Giuseppina Mansi

Neonatal Urinary Cotinine Correlates With Behavioral Alterations in Newborns Prenatally Exposed to Tobacco Smoke

Altered behavior due to prenatal smoke exposure was examined in 25 neonates born from smoking mothers who consumed at least 5 cigarettes/d during the entire gestation. Data were compared with 25 matched neonates born from nonsmoking mothers. Neonatal behavior was evaluated using the Brazelton Neonatal Behavioral Assessment Scale (BNBAS). Antenatal exposure to tobacco smoke at the end of the pregnancy was determined by measurement of urinary cotinine. Newborns from smoking mothers showed significant lower scores in various BNBAS items compared with neonates from nonsmoking mothers. A strong correlation was observed between infant irritability and urinary cotinine in newborns from smoker and nonsmoking mothers and with number of daily smoked cigarettes and maternal nicotine daily intake of infants exposed to active maternal smoking. Linear regression analysis showed that urinary cotinine was the best predictor of infant irritability (r2 = 0.727). The latter was also associated to the neonates low level of attention and poor response to inanimate auditory stimuli. Among infants from nonsmoking mothers, paternal smoking significantly correlated with infant urinary cotinine and infant irritability, being also the best predictor of irritability (r2 = 0.364). Neonatal behavior can be significantly altered in a dose-dependent manner even after modest prenatal exposure to tobacco smoke.

Long-Term Enzyme Replacement Therapy for Pompe Disease With Recombinant Human Alpha-glucosidase Derived From Chinese Hamster Ovary Cells

Pompe disease is a rare autosomal recessive myopathy due to the deficiency of lysosomal acid alpha-glucosidase. Clinical phenotypes range from the severe classic infantile form (hypotonia and hypertrophic cardiomyopathy), to milder late onset forms (skeletal myopathy and absence of significant heart involvement). Enzyme replacement therapy with recombinant human alpha-glucosidase derived from either rabbit milk or Chinese hamster ovary cells has been introduced and is undergoing clinical trials. Reported is a long-term follow-up of 3 Pompe patients presenting without cardiomyopathy, treated with recombinant human alpha-glucosidase derived from Chinese hamster ovary cells. This study suggests that enzyme replacement therapy can lead to significant motor and respiratory improvement in the subgroup of patients who start the therapy before extensive muscle damage has occurred. The recombinant enzyme derived from Chinese hamster ovary cells, administered at doses significantly higher than previously reported, appears to have the same safety as the drug derived from rabbit milk.

Behaviour of preterm newborns reaching term without any serious disorder

We studied the behaviour of 20 preterm infants (average gestational age 33 weeks) brought to term, without any serious disorder. These infants were compared with a group of 21 healthy term infants. To evaluate behaviour we used the 26 items of the Brazelton Neonatal Behavioural Assessment Scale (BNBAS). Our preterm infants had on the whole better scores than those reported in the literature for preterm infants with various disorders. Apart from lower ability to bring hand to mouth and in getting used to visual stimuli (these differences are statistically significant) they had, in the items of orientation a lower score only in ability to follow a voice and a face (not statistically significant). These results show that preterm infants reaching term without any serious disorder do on the whole as well as full-term infants. This correlates with the observations of Dubowitz on behaviour and particularly on visual function of preterm infants and confirms the preliminary report of Daum regarding the influence of the type of neonatal pathology on the ability of orientation at the moment of term.

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, I‐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. In no case was the predicted mortality significantly different from the observed one. At two years of age, 8 children were blind and 48 had motor disability. Of these, 46 had cerebral palsy: based on a functional evaluation score 14 had severe (degree 4), 20 intermediate (degree 3) and 12 mild cerebral palsy (degree 2). Among 25 variables entered in a logistic regression as risk factors for cerebral palsy, only periventricular leucomalacia and acidosis were significantly associated with the outcome.

Early Intervention for Children With Down Syndrome in Southern Italy: The Role of Parent-implemented Developmental Training

The aim of this study was to assess whether parent-implemented developmental training—by means of the Carolina Curriculum for Infants and Toddlers with Special Needs (CCITSN)—could be of greater benefit to young children with Down syndrome (DS) than the standard therapist-implemented treatment provided by the National Health Service of the southern Italian region of Campania (NHST). A total of 47 children with DS were randomly assigned either to the experimental (CCITSN) or to the comparison (NHST) group. Children from both groups were tested periodically with the Brunet-Lézine Psychomotor Development Scale. After completion of the 12-month followup, children in the CCITSN group showed developmental gains over time while children in the comparison group showed a slight but not statistically significant improvement. Moreover, mean developmental quotient scores of the CCITSN group, over the entire study period, were significantly higher than those of the comparison group. A commitment to using parents as interventionists is not a common practice in Italy and many other countries, but may be the most effective and cost-efficient way of providing services to young children with DS and other developmental disabilities.

