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Costa S, Priolo F, Fattore S, Tedesco M, Rubortone SA, Giordano L, Chioma R, Neri Md C, Lanzone A, Buonsenso D, Valentini P, Vento G. Rooming-In Practice During the Pandemic: Results From a Retrospective Cohort Study. J Hum Lact 2022; 38:443-451. [PMID: 35272513 DOI: 10.1177/08903344221081840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic emerged in December 2019 and spread rapidly worldwide. So far, evidence regarding the breastfeeding and rooming-in management of mothers with COVID-19 and their newborn infants is scarce. RESEARCH AIMS 1) To assess the rate of exclusive breastfeeding at discharge among mothers with COVID-19 and their newborn infants managed either using a rooming-in or a separation regimen; and 2) to evaluate different neonatal outcomes, including the need for re-hospitalization related to COVID-19 among newborn infants in the two groups. METHOD We conducted a retrospective two-group comparative observational study. The sample was participants with COVID-19 and their newborn infants (N = 155 dyads) between March 1, 2020, and April 30, 2021. Two time periods were outlined resulting from the two different clinical practices of mother-infant separation and rooming-in. RESULTS Within the sample, 145 (93.5%) were asymptomatic. All neonates had documented Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) test results, and six tested positive by reverse transcriptase polymerase chain reaction within 48 hr of life. The rate of exclusive breastfeeding was significantly higher (p < .0001) within the rooming-in group. Length of hospital stay was significantly lower (p = .001) within the rooming-in group. CONCLUSIONS Protected rooming-in practice has proven to be safe and effective in supporting breastfeeding: None of the infants enrolled were hospitalized due to COVID-19 infection and the rate of exclusive breastfeeding at discharge was increased compared to those infants separated from their mothers.
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Affiliation(s)
- Simonetta Costa
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Priolo
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Serena Antonia Rubortone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Giordano
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Caterina Neri Md
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Danilo Buonsenso
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piero Valentini
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Vento
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Priolo F, Fattore S, Tedesco M, De Rose DU, Chioma R, Perri A, Costa S, Rubortone SA, Patti ML, Sbordone A, Maggio L, Vento G. Presepsin levels in neonatal cord blood are not influenced by maternal SARS-CoV-2 infection. Clin Chem Lab Med 2022; 60:1486-1491. [PMID: 35748906 DOI: 10.1515/cclm-2022-0238] [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: 03/14/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Coronavirus disease (COVID-19) can present with various symptoms and can involve multiple organs. Women infected during pregnancy have a higher incidence of obstetrical complications and infants born to "positive" mothers may get the infection with different manifestations. Presepsin seems to be a promising sepsis biomarker in adults and neonates. The aim of this study was to assess if presepsin levels in neonatal cord blood could be influenced by maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS A total of 119 neonates born from women with a confirmed diagnosis of SARS-CoV-2 infection were enrolled and presepsin levels of cord blood samples were collected. All neonates were tested for SARS-CoV-2 infection at birth and after 48-72 h. RESULTS The median presepsin value in umbilical cord blood samples collected after birth was 455 pg/mL. Presepsin levels were not influenced by maternal symptoms of COVID-19, weight for gestational age, or delivery mode, and did not significantly differ between infants with and without adverse neonatal outcomes. Infants hospitalized for more than 5 days had a significantly higher presepsin level at birth rather than those discharged up to 4 days of life. Three infants with positive nasopharyngeal swab at birth had higher Presepsin levels than two infants tested positive at 48 h. CONCLUSIONS This is the first study reporting cord presepsin levels in term and preterm infants born to mothers with COVID-19, that appeared to be not influenced by maternal clinical presentation. However, further studies are needed to explain the mechanisms of P-SEP increase in neonates exposed to perinatal maternal SARS-CoV-2 infection or with an indeterminate/possible SARS-CoV-2 infection in the same neonates.
