Giulia Ruffinazzi

Prevention of Nosocomial Infections in Neonatal Intensive Care Units

Neonatal sepsis causes a huge burden of morbidity and mortality and includes bloodstream, urine, cerebrospinal, peritoneal, and lung infections as well as infections starting from burns and wounds, or from any other usually sterile sites. It is associated with cytokine - and biomediator-induced disorders of respiratory, hemodynamic, and metabolic processes. Neonates in the neonatal intensive care unit feature many specific risk factors for bacterial and fungal sepsis. Loss of gut commensals such as Bifidobacteria and Lactobacilli spp., as occurs with prolonged antibiotic treatments, delayed enteral feeding, or nursing in incubators, translates into proliferation of pathogenic microflora and abnormal gut colonization. Prompt diagnosis and effective treatment do not protect septic neonates form the risk of late neurodevelopmental impairment in the survivors. Thus prevention of bacterial and fungal infection is crucial in these settings of unique patients. In this view, improving neonatal management is a key step, and this includes promotion of breast-feeding and hygiene measures, adoption of a cautious central venous catheter policy, enhancement of the enteric microbiota composition with the supplementation of probiotics, and medical stewardship concerning H2 blockers with restriction of their use. Additional measures may include the use of lactoferrin, fluconazole, and nystatin and specific measures to prevent ventilator associated pneumonia.

Recent advances in prevention of sepsis in the premature neonates in NICU

Sepsis-related morbidity and mortality are major problems in NICU. Preterm neonates display clinical characteristics that make them prone to infections. Due to the high frequency of severe neurodevelopmental sequelae in survivors, the best possible strategy to manage sepsis in NICU is to prevent them. Hygiene, cohorting, stewardship on use of H2-blockers, steroids and broad-spectrum antibiotic are mandatory, as well as proper management of central venous accesses and surgical devices. In addition, clinical research offers the opportunity of adopting pharmacological preventative strategies such as use of palivizumab to prevent RSV infection, use of fluconazole to prevent fungal sepsis, use of probiotics and lactoferrin to enhance the innate immunity, and use of pagibaximab to prevent staphylococcal sepsis.

Monolateral suppurative parotitis in a neonate and review of literature

OBJECTIVES Neonatal suppurative parotitis is a rare condition characterized by swelling, pain, and erythema over the affected gland. Antimicrobials and adequate hydration are an essential part of treatment. Surgical intervention is reserved for organized abscesses and for infections not responding to medical management. METHODS A case report and review of the literature. RESULTS Only few case reports and case series are reported in literature on neonatal parotitis. Transmission of bacteria seems to occur mainly by ascending spread through Stensens duct, or by hematogenous spread from a distant focus. Dehydration, low birth weight, immune suppression, ductal obstruction, oral trauma and structural abnormalities of the parotid gland are recognised as risk factors. The most common pathogen is Staphylococcus aureus. Other less frequent agents are other Gram-positive cocci, Gram-negative bacilli and rarely anaerobic bacteria. Advances in antimicrobial therapy have improved both outcome and prognosis. CONCLUSIONS Thanks to the prompt antibiotic treatment complications are now drastically reduced. Ultrasound examination may help in the diagnosis and monitoring of clinical course.

Correct choices for correct treatments: key issues in the management of Candida infections in preterm neonates

Invasive Candida infections (ICI) have a high burden of morbidity and mortality in the neonatal setting. Although the identification of effective prophylactic strategies has recently led to the prevention of many episodes of systemic fungal disease, the identification of effective treatment strategies is still a priority. The correct choice of the most appropriate antifungal drug for treatment of such infections requires specific expertise, as well as careful consideration of a number of variables related both to the characteristics of the patient and to the peculiarities of these infections in neonates. The ideal antifungal drug for preterm neonates should have a good ability to target fungal biofilms, in order to prevent or improve the course of end-organ localisations. It should also be active against fluconazole-resistant species, as well as safe enough to be used with no or limited interference with other neonatal drugs. In this view, the echinocandin class of antifungal agents has recently proven to be a suitable option for treatment. However, further studies are warranted to better establish kinetics and appropriate dosing of these agents in premature and term infants, as well as their ability to improve late outcomes of ICI.

Un caso di Sindrome di Prader-Willi ad esordio neonatale

We report a case of Prader-Willi syndrome in a female newborn admitted the third day of life to the neonatal intensive care unit for severe hypotonia, weight loss and feeding difficulties.

