. Neonatal outcomes are unaffected by the presence of the disease.
Collapse
Affiliation(s)
- Stefano Uccella
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy.,Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Nicola Marconi
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Baldo Gisone
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Andrea Miraglia
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Sara Biasoli
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Pier Carlo Zorzato
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Stefania Ferrari
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Gabriele Lanzo
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Francesca Bertoli
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | | | - Davide Gallina
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Massimo Agosti
- Department of Neonatology and Neonatal Intensive Care Unit, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| |
Collapse
|
42
|
Abstract
OBJECTIVE The Marfan syndrome (MFS) is an autosomal dominant disorder of connective tissue resulting from pathogenic variants of the fibrillin-1 gene (FBN1) with skeletal, cardiac, and ocular involvement. STUDY DESIGN We report on a full-term male neonate, who showed at birth characteristics and dysmorphisms suggestive of nMFS, combined with the detection of severe cardiovascular disease. A multidisciplinary team made up of neonatologists and pediatricians, cardiologists, geneticists, ophtalmologists, physiatrists and physioterapists was formed to manage this patient. RESULTS AND CONCLUSION Early diagnosis of this rare condition is critical for adequate treatment and specific follow-up, and impacts significantly on prognosis.
Collapse
Affiliation(s)
- Eleonora Tognato
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Degli Infermi Hospital, Biella, Italy
| | - Anna Perona
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Degli Infermi Hospital, Biella, Italy
| | - Angela Aronica
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Degli Infermi Hospital, Biella, Italy
| | - Antonella Bertola
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Degli Infermi Hospital, Biella, Italy
| | - Lina Cimminelli
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Degli Infermi Hospital, Biella, Italy
| | - Simona De Vecchi
- Division of Cardiology, Department of Medicine and Urgency, Degli Infermi Hospital, Biella, Italy
| | - Mohammad Reza Eshraghy
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Degli Infermi Hospital, Biella, Italy
| | - Bruna Loperfido
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Degli Infermi Hospital, Biella, Italy
| | - Claudia Vivenza
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Degli Infermi Hospital, Biella, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Degli Infermi Hospital, Biella, Italy
| |
Collapse
|
43
|
Luparia M, Landi F, Mesini A, Militello MA, Galletto P, Farina D, Castagnola E, Manzoni P. Fungal Ecology in a Tertiary Neonatal Intensive Care Unit after 16 Years of Routine Fluconazole Prophylaxis: No Emergence of Native Fluconazole-Resistant Strains. Am J Perinatol 2019; 36:S126-S133. [PMID: 31238373 DOI: 10.1055/s-0039-1691808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We analyzed the fungal ecology of a neonatal intensive care unit (NICU) over a period of 20 consecutive years following the introduction of routine fluconazole prophylaxis for all very low birth weight (VLBW; <1,500 g at birth) preterm babies. The aim was to detect the possible appearance of any ecological shifts toward the emergence of native fluconazole-resistant (NFR) fungal species. STUDY DESIGN This was a retrospective analysis of clinical and microbiological data of VLBW preterm neonates admitted to a large tertiary NICU in Italy from 1997 to 2016 and surviving more than 3 days. Colonization and infection incidence rates, both for fluconazole-sensitive Candida spp and NFR Candida spp, were calculated for each year. We compared the first 4-year period without prophylaxis (1997-2000) with the last 16-year period with use of routine fluconazole prophylaxis (2000-2016). RESULTS Overall, the incidence of fungal colonization significantly decreased after the introduction of prophylaxis (from 43.4% to 16.5%) as well as the systemic fungal infection incidence (from 16% to 3.7%). The proportion of colonization and infection by NFR Candida spp, on the other hand, did not increase, remaining stable throughout the 16 years of exposure to fluconazole. During the prophylaxis period, 42 of 1,172 VLBW neonates were colonized by NFR species (3.6%), and of them 11 developed a systemic infection (0.9%). During the preprophylaxis period, colonization by these particular species affected 11 of 285 VLBW neonates (3.8%), and a systemic infection involved 4 neonates (1.4%). CONCLUSION Fluconazole prophylaxis is effective in decreasing Candida colonization and systemic infections in preterm neonates in NICU and did not cause emergence or shifts toward NFR Candida spp over a 16-year surveillance period.