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Affiliation(s)
- Francesca Priolo
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | | | | | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of the Fetus - Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | | | - Alessandro Perri
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Simonetta Costa
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Serena Antonia Rubortone
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Maria Letizia Patti
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Annamaria Sbordone
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Luca Maggio
- Università Cattolica del Sacro Cuore, Rome, Italy.,Neonatal Intensive Care Unit, Maternal-Fetal Department, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Rubortone SA, Costa S, Perri A, D'Andrea V, Vento G, Barone G. Real-time ultrasound for tip location of umbilical venous catheter in neonates: a pre/post intervention study. Ital J Pediatr 2021; 47:68. [PMID: 33736669 PMCID: PMC7977571 DOI: 10.1186/s13052-021-01014-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/22/2020] [Accepted: 02/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Recent guidelines advocate the use of real-time ultrasound to locate umbilical venous catheter tip. So far, training programs are not well established. METHODS A pre/post interventional study was carried out in our tertiary neonatal intensive care unit centre to evaluate the efficacy of a training protocol in the use of real-time ultrasound. Primary outcome was the percentage in the use of real-time ultrasound. RESULTS Fifty-four patients were enrolled. The use of real-time ultrasound for tip location significantly increased after the training program (15.3% vs 89.2%, p < 0.0001). After the training the tip of the catheters was more frequently placed at the junction of the inferior vena cava and right atrium (75% vs 30.7%, p = 0.0023). Twenty-two catheters were also evaluated with serial scans during the intervention phase to assess migration rate which was 50%. CONCLUSION a multimodal, targeted training on the use of real-time ultrasound for umbilical venous catheter placement is feasible. Real-time ultrasound is easily teachable, increases the number of umbilical venous catheters placed in a correct position, reduces the number of line manipulations and the need of chest-x-rays.
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Affiliation(s)
- Serena Antonia Rubortone
- Department of Woman and Child Health and Public Health, Division of Neonatology, University Hospital Fondazione Policlinico Gemelli IRCCS, Rome, Italy.
| | - Simonetta Costa
- Department of Woman and Child Health and Public Health, Division of Neonatology, University Hospital Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Alessandro Perri
- Department of Woman and Child Health and Public Health, Division of Neonatology, University Hospital Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Vito D'Andrea
- Department of Woman and Child Health and Public Health, Division of Neonatology, University Hospital Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Division of Neonatology, University Hospital Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini, AUSL of Romagna, Italy
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D'Andrea V, Prontera G, Rubortone SA, Pezza L, Pinna G, Barone G, Pittiruti M, Vento G. Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training. Front Pediatr 2021; 9:774705. [PMID: 35174113 PMCID: PMC8841780 DOI: 10.3389/fped.2021.774705] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/20/2021] [Indexed: 12/30/2022] Open
Abstract
The umbilical venous catheter (UVC) is one of the most commonly used central lines in neonates. It can be easily inserted soon after birth providing stable intravenous access in infants requiring advanced resuscitation in the delivery room or needing medications, fluids, and parenteral nutrition during the 1st days of life. Resident training is crucial for UVC placement. The use of simulators allows trainees to gain practical experience and confidence in performing the procedure without risks for patients. UVCs are easy to insert, however when the procedure is performed without the use of ultrasound, there is a quite high risk, up to 40%, of non-central position. Ultrasound-guided UVC tip location is a simple and learnable technique and therefore should be widespread among all physicians. The feasibility of targeted training on the use of point-of-care ultrasound (POCUS) for UVC placement in the neonatal intensive care unit (NICU) among neonatal medical staff has been demonstrated. Conversely, UVC-related complications are very common and can sometimes be life-threatening. Despite UVCs being used by neonatologists for over 60 years, there are still no standard guidelines for assessment or monitoring of tip location, securement, management, or dwell time. This review article is an overview of the current knowledge and evidence available in the literature about UVCs. Our aim is to provide precise and updated recommendations on the use of this central line.
