Stefania Longo

Short-term and long-term sequelae in intrauterine growth retardation (IUGR)

Intrauterine Growth Retardation (IUGR) is defined as a rate of growth of a fetus that is less than normal for the growth potential of the fetus (for that particular gestational age). Small for Gestational Age (SGA) is defined infant born following IUGR, with a weight at birth below the 10th percentile.Suboptimal fetal growth occurring in IUGR fetuses is an important cause of perinatal mortality and morbidity. The acute neonatal consequences of IUGR include metabolic and hematological disturbances, and disrupted thermoregulation; in addition, respiratory distress (RDS), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP) may contribute to perinatal morbidity. Metabolic disturbances are related to glucose and fatty acid metabolism. It is well-known that individuals who display poor growth in utero are at significantly increased risk for type 2 diabetes mellitus (T2DM), obesity, hypertension, dyslipidemia, and insulin resistance (the so-called metabolic syndrome, MS). MS ultimately leads to the premature development of cardiovascular diseases. In addition, short stature in children and adults, premature adrenarche, and the polycystic ovarian syndrome (PCOS) are endocrinological sequelae of IUGR. (8) Early onset growth delay and prematurity significantly increase the risk for neurological sequelae and motor and cognitive delay.Future prospective studies need to investigate risk factors for infants who are SGA. If reliable prediction can be achieved, there is potential to reduce future perinatal morbidity and mortality, and long term consequences among SGA babies.

Cerebral and somatic rSO2 in sick preterm infants

Near infrared spectroscopy (NIRS) measures the regional tissue oxygen saturation (rSO2) of various organs and provides a reflection of the balance between tissue oxygen supply and demand. Oxymetry assessed via NIRS has been proposed as a ‘standard of care’ and today it is already widely used in the NICU. This approach allows detection of any acute change in cerebral haemodynamics and continuous monitoring of cerebral and somatic oxygenation. This work describes three clinical cases of preterm VLBW infants which showed special points of interest during both cerebral and somatic NIRS monitoring.

IUGR and infections

Intra-uterine growth retardation (IUGR) is usually defined as impaired growth and development of the fetus and/or its organs during gestation. Infants are defined small for gestational age (SGA), following IUGR, when the birth weight is below the 10th percentile. Pre-natal congenital infections caused by T. gondii, rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), and Treponema are associated with, and account for, approximately 5 to 15% of IUGR. On the other hand, SGA preterm infants are at increased risk of post-natal infection compared to their age-matched appropriately grown controls, in particular nosocomial infection, irrespective of the responsible pathogen. One possible mechanism is the retarded development in the immune system which has been described in association with IUGR. Indeed, SGA infants have a disproportionately small thymus and low leukocyte, lymphocyte and macrophage counts. However, immune therapies, including prophylactic intravenous immunoglobulins and GM-CSF have not proven to be effective in reducing the incidence of sepsis, and further research is required.

Which is the optimal algorithm for the prevention of neonatal early-onset group B streptococcus sepsis?

The incidence of neonatal early-onset group B streptococcus (GBS EOS) sepsis has declined during the last decade since the implementation of intrapartum antibiotic prophylaxis endorsed by Centers for Disease Control and Prevention (CDC) guidelines. All the CDC guidelines versions provide recommendations for neonatal management. The neonatal algorithm of CDC has not been universally accepted and hence different algorithms have been suggested. Since all approaches to disease prevention are still imperfect, an optimal algorithm for GBS EOS prevention is still lacking; the development of improved diagnostic methods of distinguishing at-risk infants may contribute to improve the clinicians approach.

Different subsets of circulating angiogenic cells do not predict bronchopulmonary dysplasia or other diseases of prematurity in preterm infants

Bronchopulmonary dysplasia (BPD) is a chronic lung disease occurring in very and extremely preterm infants undergoing mechanical ventilation. Given the altered lung vascular growth characterizing BPD, circulating angiogenic cells could be useful biomarkers to predict the risk. The objective of the study was to determine whether the percentages of circulating angiogenic cells (CD34+VEGFR-2+, CD34+CD133+VEGFR-2+, and CD45-CD34+CD133+VEGFR-2+ cells), assessed in the peripheral blood at birth by flow cytometry, could be used as markers for the risk of BPD. In one-hundred and forty-two preterm neonates (gestational age < 32 weeks and/or birth weight < 1500 g) admitted to our tertiary care Neonatal Intensive Care Unit between 2006 and 2009, we evaluated the percentages of circulating angiogenic cells at birth, at 7 days, and, in a subset of infants (n=40), at 28 days of life. The main outcome was the correlation between cell counts at birth and the subsequent risk of developing BPD. In our study, all the three cell populations failed to predict the development of BPD or other diseases of prematurity. We suggest that these cells cannot be used as biomarkers in preterm infants, and that research is needed to find other early predictors of BPD.

Prevention of early onset group B streptococcal disease: controversial issues

Intrapartum chemoprophylaxis is currently the most effective preventive strategy against the neonatal early-onset group B streptococcal infection. The principal controversies on strategies for intrapartum antibiotic administration, possible adverse effects, management of newborn and possible future preventive strategies reported in the literature are considered.

Diagnosi prenatale tardiva di infezione da Toxoplasma Gondii: un grave caso di idrocefalo

We describe a case of severe fetal hydrocephalus due to Toxoplasmosis which could not be diagnosed until late gestational age due to the lack of a serologic surveillance during pregnancy. Abnormal ultrasound in the third trimester revealed a massive bilateral ventriculomegaly and Toxoplasma Gondii was demonstrated in maternal blood. This case is an example of severe fetal toxoplasmosis diagnosed in utero.

Un nuovo caso di sindrome di Hallermann-Streiff

Hallermann-Streiff Syndrome (HSS) is a rare disorder characterized primarily by head and face anormalities, with dental abnormalities also present in 50-80 percent of cases. The first description seems to have been made by Aubry in 1893. HSS was first described completely in 1948 by Hallermann, and then in 1950 by Streiff. In this paper, we report the case of a newborn with HSS who presents facial abnormalities, frontal and parietal bossing, retrognathia, a beak-shaped nose, microphtalmia, congenital cataract, nystagmus, crypthorchidism, hypotrichosis, premature dental eruption and failure to thrive.

Un caso di Sindrome di Bartter ad esordio prenatale

Antenatal Bartter Syndrome (ABS) is a rare autosomic recessive tubulopathy characterized by idiopathic hydramnios, fetal polyuria and elevated levels of amniotic chloride. It is associated with hypokalemic metabolic alkalosis with high renin and aldosterone plasma concentration with low or normal blood pressure. Bartter Syndrome is related to mutations affecting several transporters in the loop of Henle. We report an infant with antenatal Bartter syndrome, who improved with potassium and sodium supplements.