Collapse
Affiliation(s)
- Martina Luparia
- Department of Neonatology and NICU, Sant'Anna Hospital, Torino, Italy
| | - Francesca Landi
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessio Mesini
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Angela Militello
- Division of Pediatrics, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale degli Infermi, ASL Biella, Italy
| | - Paolo Galletto
- Department of Neonatology and NICU, Sant'Anna Hospital, Torino, Italy
| | - Daniele Farina
- Department of Neonatology and NICU, Sant'Anna Hospital, Torino, Italy
| | - Elio Castagnola
- Division of Infectious Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Manzoni
- Department of Neonatology and NICU, Sant'Anna Hospital, Torino, Italy.,Division of Pediatrics, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale degli Infermi, ASL Biella, Italy
| |
Collapse
|
44
|
Militello MA, Re MP, Vitaliti G, Finazzo F, Manzoni P, Vitaliti SM. Use of Zoledronic Acid in a Neonate with Subcutaneous Fat Necrosis Complicated with Severe, Refractory Hypercalcemia. Am J Perinatol 2019; 36:S134-S138. [PMID: 31238374 DOI: 10.1055/s-0039-1691777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Subcutaneous fat necrosis (SCFN) is a rare condition that may occur in the neonatal period. SCFN is an inflammatory disorder of the adipose tissue, usually found in full-term healthy infants who have a history of intrauterine or perinatal distress. It is usually a self-limited condition; however, in some cases, it can get complicated, leading to severe hypercalcemia that may be life-threatening. STUDY DESIGN We report and describe a classic presentation of SCFN that led to severe hypercalcemia refractory to standard treatment. The diagnosis of SCFN was made based on the finding of subcutaneous nodules and of hypercalcemia. The serum calcium level reached 16.6 mg/dL. Hypercalcemia was treated first with intravenous infusions of fluids and furosemide and then of methylprednisolone. This standard treatment was not effective; therefore, we administered a single low dose of zoledronic acid, which, in turn, was efficacious in ultimately managing the hypercalcemia. CONCLUSION Our case shows how a single low dose of zoledronic acid was safe and effective in managing severe hypercalcemia unresponsive to conventional treatment while minimizing the risk of hypocalcemic rebounds.
Collapse
Affiliation(s)
- Maria Angela Militello
- Division of Pediatrics, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Maria Paola Re
- U.O.C. Neonatologia - TIN - Nido, ARNAS Civico, Palermo, Italy
| | - Giuliana Vitaliti
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile G. D'Alessandro, University of Palermo, School of Medicine, Palermo, Italy
| | | | - Paolo Manzoni
- Division of Pediatrics, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale degli Infermi, Biella, Italy
| | | |
Collapse
|
45
|
Uccella S, Manzoni P, Marconi N, Toscani C, Biasoli S, Cianci S, Franchi M, Sorice P, Bertoli F, Zorzato PC, Gallina D, Ghezzi F, Serati M. Impact of Sport Activity and Physical Exercise on Obstetrical and Perineal Outcomes at Delivery: A Prospective Study. Am J Perinatol 2019; 36:S83-S90. [PMID: 31238366 DOI: 10.1055/s-0039-1691816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study was aimed to investigate the effects of physical activity on perineal outcomes at delivery according to the different levels and types of maternal physical activity before and during pregnancy. STUDY DESIGN We prospectively evaluated the obstetrical and perineal outcomes of all consecutive women who delivered at the Del Ponte Hospital, in the period between July 2014 and September 2014. Women were divided into three groups according to the features of physical activity performed before pregnancy: group 1: "very sporty women," group 2: "moderately sporty women," and group 3: "inactive women." A subanalysis of our data was performed based on the specific type of sport activity, on the degree of involvement of perineal muscles during physical activity, and on the continuation/discontinuation of this activity during pregnancy. RESULTS A total of 135, 84, and 85 women were included in group 1, group 2, and group 3, respectively. The demographic characteristics were comparable among all the groups. Sport activity during pregnancy was more frequent in groups 1 and 2 (59.3 and 53.6%, respectively, vs. 29.4% in group 3; p = 0.003). No differences among groups were detected in terms of perineal outcomes. A lower rate of episiotomy/lacerations ≥ 2nd degree was found among women who practiced sports that specifically involved the perineal muscles and who continued this practice during pregnancy. CONCLUSION Perineal outcomes are not influenced by the intensity of sport activity performed before/during pregnancy. Continuous sports during pregnancy that specifically train the perineal muscles are associated with a lower rate of episiotomy and perineal lacerations ≥ 2nd degree.