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Affiliation(s)
- Vito D'Andrea
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giorgia Prontera
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Serena Antonia Rubortone
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Lucilla Pezza
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Pinna
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Vento
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Bersani I, De Carolis S, Foell D, Weinhage T, Garufi C, De Carolis MP, Rossi ED, Casella G, Rubortone SA, Speer CP. Impact of chorioamnionitis on maternal and fetal levels of proinflammatory S100A12. Eur J Pediatr 2021; 180:39-45. [PMID: 32514673 DOI: 10.1007/s00431-020-03695-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 11/26/2022]
Abstract
Histologic chorioamnionitis (HCA) may lead to the fetal inflammatory response syndrome (FIRS). The aim of this pilot study was to evaluate S100A12, a marker of innate immune activation, in mothers with or without HCA and in their infants. Concentrations of S100A12, interleukin 6 (IL-6), and C-reactive protein (CRP) were evaluated in maternal, cord, and neonatal blood of very preterm infants. Histologic examinations of the placenta and umbilical cords were performed. The 48 mother-neonate pairs enrolled were subdivided into two groups: HCA group (N = 15) and control group without HCA (N = 33). Maternal S100A12 levels were similar between HCA and control group. Similarly, S100A12 concentrations in cord and neonatal blood did not differ between the groups. However, high S100A12 concentrations were detected in cord and neonatal blood of two out of three neonates exposed to HCA associated with advanced funisitis. Concentrations of IL-6 and CRP were higher in maternal blood of the HCA group compared with controls (p < 0.05, p < 0.001; respectively), but no differences in cord or neonatal blood was found.Conclusion:S100A12 did neither identify mothers with HCA nor very preterm infants exposed to HCA. It is currently unknown if S100A12 may identify neonates with FIRS. What is known: • Histologic chorioamnionitis (HCA) may lead to the fetal inflammatory response syndrome (FIRS). • S100A12 represents an early, sensitive, and specific diagnostic marker of inflammatory processes. What is new: • S100A12 did neither identify mothers with HCA nor very preterm infants exposed to HCA. • It is currently still unclear if S100A12 has a potential in identifying preterm infants with FIRS.
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Affiliation(s)
- Iliana Bersani
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Sara De Carolis
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - Toni Weinhage
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - Cristina Garufi
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza University of Rome, Rome, Italy
| | - Maria Pia De Carolis
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giovanna Casella
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Serena Antonia Rubortone
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
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Perri A, Tana M, Riccardi R, Iannotta R, Giordano L, Rubortone SA, Priolo F, Di Molfetta DV, Zecca E, Vento G. Neonatal lung ultrasonography score after surfactant in preterm infants: A prospective observational study. Pediatr Pulmonol 2020; 55:116-121. [PMID: 31710177 DOI: 10.1002/ppul.24566] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess changes in neonatal lung ultrasonography score (nLUS) after surfactant administration in preterm infants with respiratory distress syndrome (RDS). WORKING HYPOTHESIS The reduction of nLUS score before (nLUSpre), 2 hours (nLUS2h), and 12 hours (nLUS12h) after surfactant administration to identify patients who will not need a second treatment. STUDY DESIGN AND SETTING Prospective observational study in the tertiary neonatal intensive care unit. PATIENTS SELECTION Forty-six preterm neonates with RDS of 32 weeks median gestational age (IQR 30-33) and mean birth weight of 1650 ± 715 g. METHODOLOGY Lung ultrasonography was performed before, 2 hours, and 12 hours after surfactant administration in preterm infants with RDS needing surfactant treatment. Resulting nLUS was analyzed. RESULTS The Wilcoxon signed-rank test demonstrated an nLUS lowering after 2 hours (P < .001) and 12 hours (P < .001) from surfactant administration. Sixteen newborns required surfactant retreatment with median gestational age of 32 weeks (IQR 29-33) and mean birth weight of 1519 ± 506 g.The receiver operating characteristic analysis for the nLUS2h yielded an area under the curve of 0.80 (95% confidence interval, 0.76-0.85; P < .001). A nLUS2h ≥7 showed a sensitivity of 94% and a specificity of 60% for needing a second treatment with surfactant. CONCLUSIONS In preterm infants with RDS requiring surfactant treatment, nLUS evaluated 2 hours after surfactant administration can be used to identify patients who will not need a second treatment.
