Lorenzo Quartulli

Prenatal pseudocysts of the germinal matrix in preterm infants.

Sonographic characteristics of germinal‐matrix (PGM) pseudocysts of prenatal origin detected on cranial ultrasound in preterm newborns were correlated with their outcomes. PGM cysts were classified as typical or atypical, according to their location. Typical PGM cysts were present at the head of the caudate nucleus or slightly medially, adjacent to the foramen of Monro. Cysts were defined as atypical when they were located subependymally elsewhere.

Changes over time in delivery room management of extremely low birth weight infants in Italy

AIM To identify changes in practice between two historical periods (2002 vs. 2011) in early delivery room (DR) management of ELBWI in Italian tertiary centres. METHODS A questionnaire was sent to the directors of all Italian level III centres between April and August 2012. The same questionnaire was used in a national survey conducted in 2002. Among the participating centres, those that filled the questionnaire in both study periods were selected for inclusion in this study. RESULTS There was an 88% (n=76/86) and 92% (n=98/107) response rate in the 2 surveys, respectively. The two groups overlapped for 64 centres. During the study period, the use of polyethylene bags/wraps increased from 4.7% to 59.4% of the centres. The units using 100% oxygen concentrations to initiate resuscitation of ELBWI decreased from 56.2% to 6.2%. The approach to respiratory management was changed for the majority of the examined issues: positive pressure ventilation (PPV) administered through a T-piece resuscitator (from 14.0% to 85.9%); use of PEEP during PPV (from 35.9% to 95.3%); use of CPAP (from 43.1% to 86.2%). From 2002 to 2011, the percentages of ELBWI intubated in DR decreased in favor of those managed with N-CPAP; ELBWI receiving chest compressions and medications at birth were clinically comparable. CONCLUSIONS During the two study periods, the approach to the ELBWI at birth significantly changed. More attention was devoted to temperature control, use of oxygen, and less-invasive respiratory support. Nevertheless, some relevant interventions were not uniformly followed by the surveyed centres.

Oxygen administration for the resuscitation of term and preterm infants

Oxygen has been widely used in neonatal resuscitation for about 300 years. In October 2010, the International Liaison Committee on Neonatal Resuscitation released new guidelines. Based on experimental studies and randomized clinical trials, the recommendations on evaluation and monitoring of oxygenation status and oxygen supplementation in the delivery room were revised in detail. They include: inaccuracy of oxygenation clinical assessment (colour), mandatory use of pulse oximeter, specific saturation targets and oxygen concentrations during positive pressure ventilation in preterm and term infants. In this review, we describe oxygen management in the delivery room in terms of clinical assessment, monitoring, treatment and the gap of knowledge.

Delivery room management of extremely low birthweight infants shows marked geographical variations in Italy

To evaluate any geographical variations in practice and adherence to international guidelines for early delivery room management of extremely low birthweight (ELBW) infants in the North, Centre and South of Italy.

A New Phenotypical Variant of Intrauterine Growth Restriction

OBJECTIVES. A link between intrauterine growth restriction and major adult-onset diseases has been reported. In this study we observed a series of hitherto-unrecognized clinical features in a population of children with intrauterine growth restriction. PATIENTS AND METHODS. A total of 77 Italian children (aged 9.45 ± 2.08 years) with antenatally diagnosed intrauterine growth restriction and small-for-gestational-age birth, along with their parents, were examined. The children with intrauterine growth restriction and were small for gestational age were subdivided into 2 groups (“variant” versus control subjects) according to evidence of auricle morphology deviation from normal. The following variables were determined: (1) external ear auricle geometry; (2) function of the posterior communicating arteries of the circle of Willis, as assessed by transcranial Doppler ultrasonography; (3) articular mobility, as assessed by Beightons 9-point scale; (4) skin softness; and (5) distortion product–evoked otoacoustic emissions. RESULTS. Intrauterine growth restriction–variant children (n = 27) showed a significant female predominance, a lower proportion of maternal pregnancy-induced hypertension/ preeclampsia, and a higher head circumference as compared with intrauterine growth restriction control subjects. Mothers of small-for-gestational-age–variant children showed significantly different auricular geometry parameters as compared with the intrauterine growth restriction controls mothers. An excess of bilaterally nonfunctioning posterior communicating arteries was observed both in the children with the intrauterine growth restriction–variant phenotype and their mothers as compared with the control groups. Significantly increased proportions of joint hypermobility and skin softness were observed in the intrauterine growth restriction–variant children as compared with controls subjects. Children with the intrauterine growth restriction–variant phenotype and their mothers showed bilateral distortion product–evoked otoacoustic emissions notches versus none in the control subjects, with an associated reduction of the area under the curve in both the intrauterine growth restriction–variant children and their mothers. No significant differences between the variant and control groups regarding the fathers were observed. CONCLUSIONS. We propose that the observed phenotypical constellation may represent an unrecognized variant of intrauterine growth restriction.