Collapse
Affiliation(s)
- Stefano Uccella
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Neonatal and Infant Medicine, Nuovo Ospedale degli Infermi, ASL Biella, Italy.,Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal and Infant Medicine, Nuovo Ospedale degli Infermi, ASL Biella, Italy
| | - Nicola Marconi
- Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Carlotta Toscani
- Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Sara Biasoli
- Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Stefano Cianci
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, University of Verona, Italy
| | - Paola Sorice
- Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Francesca Bertoli
- Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Pier Carlo Zorzato
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Neonatal and Infant Medicine, Nuovo Ospedale degli Infermi, ASL Biella, Italy
| | - Davide Gallina
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, Neonatal and Infant Medicine, Nuovo Ospedale degli Infermi, ASL Biella, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| |
Collapse
|
46
|
Petrillo F, Valenzano L, Franco C, Calò G, Dentico D, Manzoni P, D'Amato G, Del Vecchio A. Pulmonary Recruitment Strategy in Preterm Neonates < 29 Weeks of Gestational Age to Reduce the Need for Intubation in the Delivery Room. Am J Perinatol 2019; 36:S115-S119. [PMID: 31238371 DOI: 10.1055/s-0039-1692134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The application of noninvasive ventilation (NIV) modalities from birth in the delivery room (DR) during fetal-neonatal transition reduces the need for invasive mechanical ventilation, mortality, and bronchopulmonary dysplasia (BPD). The use of a RAM nasal cannula (RAM NC) in the DR for resuscitation results in less need for intubation, chest compressions, and epinephrine administration when compared with using a face mask for PPV in the DR. OBJECTIVE To evaluate the need for endotracheal intubation in the DR among extremely low gestational age neonates treated at birth with sustained inflation (SI) followed by a nasal continuous positive airway pressure (NCPAP) (range: 6-8 cm of H2O) delivered through the RAM NC. STUDY DESIGN A retrospective study was conducted to compare the use of NIV techniques in the DR and the need for intubation in the DR in premature infants 23 to 28 weeks' gestational age from December 2016 to July 2018 (group A). These data were compared with those of premature inborn infants with similar GA born between April 2015 and November 2016 (group B). In the DR, immediately after birth, neonates in group A received SI through RAM NC followed by CPAP ranging from 6 to 8 cm H2O, whereas the neonates in group B were treated in the DR with SI administered through a face mask followed by the application of CPAP of 5 cm H2O delivered through a nasopharyngeal tube. RESULTS A total of 65 preterm infants 23 to 28 weeks of gestational age, 31 in group A and 34 in group B, were included in the study. The percentage of neonates intubated in the DR was significantly lower in group A (p < 0.008). In both groups, no neonates died in the DR, and no one required epinephrine and/or chest compressions. For those neonates who did not require intubation in the DR, there was no significant difference in the average FiO2 on arrival in the neonatal intensive care unit, rate of intubation within 24 hours, and use of surfactant. The incidence of BPD was similar in the two groups. Only one infant in group A developed moderate BPD, and no one needed oxygen and/or ventilatory assistance at discharge. Mortality was similar in the two groups, with a slight prevalence in group B (27.7 vs. 19.2%). CONCLUSION SI with RAM NC followed by NCPAP ranging from 6 to 8 cm H2O, administered with RAM NC resulted in a significant reduction of intubation in the DR.