Effects of Different Ways of Covering the Eyes on Behavior of Jaundiced Infants Treated with Phototherapy

This study was performed to determine whether covering the eyes with an opaque screen over the head end of the bassinet instead of the normal patch would improve the behavioral organization of jaundiced, but otherwise healthy, term infants treated with phototherapy. 38 matched infants were randomly assigned to have a patch or a screen. Serum bilirubin at the time of observation was 11.2-17.5 mg/100 ml (mean = 13.7, patch) and 9.4-16.4 mg/100 ml (mean = 13.4, screen). 19 infants, of whom 11 were jaundiced (6.2-14.3 mg/100 ml, mean = 10.3), served as control subjects. The infants were examined with the Brazelton scale on the 3rd day after birth, when the patch subjects had been under blue light from 6 to 45 h (mean = 23.9), and the screen subjects from 6 to 61.5 h (mean = 22.6). The control subjects scored better (all differences, p less than 0.05) than the patch subjects on inanimate visual, animate visual, visual and auditory, alertness. The control subjects also did better than the screen subjects on inanimate visual, animate visual, animate auditory, visual and auditory, alertness, but poorer on motor maturity and consolability. The screen subjects did poorer than the patch subjects only on skin color lability. At 1 month of age, 9 sets of matched infants were examined. The only difference was that the control subjects did better than the patch subjects on animate visual and lability of state. Our data confirm the poorer short-term orientation performance of jaundiced infants treated with phototherapy but do not indicate that covering the eyes with an opaque screen improves behavioral organization.

Moderate Hyperbilirubinemia Does Not Influence the Behavior of Jaundiced Infants

Several recent reports have described short-term effects of moderate hyperbilirubinemia, and have questioned the treatment protocols of neonatal jaundice. However, most of these studies were not designed to investigate the effects of hyperbilirubinemia per se and could have been influenced by phototherapy. We have evaluated with the Brazelton Neonatal Behavioral Scale 17 moderately jaundiced term 3-day-old infants (mean bilirubin level 10.6 mg/100 ml, range 8.4-14.3) not treated with phototherapy and 17 not jaundiced matched subjects; 14 jaundiced 4-day-old subjects (mean bilirubin level 10.4 mg/100 ml, range 8.4-12.9) and 14 not jaundiced matched subjects; 10 ex-jaundiced 1-month-old infants (mean bilirubin level 11.5 mg/100 ml, range 9.1-15.9) and 10 matched not jaundiced infants. No differences were found between jaundiced infants and not jaundiced infants. Our data indicate that moderate levels of hyperbilirubinemia not treated with phototherapy do not influence neonatal behavior. Hence, more aggressive treatment is not justified, at least in term infants.

1446 MODERATE LEVELS OF HYPERBILIRUBINEMIA DO NOT INFLUENCE THE BEHAVIOR OF JAUNDICED INFANTS

Recently several reports have suggested some short-term effects of moderate hyperbilirubinemia questioning the treatment protocols used for neonatal jaundice. The majority of these studies were not designed to tease out the effects bf phototherapy. In our study with the Brazelton Neonatal Behavioral Scale we evaluated a group of 17 heathy moderately jaundiced term infants (mean bilirubin level 10.6 mg/100ml, range 8.4-14.3) not treated with phototherapy compared to 17 not jaundiced matched subjects on the 3rd day of life. No differences were found between the 2 groups. On the 4th day of life we evaluated 14 jaundiced subjects (mean bilirubin level 10.4 mg/100ml, range 8.4-12.9) and 14 not jaundiced matched infants and again we did not find any differences. At one month of age, 10 ex-jaundiced infants (mean bilirubin level 11.5mg/100ml, range 9.1-15.9) and 10 matched not jaundiced subjects were available, and still no differences were found between the 2 groups. Our data therefore indicate that moderate levels of hyperbilirubinemia do not influence neonatal behavior. Therefore we do not advocate more aggressive treatment protocols at least for term infants.