Publications by authors named "Seri I"

Less invasive surfactant administration techniques, together with nasal continuous airway pressure (LISA-nCPAP) ventilation, an emerging noninvasive ventilation (NIV) technique in neonatology, are gaining more significance, even in extremely premature newborns (ELBW), under 27 weeks of gestational age. In this review, studies on LISA-nCPAP are compiled with an emphasis on short- and long-term morbidities associated with prematurity. Several perinatal preventative and therapeutic investigations are also discussed in order to start integrated therapies as numerous organ-saving techniques in addition to lung-protective ventilations.

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A perinatalis stroke egy heterogen neurologiai szindroma, mely agyi erserules kovetkezteben alakul ki, es hosszu tavon altalaban kronikus neurologiai kimenetellel jar. Az akut stroke-ok koze a perinatalis arterias ischaemias stroke, a sinusthrombosis es a perinatalis verzeses stroke tartozik. A kes??bb, altalaban 4-8 honapos kor kozott motoros aszimmetriat okozo korkepeket feltetelezetten perinatalis eredet?? stroke-nak nevezzuk.

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Aim: To assess the long-term neurodevelopmental outcome of neonates born at term diagnosed with perinatal haemorrhagic stroke (PHS) and investigate the associations among brain territorial involvement, clinical risk factors, and neurodevelopmental outcomes.

Method: We conducted a population-based study enrolling 55 neonates born at term with PHS confirmed by magnetic resonance imaging born between 2007 and 2017. Long-term neurodevelopmental outcome was assessed using the Bayley Scales of Infant Development, Second Edition, the Brunet-Lézine test, and the Stanford-Binet Intelligence Scales, Fifth Edition.

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Article Synopsis
  • Neonatal arterial ischemic stroke (NAIS) poses a significant long-term neurodevelopmental risk for affected term neonates, with a study assessing outcomes in 79 cases confirmed by MRI.
  • Following up at a median age of 60 months, only 43% of infants showed normal neurodevelopment, with severe risks identified related to main MCA strokes, multiple strokes, and inflammation.
  • Key predictors of poor outcomes included the location of the stroke in the brain and clinical factors, highlighting the complexity of how these elements affect NAIS survivorship.
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Introduction: Simulators are increasingly used for training in echocardiography. However, there is no objective method to assess the skills acquired. Our objective was to develop and test an automated method to assess echocardiography skills.

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There is a great need for training in pediatric echocardiography. In addition to physicians being trained in pediatric cardiology and echocardiography technologists, neonatologist, pediatric intensivists, and other health care professionals may be interested in such training. Since, there is limited opportunity of training on live patients, echocardiographic simulators may be of help.

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Objective: To delineate the systemic and cerebral hemodynamic response to incremental increases in core temperature during the rewarming phase of therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy (HIE).

Study Design: Continuous hemodynamic data, including heart rate (HR), mean arterial blood pressure (MBP), cardiac output by electrical velocimetry (CO), arterial oxygen saturation, and renal (RrSO) and cerebral (CrSO) regional tissue oxygen saturation, were collected from 4 hours before the start of rewarming to 1 hour after the completion of rewarming. Serial echocardiography and transcranial Doppler were performed at 3 hours and 1 hour before the start of rewarming (T-3 and T-1; "baseline") and at 2, 4, and 7 hours after the start of rewarming (T+2, T+4, and T+7; "rewarming") to determine Cardiac output by echocardiography (CO), stroke volume, fractional shortening, and middle cerebral artery (MCA) flow velocity indices.

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Background: Determination of cardiac output requires measurement of both heart rate and stroke volume. Techniques for measuring heart rate are widespread, and 1 technique for bedside monitoring of stroke volume is electrical impedance cardiography.

Objectives: To determine the accuracy and precision of stroke volume measured via impedance cardiography and whether the technique can be used to detect trends.

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Objective: To investigate the changes in systemic and cerebral haemodynamics between supine and prone sleep in healthy term infants during the early postnatal period.

Design/methods: Healthy term infants without congenital anomalies, patent ductus arteriosus and/or small for gestational age status were enrolled. Infants were placed in supine (SP), prone (PP) and back in supine (SP) position for 15 min each while asleep.

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The transition of the fetus at birth to extrauterine life is an extremely complex process. As part of the hemodynamic transition, the closure of ductus arteriosus, a fetal shunt, is among the key steps to achieve normal postnatal cardiovascular function. However, significant gaps remain in our knowledge pertaining to the hemodynamics of normal ductal closure, and in case of failure of closure, to the hemodynamic consequences and treatment of the patent ductus arteriosus (PDA) in preterm infants.

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Background: Each newborn enters this world facing tremendous respiratory, hemodynamic and neuroendocrine challenges while going through drastic physiological changes during the process of adaption from fetal to postnatal life. Even though the vast majority of term infants transition smoothly without apparent consequences, this task becomes increasingly arduous for the extremely preterm infant.

Methods & Results: This article reviews the physiology and pathophysiology of cardiovascular adaptation of the very preterm neonate.

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Objective: To investigate the feasibility of 'tele-rounding' in the neonatal intensive care.

