Sabrina Salvadori

Brain Auditory Activation Measured by Near-Infrared Spectroscopy (NIRS) in Neonates

This study presents a new measure of the hemodynamic changes to an auditory stimulus in newborns. Nineteen newborns born at 28-41 wk and aged 1 to 49 d were studied in waking and/or sleeping state, for a median time of 4 min 40 s before, 2 min 40 s during, and 3 min 5 s after an acustic stimulus (tonal sweep of frequency increasing from 2 to 4 kHz, intensity 90 dB SPL) originating 5 cm from the external auditory meatus. The emitter and detector optodes were placed over the left or right temporal region, corresponding to T3 or T4 EEG electrodes. The concentration changes in cerebral chromophores Δ[HbO2], Δ[Hb] and Δoxidized-reduced cytochrome aa3 were recorded every 5 s. Changes in cerebral blood volume were calculated from the changes in total Hb × 0.89/large vessel Hb concentration. Increased oxyhemoglobin, Δ[HbO2], total Hb, Δ[Hb sum], and cerebral blood volume, ΔCBV, were found in 13/19 neonates, with the exception of a neonate who only had increased in Δ[Hb], Δ[Hb sum] and ΔCBV. During the stimulation phase there was a significant increase in ΔCBV (t test, p = 0.00006) in the responsive newborns from a mean value of 0.006 (±0.02) mL/100 g in the pretest phase to 0.09 (±0.06) mL/100 g during the auditory stimulus. After the test ΔCBV decreased to 0.04 (±0.07) mL/100 g (t test, p = 0.01), so did Δ[Hb sum] (p = 0.02). Hemodynamic responses of the subjects who showed increases in Δ[Hb sum] and Δ[HbO2] were analyzed to study the Δ[Hb]. The responder subjects could be classified into two groups according to Δ[Hb] changes: 8/13 (61.5%) showed an increase of Δ[Hb] (pattern A), while 5/13 (38.4%) showed a decrease (pattern B) (t test, p = 0.03). These two patterns did not show differences related to Δ[HbO2] and Δ[Hb sum]. The ΔCBV changes in nonresponders presented a decrease during the test phase (t test, p = 0.04). CBV did not return to pretest values, suggesting a fronto-temporal brain pathway for storing unusual sounds. The increase in CBV followed the local increase in oxyhemoglobin and total Hb concentrations due to a greater use of oxygen in the homolateral temporal cortex of the newborns.

Neonatal resuscitation courses for pediatric residents: comparison between Khartoum (Sudan) and Padova (Italy)

Background:  The efficacy of a Neonatal Resuscitation Program (NRP) has been previously evaluated in developed countries, but there is a lack of information regarding the impact of this teaching program in developing countries. Our aim was to compare the knowledge gained by University of Khartoum (Sudan) and University of Padova (Italy) pediatric residents following participation in the NRP course.

Mid-childhood lung function in a cohort of children with “new bronchopulmonary dysplasia”

Recent advances in perinatal care and neonatal respiratory therapy have led to a new phenotype of bronchopulmonary dysplasia (“new BPD”). The long‐term respiratory outcome of this new form of BPD has yet to be adequately described. Aim of this study was to provide longitudinal data on lung function of an unselected cohort of children born extremely premature (EP) with an extremely low birth weight in the post‐surfactant era.

Continuous infusion of ibuprofen for treatment of patent ductus arteriosus in very low birth weight infants.