16 COLOR DOPPLER ECHOENCEPHALOGRAPHY

From January to December 1990, 100 color doppler echoencephalograms were obtained in 40 infants without cardiopulmonary affections and with a mean birth weight of 2940g (range 1760-3420 g), a mean gestational age of 37.2 weeks (range 34-40w). The examinations were performed using a real-time 2-D Doppler Scanner and a 3,75 MHz sector transducer. Serial scans were obtained in sagittal, coronal and axial plans. Detection rate of intracranial vessels was: internal carotid, anterior cerebral, pericallosal, basilar, vertebral artery (100%); callosomarginal artery (90%); frontopolar artery (82%); medial and lateral striate artery (17%); internal, great cerebral vein(GCV) and straight sinus (SS) (100%); superior sagittal sinus (69%); occipital sinus (39%). Flow mean velocity of GCV and SS was 6-10 and 15-24 cm/sec respectively. Usually vein curve has a continuous profile (therefore we can calculate only mean velocity) while sometimes, expecially in the biggest vein (SS), we observe particular aspects of vein flow similar to arterys one with a sort of systolic and diastolic phase. Probably this waving venous curve is within respiratory control becouse the “squeeze” of superior cava vein may induce an increase of vein flow velocity during inspiration.

98: DOPPLER ULTRASONOGRAPHY

Prediction by cerebral artery Doppler ultrasonography of neurological outcome in 20 term infants with hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia and in 20 normal babies (control group) was evaluated. The infants with HIE were divided in 3 groups, grated I to III, according to Sarnats classification. Blood velocity of anterior and medial cerebral arteries were studied by range gated Doppler velocimeter. Pourcelots resistance index (PI) and spectral analysis (SA) were considered. 2 infants, both with HIE, died in hospital and 18 were followed to 18-24 months. Adverse outcome was defined as cerebral palsy, developmental delay or death. No infant with normal SA and only a newborn with PI > 0.55 had adverse outcome. Of the 8 infants with PI < 0.55 and of the 9 infants with abnormal SA, 7 and 8 rispectively had an adverse outcome. The measurement of PI and SA were helpful for predicting neurological outcome after perinatal asphyxia (sensivity of 100%, specificity of 89%, accurancy of predicting outcome of 98%.

122: CARDIAC OUTPUT IN INFANTS OF DIABETIC MOTHERS

Cardiac output (CO) in 12 infants of diabetic mothers (I DMs) and in 20 normal neonates (control group) was estimated evaluating blood velocity in ascending aorta, using a gated pulsed Doppler velocimeter with a 5MHz transducer positionated in the suprasternal nocth. CO (mL/min/Kg) was calculated from the equation: CO = SV · HR, where SV-stroke volume (mL/Kg) and HR = heart rate (bpm). Ventricular septal hypertrophy (IVDS>0.35 cm) was found in 5 of 12 IDMs, but in none control group. In the group with IVDS > 0.35 cm, CO and SV were reduced at comparable HR. Reduced CO in IDMs with hypertrophic cardiomyopathy was related to lower SV, due to decreased left ventricular compliance and limited pre-load.

Delivery room management of extremely low birth weight infants in Italy: comparison between academic and non-academic birth centres

Abstract Objective: International Guidelines provide a standardised approach to newborn resuscitation in the DR and, in their most recent versions, recommendations dedicated to management of ELBWI were progressively increased. It is expected that introduction in clinical practice and dissemination of the most recent evidence should be more consistent in academic than in non-academic hospitals. The aim of the study was to compare adherence to the International Guidelines and consistency of practice in delivery room management of extremely low birth weight infants between academic and non-academic institutions. Methods: A questionnaire was sent to the directors of all Italian level III centres between April and August 2012. Results: There was a 92% (n = 98/107) response rate. Apart from polyethylene wrapping to optimise thermal control, perinatal management approach was comparable between academic and non-academic centres. Conclusions: There were minor differences in management of extremely low birth weight infants between Italian academic and non-academic institutions, apart from thermal management. Although there was a good, overall adherence to the International Guidelines for Neonatal Resuscitation, temperature management was not in accordance with official recommendations and every effort has to be done to improve this aspect.

Delivery room management of extremely low birth weight infants in Italian level III hospitals

Results There was a 92% (n=98/107) response rate. Participating centers reported an overall number of 198.322 births during 2011, and of these, 1933 were ELBW infants. Northern and Central centers had a higher median of births and of ELBW infants than Southern centers. A provider skilled in neonatal resuscitation is present in high-risk deliveries in 46% of III level centers: this rate was higher in Northern (77.5%) than in Central (33.3%) and Southern (21.6%) centers. The team leader for neonatal resuscitation is generally a Pediatrician/ Neonatologist (67.2%). The median delivery room temperature was 24°C (IQR: 22–25). Only 18 centers (20.2%) achieved a delivery room temperature over 25°C. A polyethylene bag/wrap was used by 54 centers (55.1%). Most centers had a pulse oxymeter (91/98, 92.9%) available in delivery room and used saturation targets (82/98, 83.7%). In Northern regions, one centre (2.5%) said it used oxygen concentrations >40% to initiate positive pressure ventilation in ELBW infants. These proportions were higher in the Central (14.3%) and Southern (16.2%) areas. A T-piece device for positive pressure ventilation was widely used (77/97, 79.4%). The percentage of ELBW infants intubated at birth had a median of 60% (IQR: 40%–80%), with the highest values in Central group (median 66%, IQR: 50%–75%). A median of 13% (IQR: 5%–30%) of ELBW infants received chest compressions at birth in Italy.