[The Outpatient Health Care Package for the very premature infant: application of the program to follow-up services for the Neonatal Intensive Care, Pediatrics Department, Università "La Sapienza" I Facoltà, Roma (June 2008-March 2010)].

Fifty-nine children were enrolled in the Outpatient Health Care Package (OHCP) from 01/06/2008 to 31/03/2010. All children, except two, attended entirely the follow-up appointments; a satisfactory result, considering also that 30% of family were living outside the urban area and more than a third of the families was originated in a foreign country. At 3 months corrected age(CA) Haemoglobin mean values of 47 infants, all in iron treatment, were: 12.

Central venous lines and how to manage them.

The importance of vascular access in neonatal clinical practice is increasing, because of the survival of a larger number of premature babies, who require administration of long-term intravenous fluids and medications than in the past. In these newborn central venous lines are preferred to peripheral lines, particularly Peripherally Inserted Central Venous Catheter (PICC). Despite of the benefits of this device, PICC complications can negatively affect morbidity and mortality of the neonate.

Nasal flow-synchronized intermittent positive pressure ventilation to facilitate weaning in very low-birthweight infants: unmasked randomized controlled trial.

Background: Nasal flow-synchronized intermittent positive pressure ventilation (NFSIPPV) is a new non-invasive ventilatory mode that delivers synchronized mechanical breaths through the nasal prongs. An unmasked, prospective randomized controlled trial was conducted to compare the efficacy of NFSIPPV and conventional nasal continuous positive airway pressure (NCPAP) in increasing the likelihood for successful extubation in very low-birthweight infants.

Methods: Consecutive infants who weighed <1251 g at birth, required endotracheal intubation within 48 h of birth and met specific predetermined criteria for extubation by day 14 of life were recruited.

Pathogenesis of apparent life-threatening events in infants with esophageal atresia.

Many infants with a repaired esophageal atresia (EA) undergo fundoplication, aortopexy, or glossopexy because the mechanisms most responsible for airway obstruction and/or apparent life-threatening event (AO/ALTE) syndrome are considered to be gastroesophageal reflux (GER), tracheal compression (TC), or obstructive apnea, respectively. In the present study, we investigated whether these mechanisms are independent or interrelated. We developed a database of 120 consecutive patients with EA treated by the senior author between 1967-2002.

Neonatal Candida albicans septic thrombosis of the portal vein followed by cavernous transformation of the vessel.

We report two premature neonates with Candida albicans septic thrombosis of the portal vein who developed, in very early childhood, the sonographic appearance of cavernous transformation of the vessel and/or clinical signs of extrahepatic portal hypertension.

Circulating thrombopoietin levels in neonates with infection.

Thrombocytopenia is a commonly encountered hematologic complication in neonates with sepsis. Thrombopoietin (TPO) is the principal physiologic regulator of megakariocytopoiesis and platelet production. This study was carried out to determine whether variations in circulating TPO levels would occur in infected neonates and/or if they would correlate with platelet counts.

[Characteristics of airway colonization in mechanically ventilated newborn infants].

This study was designed to define the pattern of airway colonization in mechanically ventilated neonates and to assess whether this is associated with clinical signs of infection and/or local or systemic inflammation. One hundred and fifty-seven bronchoalveolar lavages (BAL) were obtained from 40 intubated neonates for microbiologic and cytologic evaluation of the distal airway. Concomitantly with each BAL, clinical data and laboratory tests were recorded.

[Purpura fulminans in the newborn. Report of two cases successfully treated with heparin and antithrombin III].

Purpura fulminans is a rare form of disseminated intravascular coagulation characterized by rapidly progressive purpuric lesions, hypotension and, in some cases, fever. In neonates, purpura fulminans usually develops following deficiency of anticoagulant protein C or S, although acquired forms have been described. The management of disseminated intravascular coagulation is still controversial, with some studies finding a positive effect of anticoagulants and others showing no effect or even a detrimental one.

Care procedures in the healthy full-term newborn infant: a territorial survey.

The Italian Academy of Pediatrics and the Italian Academy of Neonatology have carried out an investigation regarding assistance routines for the healthy full-term newborn. The results confirm a need for modifications in the majority of the centers, especially with regard to Vitamin K prophylaxis which is implemented with extremely variable dosages and not repeated, and to breast-feeding and rooming-in, both of which should be more encouraged. The length of stay in hospital for both vaginal and cesarean deliveries, especially in Lazio, is excessive.

Clinical approach to the analysis of causes of death in the first two years of life of very-low-birthweight infants in a multicentre setting.

Mortality in the first 2 years of 634 very-low-birthweight infants admitted to eight neonatal intensive care units in Italy, and the factors associated with the net probability of death from each cause, were studied by means of the Cox proportional hazard model. A clinical classification of the causes of death was used. Overall mortality was 33.

