Davide Silvagni

Obesity and Inflammation: Evidence for an Elementary Lesion

In obesity, an inflammatory process of the adipose tissue has been hypothesized; however, direct evidence for a tissue lesion is still lacking. Macrophage infiltration in the adipose tissue of obese individuals seems to be proven, but other alterations of the tissue have not been demonstrated. Moreover, in humans it has not been clarified whether inflammation is an early characteristic of obesity, because no data from obese children are available. In the present study, we assessed the inflammatory involvement of the adipose tissue and identified the elementary “inflammatory” lesion in a group of obese children. The study of children gives us the chance to investigate adipose tissue during early phases of obesity. In all the obese subjects, ultramicroscopic analysis of the adipose tissue demonstrated inflammatory involvement, and the extent of the lesions seemed to depend on the SD score of body mass index. The elementary lesion is a microgranuloma, with fragments of adipocytes, that evolves to fibrosis. Macrophages (and less frequently, lymphocytes or granulocytes) were found in perivascular positions. The lesions were not found in nonobese children. Our study proved that an “inflammatory” process exists in the adipose tissue of obese children, confirming previous findings in animals and obese adults and demonstrating that it is an early alteration in humans. However, the accumulation of macrophages was just one of the components of the inflammatory lesion, which also involved adipocyte degeneration, fibrosis, and, to a lesser extent, granulocyte/lymphocyte accumulation. The finding of fragments of adipocytes in the elementary lesion suggests that, at the beginning of the process, adipocytes may degenerate and that the materials generated by this process can recruit macrophages and other leukocytes. These preliminary results suggest that additional studies should be designed to clarify the cause of adipocyte fragility in obese children.

Prevalence of overweight and obesity in 2- to 6-year-old Italian children

Objective: To assess the prevalence of overweight and obesity in 2‐ to 6‐year‐old Italian children and to compare the prevalence between the north and the south of the country.

Early Detection of Neonatal Depression and Asphyxia

Perinatal asphyxia is an insult to the fetus or newborn due to hypoxia and/or ischemia, persisting long enough to cause pathological biochemical changes and a variable degree of injury to various organs, including the brain. The effects of hypoxia and ischemia are often difficult to separate clinically. Hypoxia refers to an arterial concentration of oxygen that is less than normal, while ischemia occurs when the blood flow to the cells or organs is insufficient to maintain normal function. In its more severe forms, the impaired gas exchange secondary to asphyxia is also associated with tissue lactic acidosis and hypercapnia [1].

Fever in the first month of life

Background Fever is a common presenting sign in children and infants. However, the management of febrile neonates (< 30 days) could be particularly challenging, mainly due to the paucity of specific signs and symptoms to discriminate “simple, self-limited infections”, mostly of viral origin, from serious, life-threatening infections, mostly of bacterial aetiology. Despite several strategies and protocols have been proposed in the medical literature, management of fever do remain a complex issue in the neonatal patient.

Weaning newborn infants from mechanical ventilation

Invasive mechanical ventilation is a life-saving procedure which is largely used in neonatal intensive care units, particularly in very premature newborn infants. However, this essential treatment may increase mortality and cause substantial morbidity, including lung or airway injuries, unplanned extubations, adverse hemodynamic effects, analgosedative dependency and severe infectious complications, such as ventilator-associated pneumonia. Therefore, limiting the duration of airway intubation and mechanical ventilator support is crucial for the neonatologist, who should aim to a shorter process of discontinuing mechanical ventilation as well as an earlier appreciation of readiness for spontaneous breathing trials. Unfortunately, there is scarce information about the best ways to perform an effective weaning process in infants undergoing mechanical ventilation, thus in most cases the weaning course is still based upon the individual judgment of the attending clinician. Nonetheless, some evidence indicate that volume targeted ventilation modes are more effective in reducing the duration of mechanical ventilation than traditional pressure limited ventilation modes, particularly in very preterm babies. Weaning and extubation directly from high frequency ventilation could be another option, even though its effectiveness, when compared to switching and subsequent weaning and extubating from conventional ventilation, is yet to be adequately investigated. Some data suggest the use of weaning protocols could reduce the weaning time and duration of mechanical ventilation, but better designed prospective studies are still needed to confirm these preliminary observations. Finally, the implementation of short spontaneous breathing tests in preterm infants has been shown to be beneficial in some centres, favoring an earlier extubation at higher ventilatory settings compared with historical controls, without worsening the extubation failure rate. Further research is still required to identify the best practices capable to shorten the duration of mechanical ventilation in term and preterm infants, at the same time keeping to a minimum the risk of extubation failure. Proceedings of the 9 th International Workshop on Neonatology · Cagliari (Italy) · October 23 rd -26 th , 2013 · Learned lessons, changing practice and cutting-edge research

Sodium Nitroprusside Toxicity in a Young Infant Following Cardiac Surgery

Adverse effects associated with sodium nitroprusside (SNP) administration are rarely observed in children. Monitoring of metabolic changes appears to be the most sensitive and accurate indicator of early toxicity. We report a case of acute toxicity in a 3-month-old boy treated with high-dose SNP infusion for systemic hypertension after elective coarctectomy, who developed seizures and severe lactic acidosis. We suggest blood lactate levels and base excess levels should be carefully monitored during SNP treatment in children, in order to detect early signs of toxicity, particularly when using high infusion rates. Case Study Silvagni et al.; IJMPCR, 2(5): 122-125, 2015; Article no.IJMPCR.2015.024 123

Management of red codes in the paediatric emergency room

advanced management of the critically ill child, as recommended by international guidelines. Crucial steps are the recognition and treatment of potentially reversible causes of the CA, summarized in the “ 4I ”: hypoxia, hypovolemia, hypothermia, hypo-hyperkaliemia and the “ 4T ”: cardiac tamponade, thromboembolism, toxic, tension pneumothorax. Fast-ultrasound may be useful for quantitative diagnosis of some of these causes. After the initial stabilization the child should be transferred to other units for secondary care. A mention should be given to the presence of parents during invasive manoeuvres and CPR. In fact, a number of studies demonstrate that their presence during resuscitation efforts, may be helpful for them, particularly in case of poor outcome. Conclusions