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Affiliation(s)
- Alessandro Perri
- Area of Child Health, Department of Woman, Child Health and Public Health, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Milena Tana
- Area of Child Health, Department of Woman, Child Health and Public Health, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Riccardo Riccardi
- Neonatal Intensive Care Unit, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Rossella Iannotta
- Area of Child Health, Department of Woman, Child Health and Public Health, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Lucia Giordano
- Area of Child Health, Department of Woman, Child Health and Public Health, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Serena Antonia Rubortone
- Area of Child Health, Department of Woman, Child Health and Public Health, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Francesca Priolo
- Area of Child Health, Department of Woman, Child Health and Public Health, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Domenico V Di Molfetta
- Department of Radiology, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Enrico Zecca
- Area of Child Health, Department of Woman, Child Health and Public Health, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Vento
- Area of Child Health, Department of Woman, Child Health and Public Health, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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De Carolis MP, Cocca C, Cota F, Pinna G, Rubortone SA, Romagnoli C, Mirabile L, Serio P. Double Tracheoesophageal Fistula and Azygos Lobe. Pediatr Neonatol 2016; 57:546-547. [PMID: 27251121 DOI: 10.1016/j.pedneo.2016.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/03/2016] [Accepted: 02/12/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Maria Pia De Carolis
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy.
| | - Carmen Cocca
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Cota
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Pinna
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Serena Antonia Rubortone
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Costantino Romagnoli
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
| | - Lorenzo Mirabile
- Intensive Care Unit, Children's Hospital "A. Meyer", University of Florence, Florence, Italy
| | - Paola Serio
- Intensive Care Unit, Children's Hospital "A. Meyer", University of Florence, Florence, Italy
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Bersani I, De Carolis MP, Foell D, Weinhage T, Rossi ED, De Carolis S, Rubortone SA, Romagnoli C, Speer CP. Interleukin-22: biomarker of maternal and fetal inflammation? Immunol Res 2015; 61:4-10. [PMID: 25407645 DOI: 10.1007/s12026-014-8568-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Histologic chorioamnionitis (HCA) is an intrauterine status of inflammation which may lead to the fetal inflammatory response syndrome. Inflammation is a pathogenetic mechanism also of preeclampsia, although not of microbial origin. The aim of the present pilot study was to evaluate the pattern of inflammatory cytokines in mothers and high-risk preterm infants during the perinatal period. Concentrations of proinflammatory and anti-inflammatory cytokines and C-reactive protein were evaluated in maternal, cord, and neonatal blood of very preterm infants <1,500 g birth weight. Histologic examinations of placentae and umbilical cords were performed. The 65 mother-neonate pairs enrolled were subdivided into three groups: (1) HCA group (n = 15), (2) preeclampsia group (n = 17), and (3) control group, in the absence of HCA/preeclampsia (n = 33). Maternal Interleukin (IL)-6 levels were significantly higher in women of the HCA group compared with the preeclampsia and control groups (p < 0.05). IL-22 was detected in nearly all maternal samples [median value 693.115 pg/ml (599.91-809.91 pg/ml)], with no statistical difference between the groups, but with a tendency to increased levels among preeclamptic women. Increased concentrations of IL-22 were detected in cord blood of neonates exposed to preeclampsia, compared with controls and infants exposed to HCA (p < 0.05). We speculate that the tendentially higher concentrations of IL-22 in preeclamptic mothers and the significantly higher concentrations in cord blood may reflect placental dysfunction and the underlying reparative processes at the maternal-fetal interface. Therefore, IL-22 could be an important biomarker of inflammation in preeclampsia.