Background: Ibuprofen (IBU) has proved as effective as indomethacin in the pharmacological closure of hemodynamically significant patent ductus arteriosus (HsPDA), with an efficacy inversely related to gestational age (57-89%). Objective: This study aimed to establish whether continuous infusions of IBU could be more effective in very low birth weight infants with no additional adverse effects and reduce the need for surgical ligation. Methods: A prospective, randomized, double-dummy study was conducted on 112 very low birth weight infants (mean gestational age 27.2 weeks, SD 2; birth weight 1,019 g, SD 330) with HsPDA, 56 of whom were given IBU in conventional 15-min intermittent boluses, while the other 56 were administered IBU as a 24-hour continuous infusion, both at standard doses (10/5/5 mg/kg). Extensive echocardiography was performed before and after treatment, and adverse effects were monitored. Results: Pharmacological PDA closure was achieved after 1 or 2 IBU courses in 36 of 56 infants (64.3%) after bolus administration and in 46 of 55 (83.6%) after continuous infusion (p = 0.020), and in 9 of 26 (34.6%) and 24 of 30 (80.0%), respectively, in the infants with a gestational age of 23-27 weeks (p = 0.006). Sustained pharmacological closure was observed in 38 of 56 infants (67.9%) after bolus IBU and in 47 of 55 (85.5%) after continuous infusion (p = 0.029). Surgical ligation was used less after continuous infusion than after bolus IBU (5.5 vs. 19.6%; p = 0.024). The continuous infusion group had fewer symptoms of necrotizing enterocolitis (NEC), especially in the more preterm infants, while other neonatal morbidity and mortality rates were similar. Conclusion: Continuous IBU infusion is more effective than standard boluses for sustained closure of HsPDA, with fewer NEC symptoms and less need for surgical ligation in very low birth weight infants.

Effect of Administering Low-Dose Fentanyl Infusion on Respiratory Dynamics in the Premature Ventilated for Respiratory Distress Syndrome-A Randomized Double-Blind Trial

Effect of Administering Low-Dose Fentanyl Infusion on Respiratory Dynamics in the Premature Ventilated for Respiratory Distress Syndrome-A Randomized Double-Blind Trial

Neonatal tuberous sclerosis presenting with intractable seizures

A 2-day old girl with status epilepticus, unresponsive to maximum pharmacological intervention, is reported. Findings of brain and cardiac lesions pointed to the diagnosis of tuberous sclerosis. One of the brain lesions was unusually large, occupying most of the right temporo-parietal lobe.

Heart transplantation in pediatric age

Heart transplantation, formerly the final option for terminally ill children, has now become the treatment of choice for a number of serious acquired or congenital cardiac conditions, which cannot be treated conservatively. Nevertheless, several problems remain unsolved. First of all the shortage of donors, mainly in the first months and years of life, which has become more and more significant with time, regardless of the country, religious belief or culture of the people. Secondly, the long-term impact of immunosuppression in a developing organism, and its possible inter-relation with the primary disorder, which leads to intractable heart failure. Whether a heart transplant is a cure or an ongoing disease for both the child and the family is another matter of concern. These and other topics are covered in this article.

Antibiotics Prescriptions in the Neonatal Intensive Care Unit: How to Overcome Everyday Challenges

Abstract Antimicrobial prescriptions in neonatal intensive care units (NICUs) represent a point of concern for the emergence of MDROs and for morbidity associated with prolonged antibiotic exposure (e.g., invasive candidiasis, necrotizing enterocolitis, and late‐onset sepsis). Antimicrobial stewardship programs (ASPs) have shown to be a valuable tool for the prevention of resistance with the goals of optimizing clinical outcomes while decreasing unnecessary prescribing. The most frequent ASP strategies include the correct collection and interpretation of microbiological specimens, prescription of the narrowest‐spectrum antibiotic appropriate for a particular case, and de‐escalation or discontinuation of therapy in defined situations. A robust ASP requires everyday multidisciplinary collaboration between ID physicians, neonatologist, clinical pharmacists, clinical microbiologists, infection control professionals, hospital epidemiologists, and information services specialists. Education and clinical pathways (e.g., sepsis or surgical prophylaxis pathways) are an excellent starting point if followed by proactive interventions such as prospective audits and feedback and formulary restriction with prior antimicrobial authorization. The current review outlines the problems faced in NICU antimicrobial prescribing and presents various solutions from the literature.

Early modifications of cardiac function in preterm neonates using speckle tracking echocardiography

Preterm newborns undergo hemodynamic challenges in the postnatal period. The aim of this study was to investigate myocardial mechanics changes in the postnatal period in preterm infants using speckle tracking echocardiography (STE).

Perinatal palliative care: is palliative care really available to everyone?

In recent years, the diagnostic-therapeutic developments in fetal and neonatal medicine have profoundly changed the medical and ethical context in which pediatric healthcare professionals work.