Methods: In this prospective study utilizing telemedicine technology in the NICU for daily patient bedside rounds ('tele-rounds'), twenty pairs of neonates were matched according to gestational age, diagnoses, and disease severity. One patient was cared for by the on-site NICU team lead by an on-site neonatologist.

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By continuous assessment of dynamic changes in systemic and regional perfusion during transition to extrauterine life and beyond, comprehensive neonatal hemodynamic monitoring creates numerous opportunities for both clinical and research applications. In particular, it has the potential of providing additional details about physiologic interactions among the key hemodynamic factors regulating systemic blood flow and blood flow distribution along with the subtle changes that are frequently transient in nature and would not be detected without such systems in place. The data can then be applied for predictive mathematical modeling and validation of physiologically realistic computer models aiming to identify patient subgroups at higher risk for adverse outcomes and/or predicting the response to a particular perturbation or therapeutic intervention.

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With the advances in biomedical research and neonatal intensive care, our understanding of cardiovascular developmental physiology and pathophysiology has significantly improved during the last few decades. Despite this progress, the current management of circulatory compromise depends primarily on experts' opinions rather than high level of evidence. The lack of reliable, accurate, continuous and preferably non-invasive monitoring techniques has further limited our ability to collect the information needed for the design and execution of more sophisticated clinical trials with a better chance to provide the evidence we need.

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Novel hemodynamic monitoring technologies have contributed to the understanding of developmental cardiovascular physiology and pathophysiology in general, and of developmental hemodynamics in particular. Hemodynamic disturbances play a significant role in the pathogenesis of peri/intraventricular hemorrhage (P/IVH) in preterm infants. Immaturity of the myocardium, delayed and incomplete cardiopulmonary transition, sustained patency of the ductus arteriosus, and unintended consequences of respiratory and cardiovascular supportive care are all likely to be involved in the presentation of low cardiac output syndrome and decreased organ blood flow in a large number of very preterm neonates (gestational age ≤28 weeks).

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Objective: To evaluate the cardiovascular response to short-term prone positioning in neonates.

Study Design: In this prospective study, we continuously monitored heart rate (HR), stroke volume (SV) and cardiac output (CO) by electrical velocimetry in hemodynamically stable neonates in each of the following positions for 10 min: supine, prone and back-to-supine position. Skin blood flow (SBF) was also continuously assessed on the forehead or foot using Laser Doppler technology.

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In this study, we present a system identification approach to the mathematical modeling of hemodynamic responses to vasopressor-inotrope agents. We developed a hybrid model called the latency-dose-response-cardiovascular (LDC) model that incorporated 1) a low-order lumped latency model to reproduce the delay associated with the transport of vasopressor-inotrope agent and the onset of physiological effect, 2) phenomenological dose-response models to dictate the steady-state inotropic, chronotropic, and vasoactive responses as a function of vasopressor-inotrope dose, and 3) a physiological cardiovascular model to translate the agent's actions into the ultimate response of blood pressure. We assessed the validity of the LDC model to fit vasopressor-inotrope dose-response data using data collected from five piglet subjects during variable epinephrine infusion rates.

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Objective: To noninvasively determine brain temperature of neonates with hypoxic-ischemic encephalopathy (HIE) during and after therapeutic hypothermia.

Study Design: Using a phantom, we derived a calibration curve to calculate brain temperature based on chemical shift differences in magnetic resonance spectroscopy. We enrolled infants admitted for therapeutic hypothermia and assigned them to a moderate HIE (M-HIE) or severe HIE (S-HIE) group based on Sarnat staging.

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Objective: To investigate the effect of targeted neonatal echocardiography (TnEcho) on heart rate, arterial oxygen saturation (SPO2), cerebral regional oxygen saturation (CrSO2) and cerebral fractional oxygen extraction (CFOE) in extremely preterm infants during the first 3 postnatal days.

Study Design: s a nested study in a prospective observational study, we acquired continuous data on heart rate, SPO2, CrSO2 and CFOE. Data averaged for the duration of TnEcho study were compared with the data collected during a baseline period immediately before the start of echocardiography.

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Objective: The purpose of this study was to determine risk factors for poor cognitive performance among children who are treated with in utero selective laser photocoagulation of communicating vessels for twin-twin transfusion syndrome.

Study Design: This was a prospectively enrolled cohort study. Cognitive performance at age 2 years (±6 weeks) was assessed with the Battelle Developmental Inventory 2nd Edition (BDI-2).

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Aim: High arterial carbon dioxide (PaCO2 ) and cerebral reperfusion are associated with peri/intraventricular haemorrhage. Our aim was to study the relationship between PaCO2 and cerebral blood flow (CBF) in preterm infants during postnatal transition.

Methods: We prospectively studied ≤30 weeks' gestation haemodynamically stable preterm infants during the first three postnatal days (n = 21; gestational age 25.

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A thorough understanding of developmental cardiovascular physiology is essential for early recognition of cardiovascular compromise, selective screening of at-risk groups of neonates, and individualized management using pathophysiology-targeted interventions. Although we have gained a better understanding of the physiology and pathophysiology of postnatal cardiovascular transition over the past decade with the use of sophisticated methods to study neonatal hemodynamics, most aspects of neonatal hemodynamics remain incompletely understood. In addition, targeted therapeutic interventions of neonatal hemodynamic compromise have not been shown to improve mortality and clinically relevant outcomes.

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