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Affiliation(s)
- Iliana Bersani
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
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De Carolis MP, Cocca C, Valente E, Lacerenza S, Rubortone SA, Zuppa AA, Romagnoli C. Individualized follow up programme and early discharge in term neonates. Ital J Pediatr 2014; 40:70. [PMID: 25024007 PMCID: PMC4223512 DOI: 10.1186/1824-7288-40-70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/30/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Early discharge of mother/neonate dyad has become a common practice, and its effects are measured by readmission rates. We evaluated the safety of early discharge followed by an individualized Follow-up programme and the efficacy in promoting breastfeeding initiation and duration. METHODS During a nine-month period early discharge followed by an early targeted Follow-up was carried out in term neonates in the absence of weight loss <10% or hyperbilirubinaemia at risk of treatment. Follow-up visits were performed at different timepoints with a specific flow-chart according to both bilirubin levels and weight loss at discharge. RESULTS During the study period early discharge was performed in 419 neonates and Follow-up was carried out in 408 neonates (97.4%). No neonates required readmission for hyperbilirubinaemia and dehydration during the first 28 days of life. Breastfeeding rate was 90.6%, 75.2%, 41.5% at 30, 90 and 180 days of life, respectively. A six-month phone interview was performed for 383 neonates (93.8%) and satisfaction of parents about early discharge was high in 345 cases (90.1%). CONCLUSIONS Early discharge in association with an individualized Follow-up programme resulted safe for the neonate and effective for breastfeeding initation and duration.
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Affiliation(s)
- Maria Pia De Carolis
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Carmen Cocca
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Elisabetta Valente
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Serafina Lacerenza
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Serena Antonia Rubortone
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Antonio Alberto Zuppa
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
| | - Costantino Romagnoli
- Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Largo A. Gemelli, 8, Rome 00168, Italy
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Occhipinti F, De Carolis MP, De Rosa G, Bersani I, Lacerenza S, Cota F, Rubortone SA, Romagnoli C. Correlation analysis between echocardiographic flow pattern and N-terminal-pro-brain natriuretic peptide for early targeted treatment of patent ductus arteriosus. J Matern Fetal Neonatal Med 2014; 27:1800-4. [DOI: 10.3109/14767058.2014.880879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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De Carolis MP, Rubortone SA, Bersani I, Lacerenza S, Cota F, Garufi C, Romagnoli C. Heat loss prevention in the delivery room in term and preterm infants. Turk J Pediatr 2013; 55:63-68. [PMID: 23692834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study was conducted to determine whether or not simultaneous use of additional measures to prevent heat loss and efficient training of caregivers influenced the incidence of hypothermia at birth. Two cohorts of term/late-preterm and preterm infants were compared before (Group IA and IB) and after (Group IIA and IIB) the introduction of additional measures and a specific training of caregivers. In term/late-preterm neonates of Group IIA, admission temperature was higher (36.3°C vs 36°C; p<0.001) and incidence of hypothermia lower (61.2% vs 81.0%; p<0.001) compared to Group IA, with reduction of moderate hypothermia (8.8% vs 27.3%; p<0.001). Among preterm neonates, admission temperature was higher (36.0°C vs 35.5°C; p<0.001) and incidence of hypothermia lower (68.1% vs 92.3%; p<0.001) during the second period, when no cases of severe hypothermia and reduction of moderate forms were observed (42.5% vs 70.7%; p<0.001). Additional interventions to prevent hypothermia and caregivers' training were effective in preventing hypothermia.
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De Carolis MP, Bersani I, Piersigilli F, Rubortone SA, Occhipinti F, Lacerenza S, Romagnoli C. Peripheral nerve blockade and neonatal limb ischemia: our experience and literature review. Clin Appl Thromb Hemost 2012; 20:55-60. [PMID: 22952214 DOI: 10.1177/1076029612458968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Considering the high frequency of bleeding complications following fibrinolytic treatment in neonates, peripheral nerve blockade (PNB) has been proposed alone or in association with lower doses of tissue plasminogen activator, as a possible new therapeutic approach in the management of neonatal limb ischemia (LI) secondary to vasospasm and/or thrombosis. The present article provides a review of the current knowledge about the topic, in order to evaluate the efficacy and safety of this therapeutic approach. According to the few case reports documented in literature and to our experience, PNB could be considered as valid procedure for the treatment of LI, especially during neonatal period, when the risk of serious bleeding associated with fibrinolytic or anticoagulant therapy is higher. Peripheral nerve blockade resulted in a safe and effective procedure for the treatment of neonatal vascular spasm and thrombosis.
