Maria Elena Cavicchiolo

Pandemic influenza A (H1N1v) infection in pediatric population: a multicenter study in a North-East area of Italy

Background -Data on clinical presentation, morbidity and mortality of 2009 pandemic influenza virus (H1N1v) in paediatric population are still emerging; most of the data so far available came from selected cohorts of children admitted to tertiary care paediatric hospitals.Methods -An observational study involving all the 19 Divisions of Paediatrics of the Veneto Region was conducted with the aim of investigating into the demographic and clinical characteristics, the treatment, the outcome and the risk factors for disease severity of H1N1v infection occurring in children.Results -Two hundred children, median age of 4.15 years (range 0-15) were enrolled from the last week of October till the first week of January 2010 for an overall hospitalization rate of 23/100.000. At least one underlying medical condition was found in 44% of patients. Fever and cough were the most frequent symptoms (93% and 65% respectively). 11 patients (6%) were admitted to a PICU and 5 (2.5%) required mechanical ventilation. Antiviral therapy was administered in 103 patients (51.5%) Death occurred in 2 patients (1%); both had severe prior medical conditions. Pre-existing neurologic diseases (OR 7.82; 95%CI: 1.15-53.34), the presence of hypoxemia (OR 10.47; 95%CI: 2.12-51.70) and anemia (Haemoglobin < 10 g/dL) (OR 14.15; 95%CI: 2.36-84.64) were risk factor for Intensive Care Unit admission.Conclusions -This observational study in a given area of North-East Italy confirms the rather favourable prognosis of children with influenza A H1N1 (2009). Pre-existing conditions, and which is new, significant anemia, are risk factors for a complicated course.

Neonatal independent predictors of severe NEC

PurposeNecrotizing enterocolitis (NEC) is a severe neonatal disease. The present study aimed to identify factors predisposing the development of severe forms of NEC.MethodsThis retrospective study examined NEC patients in a single centre between 2002 and 2015. Data concerning clinical characteristics, therapeutic management as well as short-term outcomes were collected. We compared the patients receiving successful medical treatment and those requiring surgical intervention. Patients who underwent surgery were distinguished in three subcategories. Bivariate and multivariate analyses were used for the statistical analysis.ResultsWe identified 155 patients in the study period. 102 were treated conservatively and 53 required surgery. 8 received a primary peritoneal drainage, 31 received a drainage and a subsequent laparotomy and 14 received a laparotomy. Multivariate regression analysis identified a lower risk for surgery with a later onset and higher serum pH values, whereas an increased risk with higher C reactive Protein (CRP) levels at the onset. Pneumatosis intestinalis was identified as a protective factor. Overall mortality was 6.4%, with higher percentage in surgical NEC.ConclusionThis study suggests that a later onset is a protective sign for the progression to surgery, whereas lower pH values and higher CRP levels are prognostic factors associated with the need for surgery. The line of treatment involving explorative laparotomy in case of perforation seems to be rewarded by low morbidity and mortality rate.

Participants' opinions of the limited impact of an adapted neonatal resuscitation course in a low‐resource setting

In Mozambique, midwives provide neonatal resuscitation at birth. On January 2014, we held an adapted one-day neonatal resuscitation programme (NRP) course, based on lectures, skill stations and practical scenarios, for the 16 midwives at the Central Hospital of Beira (1), the country’s second largest hospital, with about 4,500 deliveries per year (2). By using a video-recording system, we assessed the participants clinical performance before and after the modified NRP course. The course initially had a positive effect on the knowledge and manual skills of participants, but the improvement was only limited, and we wondered what factors could have been involved in this educational process (1). Our aim was to assess the opinions of the midwives about the impact of the modified NRP course on their clinical practice. In addition, we evaluated how well the midwives felt they performed neonatal resuscitation. To do this, we used a structured questionnaire based on three main areas: 12 questions that explored their knowledge about the main steps during neonatal resuscitation, four questions on their self-esteem with regard to the theoretical and practical skills acquired during the course and nine questions on the individual barriers that limited the application of the knowledge and skills they acquired during the course on their clinical practice. The questionnaire was submitted during a meeting, where the results of the original study and some anecdotal videos were presented (1). We assessed the three areas of interest by using a qualitative five-point Likert scale, where a score of one was very low, two was low, three was sufficient, four was good and five was excellent. With regard to the knowledge on neonatal resuscitation, the answers reflected a good theoretical level: 12 (75%) of the 16 midwives demonstrated good knowledge on the steps during neonatal resuscitation. Although the results and the videos recorded during the course showed that the resuscitations clearly remained below the recommended standards in terms of quality and time of execution, 13 (81%) of the 16 midwives scored their own clinical performance as good or excellent. Finally, in the midwives opinion, the scarce application of the theoretical knowledge and skills acquired during the course in clinical practice was due to the following reasons: lack of deep expertise on neonatal resuscitation (87%), work overload (81%), limited availability of equipment and structural barriers (75%). A very interesting finding was that 12 (75%) midwives thought that their intervention could not change the babys fate (Fig. 1). Our experience strengthens the findings of previous studies that have showed that a neonatal resuscitation course conducted in a low-resource setting had a limited impact on the clinical practice of participants (1). Nevertheless, the self-esteem of our sample of health caregivers remained high. This survey proves that, in addition to technical skills, organisational, structural and cultural aspects play a relevant role. Our findings may help to design future educational interventions in low-income settings (3).

Surfactant Components and Tracheal Aspirate Inflammatory Markers in Preterm Infants with Respiratory Distress Syndrome

&NA; In 93 preterm infants ≤32 weeks of gestational age and 12 control infants, epithelial lining fluid disaturated‐phosphatidylcholine, surfactant protein A and B, albumin, and myeloperoxidase activity were assessed after intubation and before exogenous surfactant administration. We found that disaturated‐phosphatidylcholine, surfactant protein B, and myeloperoxidase were significantly higher in preterms with chorioamnionitis.

Effect of a Low-Dose/High-Frequency Training on Real-Life Neonatal Resuscitation in a Low-Resource Setting

Background: As intrapartum-related events represent a quarter of all neonatal deaths, education on neonatal resuscitation is a critical priority. Objective: To assess the impact of a low-dose/high-frequency neonatal resuscitation training on clinical practice of midwives in a low-resource setting. Methods: Eight months after a modified Neonatal Resuscitation Program (NRP) course, we implemented a low-dose/high-frequency training for midwives at Beira Central Hospital, Mozambique. The training lasted 6 months and included weekly practice sessions. Fifty consecutive resuscitations after the low-dose/high-frequency training were compared with those registered before (n = 50) and after (n = 50) participation in the adapted NRP course using video recording. Results: All 150 neonates received the initial steps; 103 required bag-mask ventilation and 41 required chest compressions. The scores for initial steps, bag-mask ventilation and chest compressions improved after the course (p < 0.0001, p = 0.005 and p = 0.03) and did not change after the low-dose/high-frequency training (p = 0.34, p = 0.99 and p = 0.30). The low-dose/high-frequency training decreased the total time of the procedure (p < 0.0001) and anticipated start time of airway suctioning and tactile stimulation (p = 0.003 and p < 0.0001), but had no effect on the time of initiation of bag-mask ventilation (p = 0.30). Conclusions: In a low- income setting, a low-dose/high-frequency training after participation in an adapted NRP course contributed to improving the initiation and times of some procedures. However, many aspects of neonatal resuscitation remained poor. Low-dose/high-frequency training should focus on improving the prevention of thermal loss, face mask ventilation and heart rate assessment.