Vassilios Fanos

Metabolomics Application in Maternal-Fetal Medicine

Metabolomics in maternal-fetal medicine is still an “embryonic” science. However, there is already an increasing interest in metabolome of normal and complicated pregnancies, and neonatal outcomes. Tissues used for metabolomics interrogations of pregnant women, fetuses and newborns are amniotic fluid, blood, plasma, cord blood, placenta, urine, and vaginal secretions. All published papers highlight the strong correlation between biomarkers found in these tissues and fetal malformations, preterm delivery, premature rupture of membranes, gestational diabetes mellitus, preeclampsia, neonatal asphyxia, and hypoxic-ischemic encephalopathy. The aim of this review is to summarize and comment on original data available in relevant published works in order to emphasize the clinical potential of metabolomics in obstetrics in the immediate future.

Asphyxia from the eyes of the obstetrician

Nowadays it is well recognized that there are multiple potential pathways causing hypoxic-ischemic events that may lead to cerebral palsy in term infants. The signs and symptoms of neonatal encephalopathy may range from mild to severe, depending on nature and timing of brain injury. The incidence of cerebral palsy has not changed over the last 30 years and one of the obstetricians’challenge is how to recognize babies at intrapartum risk both before and during labour. A detailed description of prepartum and intrapartum risk factors is available. A close surveillance of labour and intrapartum time should be mandatory as the valuation of all available data from obstetrical examination, cardiotocography, ultrasound and labour progression to reach the correct diagnosis with the lowest possible rate of error. The close monitoring should not exclude a humanized and compliant attitude versus labouring women and their families. We analysed the Cagliari Neonatal Intensive Care Unit (NICU) activity during the last four years considering 22 asphyxiated babies (coming from 9 different hospitals) who underwent hypothermia treatment. The main result was that the need to resuscitation procedures at birth correlates with adverse outcomes. Asphyxia still remains a matter of great concern also as medico legal claims. Considering that neonatal encephalopathy is a heterogeneous condition, it is unlikely that it will be eradicated. However, a comprehensive evaluation of all risk factors and of intrapartum surveillance available tools may reduce as much as possible adverse events. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014xa0·xa0 The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

METABOLOMICS STUDY ON NECROTIZING ENTEROCOLITIS (NEC) OCCURRENCE BY GC-MS

RESUMO: Introdução: A dacriocistocele congênita é uma coleção do fluido amniótico ou muco no saco lacrimal causada pela imperfuração da válvula de Hasner. A apresentação clínica é perinatal, apresentando-se como uma tumoração azulada na região cantal medial ou abaixo dela, acompanhada de epífora. Objetivo: Relatar os aspectos clínicos, acompanhamento e tratamento de um caso referente à Dacriocistocele congênita. Metodologia: Consiste em uma pesquisa de campo de caráter exploratório, tipo relato de caso com uma abordagem qualitativa. A população-alvo foi uma única paciente (recém-nascido) com história de Dacriocistocele congênita, por meio de sua genitora, procedente e residente na cidade de Cajazeiras (PB). O local do estudo foi a residência da mãe da criança, localizada nessa cidade. A coleta de dados foi realizada por meio de um roteiro de entrevista contendo perguntas objetivas e subjetivas com ênfase nos objetivos desse estudo. A pesquisa obedeceu de maneira integral os princípios éticos, de acordo com a Resolução 466/12 do Conselho Nacional de Saúde, que trata de pesquisas e testes envolvendo seres humanos. Resultados obtidos: O estudo realizou a análise da efetividade da implementação da massagem de Crigler no tratamento dessa afecção em crianças.

Perinatal pathology: the role of the clinical pathological dialogue in problem solving

Pathologists and clinicians come together and exchange views, they instil in one another doubts, they break down barriers. Asphyxia, respiratory distress, sepsis, multi-organ failure (MOF), cerebral ischemia and neuroprotection, necrotizing enteritis, renal and biliary pathology (including congenital nephrotic syndrome), injury caused by drugs, cardiac decompensation, placental pathology, neonatal issues in mothers with tumor: these are the topics debated, in the true sense of the word, by perinatologists and pathologists. In some pathologies (e.g. MOF) the pathophysiology is surprisingly the same in the neonate and the adult. xa0Different disciplines deal for example with immunohistochemistry and metabolomics with the processing of thousands of data in search of something that cannot be found with the classic criteria of anamnesis, objective examination, laboratory tests and imaging. Big data and information science promise to change the world. To come to grips with the extreme biological complexity of our organism and each of our organs, the completeness of enormous amounts of data is of extraordinary value if assessed holistically with the “omic” disciplines. Thus we have the possibility of understanding our extraordinary interindividual variability. The new technologies and their application do not diminish the role of physicians: on the contrary, they represent a formidable instrument for extending their diagnostic potential and make possible 5-P medicine: personalized, prospective, predictive, preventive, participatory. Proceedings of the International Course on Perinatal Pathologyxa0(part of the 10 th International Workshop on Neonatology · October 22 nd -25 th , 2014)xa0·xa0Cagliari (Italy) · October 25 th , 2014xa0·xa0 The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken