Amedeo Spagnolo

Blood pressure in childhood and adolescence: The Italian normal standards

OBJECTIVES To develop a national standard level of blood pressure (BP) for Italian children on the basis of a large sample of the population. DESIGN We analyzed data available from 21 Italian studies conducted according to the recommendations of the American Task Force between 1988 and 1994. Percentile curves of systolic and diastolic BP were constructed by fitting a third-order polynomial model of BP on age and height using multiple regression analysis. PARTICIPANTS BP was measured in 11 519 healthy individuals (6258 boys and 5261 girls) aged 5-17 years in various locations throughout Italy. All measurements were performed at school. RESULTS Percentile curves (5th, 10th, 25th, 50th, 75th, 90th and 95th) of systolic and diastolic BP are reported by age and by height for males and females. CONCLUSIONS With respect to the American standards, the levels in Italy for the 90th and 95th percentiles were 3-8 mmHg higher for systolic and diastolic BP in both sexes between 5 and 12 years of age, and 2-3 mmHg higher in older males. With respect to Northern Europe, in the lower ages, levels in Italy were quite similar, although slightly higher, whereas in late adolescence, the Northern European levels were much higher, especially in males, with differences of 4-5 mmHg for the mean values and 8-12 mmHg for the 95th percentile.

Acute neonatal respiratory distress in Italy: a one-year prospective study

A prospective multicentre 12‐month survey of neonatal respiratory disorders in 63 537 Italian infants was performed to evaluate the incidence of acute neonatal respiratory disorders and of the main related complications. A total of 1427 developed respiratory disorders (2.2%), 208 of whom died (14.6%). The incidence of respiratory distress syndrome was 1.16%, with a case fatality rate (CFR) of 24%; that of transient tachypnoea was 0.93%, with a CFR of 1.3%. The rates of meconium aspiration syndrome, persistent pulmonary hypertension and pneumonia were 0.06%, 0.02% and 0.07%, with CFRs of 10.3%, 38.5% and 21.7%, respectively. The occurrences of the main complications in affected newborns were: bronchopulmonary dysplasia 5.6%, necrotizing enterocolitis 1.7%, patent ductus arteriosus 9.8%, 3o and 4o grade intraventricular haemorrhage 6.8% and air leak 4.9%. It was concluded that the incidence of acute neonatal respiratory disorders and the main related complications was lower than that reported two decades ago and that the CFR of acute neonatal respiratory disorders had increased. These results may be the consequences of (i) progress in the management of high‐risk pregnancies, (ii) an increased number of viable infants with extremely low birth weight and (iii) diffusion of antenatal treatment with corticosteroids which, in this series, seemed to reduce the morbidity but not the mortality in the high‐risk infants.

Epidemiology of Neonatal Acute Respiratory Disorders

A prospective 3-month survey of neonatal respiratory disorders in 17,192 Italian infants born in 65 hospitals, located in 17 Italian regions representative of northern, central and southern Italy, was performed to evaluate the incidence of neonatal acute respiratory disorders and their risk factors. The prematurity rate was 7.3%, while the extremely low birth weight (<1,000 g) and very low birth weight (<1,500 g) rates were 0.58% and 0.99%, respectively. Four hundred and ninety-one infants (2.8%) developed respiratory signs. Lethality or specific fatality rate (SFR) for acute respiratory disorders with regard to the overall study population was 0.45%. The male/female ratio of affected infants was 1.3:1. Among affected newborns the case fatality rate (CFR) for respiratory disorders was 15.88% (78/491) and was higher in males than in females (2:1), in infants with a gestational age of ≤28 weeks (60%) and birth weights of <1,000 g (50%). Moreover, the SFR was higher (p < 0.05) in the infants of mothers older than 34 years. SFR was 3.0% in intrauterine growth-retarded infants, 3.6% in the first twin and 3.2% in the second twin. An Apgar score of ≤3 at 5 min was strongly related to the incidence of respiratory disorders (47.1%). The antenatal prevention of neonatal respiratory distress syndrome with maternal corticosteroid treatment was performed in 84% of newborns (<32 weeks) with respiratory problems in northern Italy, and about 25% and 38% in central and southern Italy, respectively. The CFR was double in southern Italy as compared with northern and central Italy. Prematurity, low birth weight and a low Apgar score (≤3) at 1 and 5 min as well as a maternal age of >34 years are risk factors for acute respiratory disorders.

Focus on prevention, diagnosis and treatment of hypertension in children and adolescents

The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem.This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children’s gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child’s age and directly proportional to blood pressure levels. Medical history, clinical data and blood tests may guide the differential diagnosis of primary versus secondary forms. The prevention of high blood pressure is based on correct lifestyle and nutrition, starting from childhood age. The treatment of primary hypertension in children is almost exclusively dietary/behavioral and includes: a) reduction of overweight whenever present b) reduction of dietary sodium intake c) increase in physical activity. Pharmacological therapy will be needed rarely and only in specific cases.

Experimental Neurotoxicity and Urinary Metabolites of the C5-C7 Aliphatic Hydrocarbons Used as Glue Solvents in Shoe Manufacture

Rats were intermittently exposed (9 to 10 h/d, 5 to 6 d/week) to controlled concentrations of single analytical grad solvents in ambient air. After periods ranging from 7 to 30 weeks the animals were perfused with glutaraldehyde and samples of nerves were processed for light microscopy of sections and of teased fibers. Animals treated with n-hexane at 5000 ppm (14 weeks) or 2500 ppm (30 weeks) developed the typical giant axonal degeneration already described in rats treated continuously with 400 to 600 ppm of the same solvent for 7 weeks or more. No such alterations were found in rats subjected to the following intermittent respiratory treatments: n-hexane 500 ppm (30 weeks) or 1500 ppm (14 weeks), cyclohexane 1500 or 2500 (30 weeks), n-pentane 3000 ppm (30 weeks), n-heptane 1500 ppm (30 weeks), 2-methylpentane 1500 ppm (14 weeks), and 3-methylpentane 1500 ppm (14 weeks). The following metabolites were found in the urine of rats according to treatment (in parenthesis): 2-methyl-2-pentanol (2-methylpentane); 3-methyl-2-pentanol and 3-methyl-3-pentanol (3-methylpentane), 2-hexanol, 3-hexanol, gamma-valerolactone, 2,5-dimethylfuran, and 2,5-hexanedione (n-hexane). 2-Hexanol was found to be the main urinary metabolite of n-hexane, while 2,5-hexanedione was present only in a lesser proportion. This feature of rat metabolism suggests that in this species 2,5-hexanedione reaches an effective level at its site of action during intermittent respiratory treatment with n-hexane with difficulty and explains the high concentrations necessary to cause polyneuropathy in rats subjected to this treatment.

Anophthalmia and benomyl in Italy: A multicenter study based on 940,615 newborns

Following the report on clusters of anophthalmia and microphthalmia in England and Wales and their possible relation to the pesticide Benomyl, we analyzed the situation in Italy for the period 1986 to 1990 using data from the Italian registries of congenital malformations and national data on Benomyl use. Of 940,615 consecutive births, 33 cases of clinical anophthalmia and 78 cases of microphthalmia were reported (birth prevalence: 0.35 and 0.83/10,000). Birth prevalence by region for 18 of Italys 20 political regions was evaluated for the two malformations, grouped together after exclusion of defects associated with chromosomal anomalies, no dishomogeneity in space or time among registries or among regions was observed for the study period. In no region was a statistically significant difference identified between observed and expected overall birth prevalence. Correlation analysis between the prevalence of micro/anophthalmia and Benomyl use by region showed a negative, nonsignificant coefficient, and an inverse correlation was found when the 18 regions were divided into four groups by increasing levels of Benomyl use. Parental occupation in agriculture did not seem to be associated with micro/anophthalmia when compared to a control group affected with isolated prearicular tags (odds ratio 0.63; CL 0.07-2.52). On the basis of these results, though the limits intrinsic to ecologic correlation studies must be taken into account, an association between Benomyl use and congenital micro/anophthalmia appears to be unlikely.

Dietary Intake and Physical Activity of Normal Weight and Overweight/Obese Adolescents

Purpose. To evaluate the relationship between overweight/obesity and dietary/lifestyle factors among Italian adolescents. Methods. On a total of 756 adolescents with mean age 12.4 ± 0.9, body mass index, food consumption, and time dedicated to after school physical activities and to TV viewing were determined. The data were analysed according to age, nutritional status, and gender. The analysis of variance and multiple logistic regression analysis were performed to investigate the association between dietary/lifestyle factors and overweight/obesity. Results. The percentages of overweight and obesity were, respectively, 28% and 9% among boys, 24% and 7% among girls. The overweight/obesity condition in both genders was associated with parental overweight/obesity (P < .001 for mother), less time devoted to physical activity (P < .001 for boys and P < .02 for girls) and being on a diet (P < .001). Direct associations were also observed between BMI and skipping breakfast and the lower number of meals a day (boys only). Conclusions. This pilot study reveals some important dietary and lifestyle behaviour trends among adolescents that assist with identification of specific preventive health actions.

Association of selected social, environmental and constitutional factors to blood lead levels in men aged 55–75 years

Blood lead (B-Pb) levels were determined in 1802 out of 1856 non-occupationally exposed men aged 55-75 years living in the Rome area who participated, between 1989 and 1990, in an epidemiological survey for coronary heart disease (New Risk Factors Project). The median B-Pb level was 113 micrograms/l (10th-90th centiles: 74-180 micrograms/l) and only 0.7 per cent (n = 14) of the subjects had B-Pb values higher than 300 micrograms/l. B-Pb levels were significantly and positively associated to alcohol consumption. Moderate and heavy drinkers had median B-Pb level of 143 micrograms/l (10th-90th centiles: 92-233) and 165 micrograms/l (10th-90th centiles: 102-285) respectively, whereas non-drinkers had a median B-Pb level of 96 micrograms/l (10th-90th centiles: 66-143). The influence of smoking habits was less relevant. Subjects who never smoked and subjects smoking more than 20 cigarettes daily had median B-Pb levels of 103 and 133 micrograms/l, respectively. Individuals classified as habitual car-drivers had slightly higher Pb levels than non-drivers. Subjects classified as manual workers had higher B-Pb levels in comparison with non-manual workers and retired subjects. B-Pb levels were directly related to HDL-cholesterol (HDL-C, r = 0.2252) and gamma-glutamyltransferase (gamma-GT, r = 0.2207) serum levels. The alleged alcohol consumption was more related to B-Pb level (r = 0.3848) than to serum level of HDL-C (r = 0.2474) or gamma-GT (r = 0.2469). A significant correlation (r = 0.2409) also existed between B-Pb and blood cadmium levels (B-Cd). Subjects with a low Gaensler ratio, an index of respiratory function, had higher B-Pb levels. In multiple regression analyses alcohol intake was the most important predictor of B-Pb level, explaining more (14.27%) of the total variance than did B-Cd (4.98%), HDL-C (1.89%), driving habits (1.46%), gamma-GT (1.09%), skinfold thickness (0.96%), and Gaensler index (0.38%). The risk ratio of having B-Pb level higher than 180 micrograms/l (90th centile of B-Pb distribution in our subjects) was 5.3 (95% CI: 2.7-10.4) for drinkers versus non-drinkers and 1.9 (95% CI: 1.2-3.1) for current smokers versus subjects who had never smoked. B-Pb was, at least in our subjects, a more specific and sensitive objective index of alcohol consumption than gamma-GT and HDL-C.(ABSTRACT TRUNCATED AT 400 WORDS)

Serum selenium and precursors of cardiovascular risk factors in adolescents

The aim of this study was to determine, in a population of Italian adolescents, the association of serum selenium levels with precursors of biochemical and anthropometric variables known as being among the major risk factors for cardiovascular diseases in the adult population. The following measurements were taken in a school sample of 627 adolescents (aged 12–13 years): serum selenium, total cholesterol, high density lipoprotein cholesterol, non-HDL cholesterol, height, weight, body mass index, systolic blood pressure and diastolic blood pressure.The serum selenium levels were slightly higher in males (83.1 ± 10.1 μg/1) than in females (81.7 ±- 11.0 μg/1), but the difference was not statistically significant. Serum selenium was positively correlated with total cholesterol, diastolic blood pressure and HDL cholesterol in both sexes; moreover it was positively correlated with non-HDL cholesterol and negatively correlated with height in males only.

Clusters of anophthalmia: No link with benomyl in Italy..

EDITOR, - Since the Observer reported a possible link between apparent clusters of anophthalmia and microphthalmia in England and Wales and the pesticide benomyl,1 several articles have commented on possible strategies to manage public and media concern, the methodology to identify clusters, the difficulty in assessing disease clusters with unreliable data, and the weakness of retrospective studies.*RF 2-5* Analysis of cases routinely reported to the national congenital malformation …