Collapse
Affiliation(s)
- Flavia Petrillo
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
| | - Luigia Valenzano
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
| | - Caterina Franco
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
| | - Giovanna Calò
- Department of Electrical and Information Engineering, Polytechnic of Bari, Bari, Italy
| | - Domenico Dentico
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
| | - Paolo Manzoni
- Division of Neonatology and NICU, S. Anna Obstetrics and Neonatology Hospital, Torino, Italy
| | - Gabriele D'Amato
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
| | - Antonio Del Vecchio
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
| |
Collapse
|
47
|
Obando-Pacheco P, Justicia-Grande AJ, Rivero-Calle I, Rodríguez-Tenreiro C, Sly P, Ramilo O, Mejías A, Baraldi E, Papadopoulos NG, Nair H, Nunes MC, Kragten-Tabatabaie L, Heikkinen T, Greenough A, Stein RT, Manzoni P, Bont L, Martinón-Torres F. Respiratory Syncytial Virus Seasonality: A Global Overview. J Infect Dis 2019; 217:1356-1364. [PMID: 29390105 DOI: 10.1093/infdis/jiy056] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/24/2018] [Indexed: 11/12/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections in children. By the age of 1 year, 60%-70% of children have been infected by RSV. In addition, early-life RSV infection is associated with the development of recurrent wheezing and asthma in infancy and childhood. The need for precise epidemiologic data regarding RSV as a worldwide pathogen has been growing steadily as novel RSV therapeutics are reaching the final stages of development. To optimize the prevention, diagnosis, and treatment of RSV infection in a timely manner, knowledge about the differences in the timing of the RSV epidemics worldwide is needed. Previous analyses, based on literature reviews of individual reports obtained from medical databases, have failed to provide global country seasonality patterns. Until recently, only certain countries have been recording RSV incidence through their own surveillance systems. This analysis was based on national RSV surveillance reports and medical databases from 27 countries worldwide. This is the first study to use original-source, high-quality surveillance data to establish a global, robust, and homogeneous report on global country-specific RSV seasonality.
Collapse
Affiliation(s)
- Pablo Obando-Pacheco
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago.,GENVIP Research Group, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Galicia, Spain
| | - Antonio José Justicia-Grande
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago.,GENVIP Research Group, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Galicia, Spain
| | - Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago.,GENVIP Research Group, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Galicia, Spain
| | - Carmen Rodríguez-Tenreiro
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago.,GENVIP Research Group, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Galicia, Spain
| | - Peter Sly
- Children's Lung Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Octavio Ramilo
- Respiratory syncytial virus network (ReSViNET), Zeist.,Department of Pediatrics, Division of Infectious Diseases, Ohio State University, Columbus.,Center for Vaccines and Immunity at Nationwide Children's Hospital, Ohio State University, Columbus
| | - Asunción Mejías
- Respiratory syncytial virus network (ReSViNET), Zeist.,Department of Pediatrics, Division of Infectious Diseases, Ohio State University, Columbus.,Center for Vaccines and Immunity at Nationwide Children's Hospital, Ohio State University, Columbus
| | - Eugenio Baraldi
- Respiratory syncytial virus network (ReSViNET), Zeist.,Women's and Children's Health Department, University of Padova, Torino, Italy
| | - Nikolaos G Papadopoulos
- Respiratory syncytial virus network (ReSViNET), Zeist.,Department of Allergy, 2nd Pediatric Clinic, University of Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Johannesburg, South Africa
| | - Harish Nair
- Respiratory syncytial virus network (ReSViNET), Zeist.,Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Johannesburg, South Africa
| | - Marta C Nunes
- Respiratory syncytial virus network (ReSViNET), Zeist.,Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of Witwatersrand, Johannesburg, South Africa