Chlamydia trachomatis-associated respiratory disease in the very early neonatal period.

Of 103 preterm neonates admitted consecutively to the neonatal intensive care unit soon after birth for respiratory distress, 8 were found to be Chlamydia trachomatis-positive as early as within the first 24 h of life. All these patients required mechanical ventilation and supplemental oxygen. Six infants had evidence on chest radiographs of hyaline membrane disease, one of pneumonia, and one of slight bilateral parenchymal changes.

Italian multicentre study on very low-birth-weight babies. Neonatal mortality and two-year outcome.

The Italian multicentre study on very low-birth-weight babies is the first collaborative project in Italy on the health status of newborns weighing 500-1499 g at birth: 634 such babies were admitted in 1987-88 to eight Italian NICUs; 424 infants survived and were followed until two years of age, corrected for prematurity. Logistic regression analysis of pre-admission risk factors of in-hospital mortality identified eight statistically significant variables: birth weight, gestational age, sex, antepartum steroids, 1-min Apgar score and, on admission to the NICU, body temperature, pH and absence of spontaneous respiration. Using the equation derived from the logistic model, a theoretical mortality rate was calculated for each centre, predicted on the basis of the local incidence of preadmission risk factors.

[Mortality and care level of very low birth weight newborn infants. A population study].

A population study on 314 very low birth weight infants (VLBW) was carried out in 1987 in the Lazio Region of Italy to investigate the relation between the availability at birth of neonatal intensive care and infant mortality. Fifty-two percent of VLBW infants did not survive the first year of life. The mortality Odds Ratios, adjusted for four potential confounding variables, did not show a beneficial effect of Maternity units with neonatal intensive care (level 3) compared with those with special (level 2) and normal care (level 1).

Italian Multicenter Study on Very Low Birth Weight Babies.

The Italian Multicenter Study on Very Low Birth Weight babies (IMS-VLBW) is the first collaborative investigation performed in Italy on the health status of newborns weighing less than 1500 g at birth. Eight Neonatal Intensive Care Units (NICUs) participated in the study: Cagliari, Napoli, Padova, Palermo, Roma, Sassari, Trieste, Udine. Data were analyzed in the Laboratorio di Epidemiologia e Biostatistica of the Istituto Superiore di Sanità.

Immunologic follow-up of infants treated with granulocyte transfusion for neonatal sepsis.

The immunologic status and the occurrence of alloimmunization against granulocytes, platelets, lymphocytes, and red cells was evaluated in 33 babies who received granulocyte transfusion because of neonatal sepsis. Nine age-matched babies were examined as control. A first group of 19 infants was examined only once between 6 and 23 months of age.

Vitamin D-binding protein in the perinatal period.

The molecular polymorphism and quantitative levels of serum vitamin D-binding protein (DBP) were ascertained in a group of preterm, full-term and hypocalcaemic full-term newborn infants. The serum concentration of DBP is not influenced by phenotype and increases with fetal age from the 32nd-33rd week of gestation until the 35th week of gestation. Neither different DBP allele distribution nor abnormal quantitative levels found among 29 hypocalcaemic full-term newborn infants.

Transferrin C subtypes in extremely premature newborn infants.

Genetic typing of serum transferrin was performed in a group of 88 extremely premature infants (gestation age less than 32 wk) and in a control group of 351 full-term infants, using isoelectric focusing technique on ultrathin layer of polyacrilamide gel. A major incidence of C2 type was found among the preterm infants when compared to full-term infants X2 = 22,86, (P less than 0.001).

Critical vitamins for low birthweight infants.

All vitamins are "critical" by definition for the growing infant. However, some of them are particularly relevant to the preterm or low birthweight (LBW) infant in whom a deficiency can occur more frequently than in a full-term newborn. In LBW infants vitamin deficiency may develop due to (1) low body stores at birth, (2) low intake, (3) limited absorption, (4) increased need or utilization, (5) presence of certain clinical conditions.

Prolonged intermittent positive pressure ventilation by nasal prongs in intractable apnea of prematurity.

In order to avoid endotracheal intubation in very small newborn infants requiring prolonged intermittent positive pressure ventilation (IPPV), a method was developed allowing delivery of IPPV by means of nasal prongs (nasal IPPV). A series of 10 newborn infants weighing 1 200 g or less, and requiring nasal IPPV for 5 to 14 days because of intractable apnea has been reported. Five infants survived.

[Echocardiography for the evaluation of tricuspid atresia. I. Morphological analysis (author's transl)].

Twenty-five patients with tricuspid atresia, ranging in age between 3 months and 23 years, were studied by M-mode and two-dimensional (2D) echocardiography. In all of them diagnosis was confirmed by cardiac catheterization and angiocardiography and in most of them at surgery or autopsy. Some anatomical specimens of tricuspid atresia were analyzed in order to be correlated with corresponding two-dimensional pictures.