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Affiliation(s)
- Maria Pia De Carolis
- 1Department of Paediatrics, Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy
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De Carolis MP, Rubortone SA, Romano V, De Carolis D, De Carolis S. An interlabial mass. Arch Dis Child Fetal Neonatal Ed 2012; 97:F376. [PMID: 22933098 DOI: 10.1136/fetalneonatal-2011-300655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rubortone SA, De Carolis MP, Lacerenza S, Bersani I, Occhipinti F, Romagnoli C. Use of a combined SpO₂/PtcCO₂ sensor in the delivery room. Sensors (Basel) 2012; 12:10980-9. [PMID: 23112642 PMCID: PMC3472870 DOI: 10.3390/s120810980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/16/2012] [Accepted: 07/31/2012] [Indexed: 11/16/2022]
Abstract
Arterial oxygen saturation (SaO2) and partial arterial pressure of carbon dioxide (PaCO2) are important respiratory parameters in critically ill neonates. A sensor combining a pulse oximeter with the Stow-Severinghaus electrode, required for the measurement of peripheral oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (PtcCO2), respectively, has been recently used in neonatal clinical practice (TOSCA500ÒRadiometer). We evaluated TOSCA usability and reliability in the delivery room (DR), throughout three different periods, on term, late-preterm, and preterm neonates. During the first period (period A), 30 healthy term neonates were simultaneously monitored with both TOSCA and a MASIMO pulse oximeter. During the second period (period B), 10 healthy late-preterm neonates were monitored with both TOSCA and a transcutaneous device measuring PtcCO2 (TINAÒ TCM3, Radiometer). During the third period (period C), 15 preterm neonates were monitored with TOSCA and MASIMO after birth, during stabilization, and during transport to the neonatal intensive care unit (NICU). Blood gas analyses were performed to compare transcutaneous and blood gas values. TOSCA resulted easily and safely usable in the DR, allowing reliable noninvasive SaO2 estimation. Since PtcCO2 measurements with TOSCA required at least 10 min to be stable and reliable, this parameter was not useful during the early resuscitation immediately after birth. Moreover, PtcCO2 levels were less precise if compared to the conventional transcutaneous monitoring. However, PtcCO2 measurement by TOSCA was useful as trend-monitoring after stabilization and during transport to NICU.
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Affiliation(s)
- Serena Antonia Rubortone
- Division of Neonatology, Department of Paediatrics, Catholic University of Sacred Heart, Largo Gemelli 8, I-00168 Rome, Italy.
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Romagnoli C, Bersani I, Rubortone SA, Lacerenza S, De Carolis MP. Current evidence on the safety profile of NSAIDs for the treatment of PDA. J Matern Fetal Neonatal Med 2011; 24 Suppl 3:10-3. [PMID: 21749302 DOI: 10.3109/14767058.2011.604987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patent ductus arteriosus (PDA) complicates the clinical course of preterm infants. Nonsteroidal anti-inflammatory drugs, especially Indomethacin and Ibuprofen, have been widely used for both prevention and treatment of PDA. Short-term efficacy of Indomethacin or Ibuprofen is equivalent, while Ibuprofen results show a higher safety profile. Ibuprofen is associated with fewer clinical gastrointestinal and renal side effects with respect to Indomethacin even if subclinical potential effects are reported. When administered as prophylaxis, Ibuprofen has no effects on prevention of intraventricular haemorrhage unlike Indomethacin. Considering the potential adverse effects of both these drugs, a careful monitoring during and after the treatment period is highly recommended.
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Affiliation(s)
- Costantino Romagnoli
- Department of Paediatrics and Division of Neonatology, Catholic University of Sacred Heart, Rome, Italy.
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