Renato Lucchini

Neonatal respiratory morbidity and mode of delivery in a population-based study of low-risk pregnancies.

The aim of this study is to evaluate the association between the mode of delivery and the risk of neonatal respiratory complications in a cohort of term newborns in the Lazio region, Italy. Data on 139,379 term singleton infants born in 2003–2005 were retrieved from birth and hospital discharge database. Odds Ratios (ORs) adjusted by age, parity, birth weight, gestational age, and gender were calculated using logistic regression models. The rate of prelabor cesarean section (CS) was 26.2%. The rates of neonatal respiratory morbidity were 29.6/1,000 in infants delivered by prelabor CS and 17.4/1,000 in infants delivered vaginally or by CS in labor. The adjusted risk of neonatal respiratory morbidity associated with prelabor cesarean birth at 37 weeks is four times higher than in intended vaginal birth after 37 weeks. Prelabor cesarean delivery should be performed after at least 38 weeks’ of gestation in order to minimize neonatal respiratory morbidity.

Timing of repeat elective caesarean delivery and neonatal respiratory outcomes

Compared with other industrialised countries, Italy has one of the highest caesarean delivery rates, which increased from 26.1% in 1995 to 38.3% in 2005.1 While the overall effect of this mode of delivery on neonatal respiratory outcomes among term newborns is well known,2 few studies have compared the impact of gestational age at delivery on respiratory morbidity (ie, at 37 and 38 weeks’ gestation vs 39 weeks3). We conducted this analysis in the Lazio region (53 000 births/year), where the caesarean delivery rate was 42.7% in 20054; the proportion of term elective caesarean …

Genetic and Environmental Components of Neonatal Weight Gain in Preterm Infants

BACKGROUND AND OBJECTIVES: Postnatal nutrition and subsequent weight gain or failure in the neonatal period are likely regulated by both the environment and the genetic background. With the goal of estimating the variability of postnatal weight gain due to genes and environment, comparison between monozygotic (ie, genetically identical) and dizygotic (genetically similar as 2 siblings) twins can be performed. METHODS: This study selected a very homogenous set of monozygotic and dizygotic twins who met the following inclusion criteria: gestational age between 30 and 36 weeks, birth weight between 1250 and 2200 g, and length of stay >12 days. Opposite-gender pairs and pairs that differed >20% in terms of birth weight were excluded from this analysis. The outcome measure of this study was the daily weight gain expressed in grams per kilogram per day during the period between day of birth and day of discharge. The average difference between members of a pair was computed in the 2 groups of twins, and heritability was estimated. RESULTS: The within-pair differences of the outcome measure were lower for monozygotic twins than for dizygotic twins, suggesting a strong genetic component. The total variance of the phenotype under study is explained by 2 sources of variation, additive genetic (87% [95% confidence interval: 67% to 94%]) and unique environment (13% [95% confidence interval: 6% to 33%]) components. CONCLUSIONS: This high heritability estimate could suggest using this set of criteria to identify genes that regulate postnatal weight gain or failure.

Blocked Atrial Bi/Trigeminy In Utero Evolving in Supraventricular Tachycardia after Birth

Transient episodes of fetal bradycardia (heart rate less than 110 bpm) are usually benign and typically result from increased vagal stimulation in the fetus. Causes of sustained fetal bradycardia include sinus bradycardia, blocked atrial bigeminy/trigeminy, high-degree atrioventricular block, and long QT syndrome. We present the case of a 34-year-old Caucasian patient referred to our department for “blocked atrial bigeminy with pseudobradycardia” detected elsewhere at 33 weeks of gestation. A fetal echocardiography showed during all the examination a blocked atrial trigeminy with a mean fetal heart rate of 100 bpm. After birth three subsequent ECGs until day 3 showed no evidence of atrial extrasystoles, confirming the well-known frequent regression of this kind of fetal benign arrhythmia, but on day 11 recurrence of supraventricular trigeminy and development of episodes of paroxystic supraventricular tachycardia were observed. On the basis of this observation, we recommend that fetuses with complex atrial ectopic beats should be closely monitored before and after birth for evidence of new arrhythmias.

Greater frequency of premature birth when both parents do not acknowledge filiation

No abstract

Nutrition of very low birth-weight infants

Background Numerous studies have underlined the importance of early feeding on shortand long-term development of very low birth-weight (VLBW) neonates [1,2]. Nutrition of preterm infants may be divided in two subsequent periods: the early adaptive or “transition” period from birth to the second week of life followed by the “stable-growing” period up to discharge from the neonatal unit. Depending on birth weight and gestational age the transition period may be prolonged. Immediately after birth most VLBW infants are unable to start enteral feeding. Parenteral nutrition is presently proposed since the first days of life to limit malnutrition. The ideal of nutrients intake for VLBW neonates is still a matter of debate [1,2].

Newborn at social risk

The birth of a child is a moment that marks great changes in the parental couple and is usually accompanied by feelings of joy and positive expectations towards the future of the newborn. Conversely, sometimes birth is a socially problematic event in terms of psychosocial, economic and cultural distress. When this is the case, the birth of a child is often not the product of a conscious choice, but the consequence of inadequate information and communication, or the concrete manifestation of unresolved issues. Adequate and inadequate parenting are actually the opposite extremes of conditions with infinite nuances, and it is not easy to define already in the neonatal stage which condition may affect future physical, mental and relational development. Hertzman et al. argue that a good start in life is the key to reducing health and social inequalities and that governments should invest more in programmes aimed to support early child development [1]. We consider an infant at social risk any baby unlikely to receive from his family and/or environment in which he lives the moral, cultural and material resources necessary for proper development. It is possible to identify many high-risk social factors, ranging from the presence of parents with drug addiction, alcoholism, or psychiatric diseases, or in detention, to conditions of both economic and cultural poverty. Other conditions of social risk are represented by lower maternal age (according to Italian law, a minor mother cannot acknowledge her child unless she is at least 16 years), and the absence of a partner (single parent). A special condition is finally represented by the abandonment of the child at birth: this decision represents the most difficult moment of a pregnancy and involves the early intervention of social services in order to protect the child and give him/her a minimum prospective of health, growth and development. All these situations are more common among immigrant populations, which are therefore seen as more at risk of social distress. Some of the phenomena described above have a dramatic impact, but are infrequent. For example in the last 10 years (2003– 2012) in the Municipality of Rome 486 infants were abandoned and placed under protection (approximately 50 per year). The Italian detention centers currently houses about 60 children under 3 years of age who live with their mothers. However, the most frequent situations are often those that most likely escape the attention of health and social care workers, as some women and their families may want to conceal the social