Diagnosi prenatale tardiva di infezione da Toxoplasma Gondii: un grave caso di idrocefalo

We describe a case of severe fetal hydrocephalus due to Toxoplasmosis which could not be diagnosed until late gestational age due to the lack of a serologic surveillance during pregnancy. Abnormal ultrasound in the third trimester revealed a massive bilateral ventriculomegaly and Toxoplasma Gondii was demonstrated in maternal blood. This case is an example of severe fetal toxoplasmosis diagnosed in utero.

Patologia autoimmune: outcome gravidico e neonatale

The pregnancy of a woman with autoimmune disease should be considered at risk because of the inflammation process, the possible transplacental passage of maternal autoantibodies to the fetus and the possible conse-quences of the therapy performed during pregnancy. The purpose of this study was to evaluate the influence of autoimmune disease or autoantibody positivity on pregnancy and neonatal outcome. Data from 60 infants born to 55 women with autoimmune disease or with autoantibody positivity during pregnancy were collected. The results revealed a higher incidence of miscarriage (24.3% vs 10-15%), preterm (21% vs 5-9%) and low birth weight (<2500 g) (23.3% vs 10.5% ) in women with autoimmune disease than the general population. There was however no significant difference on the number of IUGR (6.7% vs 3-7%). The 45% of pregnant women presented obstetric complications. The assessment of antibody titers in infants showed positivity in 67.3% of those born from ANA positive mothers, 16/16 (100%) infants born to anti-SSA/Ro positive mothers were positive, as the only case of ENA Scl-70 positivity was trans-mitted, 4/5 (80%) of those born from mothers anti-SSB/La positive were positive. In our series, anti-SSA/Ro antibodies were present at birth in 16 infants, but no baby developed atrioventricular heart block, in agreement with the low rates found even in recent studies. There were no significative electrocardiographic abnormalities: nonspecific abnormalities of repolarization (22.91%), prevalence of right heart (33.3%), slightly lengthened cQT interval (4.17%). Ecographic investigations documented 2 cases of cardiac interventricular defect, and at cere-bral ultrasound 3 cases of intra-ventricular hemorrhage wich resulted in multicystic leukomalacia, 2 cases of white matter leukodystrophy with agenesis of the corpus callosum. Mild anemia (12.3% of the cases) and thrombocytopenia (5.4%) were detected. No cases of cholestasis were reported. In conclusion, for the increased risk of obstetric complications and the possible negative effects on the newborn, a careful monitoring of preg-nancies of women with autoimmune disease and a complete follow up of infants is necessary.

Stridore laringeo in un neonato a termine

Lo stridore laringeo e il rumore causato dall’alterato passaggio dell’aria attraverso le basse vie aeree. Si tratta di un segno clinico e non una diagnosi. Lo studio endoscopico delle alte e basse vie aeree in anestesia generale rap-presenta il gold standard nella diagnosi di stridore, sebbene rivesta un ruolo altrettanto importante la valuta-zione pre-endoscopica che include la storia clinica, l’esame fisico e lo studio radiologico. La paralisi delle corde vocali e la seconda causa piu frequente di ostruzione congenita delle vie aeree con stridore laringeo, ed e una tra le piu importanti cause di problemi respiratori in epoca neonatale. Riportiamo il caso di un neonato con paralisi transitoria congenita associata a discinesia esofagea e stridore neonatale.

Un nuovo caso di sindrome di Hallermann-Streiff

Hallermann-Streiff Syndrome (HSS) is a rare disorder characterized primarily by head and face anormalities, with dental abnormalities also present in 50-80 percent of cases. The first description seems to have been made by Aubry in 1893. HSS was first described completely in 1948 by Hallermann, and then in 1950 by Streiff. In this paper, we report the case of a newborn with HSS who presents facial abnormalities, frontal and parietal bossing, retrognathia, a beak-shaped nose, microphtalmia, congenital cataract, nystagmus, crypthorchidism, hypotrichosis, premature dental eruption and failure to thrive.

Sindrome da banda amniotica

Constriction band syndrome is a relatively rare condition in which fetal parts become entangled in the amniotic membrane, leading to deformation, malformation and amputation. Ultrasonographic analysis allows prenatal detection of constriction band syndrome by visualization of amniotic bands attached to the fetus. Treatment of constriction band syndrome must be individualized, and ranges from cosmetic repair to emergency limb-sparing band release. We report an infant with deep amniotic bands who recived treatment with circumferential Z-plasty.