| | - Leyla Kragten-Tabatabaie
- Respiratory syncytial virus network (ReSViNET), Zeist.,Julius Clinical, University Medical Center Utrecht, Zeist
| | - Terho Heikkinen
- Respiratory syncytial virus network (ReSViNET), Zeist.,Department of Pediatrics, University of Turku and Turku University Hospital, Finl
| | - Anne Greenough
- Respiratory syncytial virus network (ReSViNET), Zeist.,MRC & Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, Johannesburg, South Africa.,Department of Women and Children's Health, School of Life Course Sciences.,Faculty of Life Sciences and Medicine, King's College London
| | - Renato T Stein
- Respiratory syncytial virus network (ReSViNET), Zeist.,Pediatric Pulmonology Unit, Pontifícia Universidade Católica RS, Porto Alegre, Brazil
| | - Paolo Manzoni
- Respiratory syncytial virus network (ReSViNET), Zeist.,Neonataology and Neonatal Intensive Care Unit, S Anna Hospital, Torino, Italy
| | - Louis Bont
- Respiratory syncytial virus network (ReSViNET), Zeist.,Department of Pediatrics, University Medical Center Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, The Netherlands
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago.,GENVIP Research Group, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Galicia, Spain.,Respiratory syncytial virus network (ReSViNET), Zeist
| |
Collapse
|
48
|
Affiliation(s)
- Paolo Manzoni
- Division of Pediatrics and Neonatology, Degli Infermi Hospital, Biella, Italy
| |
Collapse
|
49
|
Hamam J, Grillet F, Guillien A, Manzoni P, Behr J, Dalphin J. SPOT : Score prédictif de Pneumothorax secondaires aux pOnction-biopsies Transthoraciques pulmonaires scanno-guidées. Étude rétrospective. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
50
|
Martin A, Ghadge A, Manzoni P, Lui K, Brown R, Tarnow-Mordi W. Protocol for the Lactoferrin Infant Feeding Trial (LIFT): a randomised trial of adding lactoferrin to the feeds of very-low birthweight babies prior to hospital discharge. BMJ Open 2018; 8:e023044. [PMID: 30282685 PMCID: PMC6169746 DOI: 10.1136/bmjopen-2018-023044] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Very-low birthweight (VLBW, <1500 g) infants comprise about 1%-1.4% of all births in high-income countries. Every year, about 3000 VLBW babies in Australia and New Zealand receive intensive care. Many die or else survive with severe brain injury, retinopathy, late-onset sepsis or necrotising enterocolitis (NEC), each of which carries substantial risk of disability. METHODS AND ANALYSIS This trial tests whether adding bovine lactoferrin (bLF) to feeds in VLBW infants improves (1) survival to hospital discharge free from brain injury, late-onset sepsis, NEC and treated retinopathy of prematurity (primary composite end point); (2) each component of the primary composite end point and (3) time to reach full enteral feeds, number of blood transfusions, chronic lung disease and length of hospital stay. It includes a cost-effectiveness analysis of bLF in improving survival free from major morbidity, and evaluates the effect of bLF on survival and developmental outcomes at 24 to 36 months corrected gestational age.This is a multicentre, two-arm, randomised trial comparing the treatment group receiving bLF added to breast milk or formula milk daily (up to 250 mg/kg/day bLF) versus the control group receiving no bLF supplementation. The intervention is administered until 34 completed weeks corrected gestation or for 2 weeks, whichever is longer, or until discharge home, if earlier. The target sample size of 1500 participants yields 85% power, at the two-sided 5% level significance, to detect a difference in proportions meeting the primary outcome assuming the true probability is 74% in controls and 80.5% in the bLF group. ETHICS AND DISSEMINATION This protocol was approved by Northern Sydney Local Human Research Ethics Committee in January 2017 (Version 2.0, Reference 1003-118M) and other relevant ethics committees. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12611000247976; Pre-results.
Collapse
Affiliation(s)
- Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alpana Ghadge
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
- School of Women’s and Children’s Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Rebecca Brown
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - William Tarnow-Mordi
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|