A surveillance system for diseases of companion animals in the Veneto region (Italy).

Experts and international public health organisations stress the lack of surveillance systems for companion animal diseases and the need to implement such surveillance as a priority of the 'One Health' perspective. This paper presents the features of a system for the collection, analysis, interpretation and dissemination of data regarding the health status of pets in the Veneto region (Italy). The system involved the construction of a Web-based database containing the diagnoses of transmissible and non-transmissible diseases of dogs and cats made by veterinarians in their practices, hospitals, kennels and catteries. Each diagnosis constitutes a single record, also containing data on the identification of the individual animal and on several characteristics of epidemiological relevance. The World Health Organization (WHO) 10th revision of the International Classification of Diseases (ICD-10) for human diseases has been adapted to canine and feline diseases to standardise the diagnostic nomenclature. Software has been specifically created for online data entry and data management. The first results show that the main disorders were digestive (21%), dermatological (18%) and cardiovascular (11%) among 1,087 diagnostic records in dogs, and digestive (23%), dermatological (15%) and urinary (14%) among 289 diagnostic records in cats. The main causes of death are represented by cardiovascular (21%) and gastrointestinal (21%) diseases in dogs and by urinary (31%) disorders in cats. At present, no institutional surveillance system for companion animal health exists in Italy, and veterinarians joining this project and sharing the outcomes of their clinical activity are acting on a voluntary basis.

Aussi bien les experts que les organisations internationales oeuvrant dans le domaine de la santé publique soulignent l'absence de systèmes de surveillance dédiés aux maladies des animaux de compagnie, alors que la mise en place de cette surveillance constitue une priorité dans une perspective « Une seule santé ¼. Les auteurs décrivent les caractéristiques d'un système introduit en Vénétie (Italie) pour collecter, analyser, interpréter et diffuser des données sur la situation sanitaire des animaux de compagnie. Le système repose sur une base de données en ligne alimentée par les rapports de diagnostic sur les maladies transmissibles et non transmissibles des chiens et des chats établis par les vétérinaires dans leur cabinet, à l'hôpital ou dans les élevages ou pensions pour chiens et chats. Chaque diagnostic fait l'objet d'une notification spécifique où sont également consignées les données d'identification individuelle de l'animal et les caractéristiques pertinentes au plan épidémiologique. La classification internationale statistique des maladies (ICD­10) de l'Organisation mondiale de la santé (OMS), qui concerne les maladies humaines, a été adaptée aux maladies des chiens et des chats afin d'utiliser une nomenclature standardisée des diagnostics. Un logiciel spécifique a été créé pour la saisie en ligne des données et leur gestion. D'après les premiers résultats, les principales affections diagnostiquées étaient, chez le chien (sur 1 087 rapports de diagnostic), des maladies digestives (21 %), dermatologiques (18 %) et cardio-vasculaires (11 %) et, chez le chat (sur 289 rapports de diagnostic), des maladies digestives (23 %), dermatologiques (15 %) et urinaires (14 %). Les principales causes de mortalité étaient respectivement les maladies cardio-vasculaires (21 %) et gastro-intestinales (21 %) chez le chien et les maladies du système urinaire (31 %) chez le chat. À l'heure actuelle, aucun système institutionnel de surveillance n'est en place en Italie pour les animaux de compagnie, de sorte que les vétérinaires qui participent à ce projet et partagent leurs résultats cliniques le font sur une base volontaire.

Tanto especialistas como organizaciones internacionales dedicadas a temas de salud pública hacen hincapié en la ausencia de sistemas de vigilancia de las enfermedades de los animales de compañía y en la necesidad de instaurar tal vigilancia como elemento prioritario de los planteamientos de «Una sola salud¼. Los autores presentan las características de un sistema destinado a reunir, analizar, interpretar y difundir datos sobre el estado de salud de los animales de compañía en la región italiana del Veneto. Para instituir ese sistema se creó una base de datos en línea que centraliza información sobre los diagnósticos de enfermedades transmisibles y no transmisibles de perros y gatos realizados por veterinarios en el ejercicio de su labor en consultorios, hospitales y residencias caninas y felinas. Cada diagnóstico constituye un registro único, que también contiene datos sobre la identidad del animal en cuestión y sobre una serie de aspectos de importancia epidemiológica. Con objeto de normalizar la nomenclatura de diagnóstico se adaptó a las enfermedades caninas y felinas la Clasificación Internacional de Enfermedades, décima revisión (CIE­10), de la Organización Mundial de la Salud (OMS), que se aplica a las enfermedades humanas. También se crearon programas informáticos destinados específicamente a la introducción de datos en línea y a su gestión. Los primeros resultados muestran que los principales trastornos en los perros, de los 1.087 diagnósticos registrados, fueron los digestivos (21%), seguidos de los dermatológicos (18%) y los cardiovasculares (11%). En el caso de los gatos, con 289 diagnósticos registrados, las dolencias más importantes fueron las digestivas (23%), las dermatológicas (15%) y las urinarias (14%). En el perro, las principales causas de mortalidad fueron las enfermedades cardiovasculares (21%) y gastrointestinales (21%), y en el gato las patologías urinarias (31%). Actualmente no existe en Italia ningún sistema institucional de vigilancia de la salud de los animales de compañía, y los veterinarios que participan en este proyecto y comparten los resultados de su praxis clínica lo hacen con carácter voluntario.

Interobserver reliability to interpret intrapartum electronic fetal heart rate monitoring: Does a standardized algorithm improve agreement among clinicians?

Our aim was to investigate the accuracy in predicting intrapartum fetal acidaemia and the interobserver reproducibility of a mathematical algorithm for the interpretation of electronic fetal heart rate (FHR) monitoring throughout labour. Eight physicians (blinded to the clinical outcomes of the deliveries) evaluated four randomly selected intrapartum FHR tracings by common visual interpretation, trying to predict umbilical artery base excess at birth. They subsequently were asked to re-evaluate the tracings using a mathematical algorithm for FHR tracing interpretation. Common visual interpretation allowed a correct estimation of the umbilical artery base excess in 34.4% of cases, with a poor interobserver reproducibility (Kappa correlation coefficient = 0.24). After implementation of the algorithm, the proportion of correct estimates significantly increased to 90.6% (p < 0.001), with excellent inter-clinician agreement (κ: 0.85). To conclude, incorporation of a standardised algorithm reduces the interobserver variability and allows a better estimation of fetal acidaemia at birth.

A low-dose multicomponent medication as a new approach in prevention and early add-on treatment of recurrent respiratory infections in children: a Delphi Consensus.

OBJECTIVE: Recurrent respiratory infections (RRIs) represent a demanding challenge in pediatricians' clinical practice. A previous Inter-Society Consensus defined criteria for identifying children with RRIs and assessed the available treatments, considering the evidence grade. MATERIALS AND METHODS: The present Delphi consensus proposed a series of statements concerning the practical use of Citomix, a multicomponent low-dose medication. The participants should be primary care, private practice, and hospital/university pediatricians with extensive experience using this product to manage children with RRIs. One hundred twelve Italian pediatricians voted for the statements. RESULTS: The agreement grade was high for all statements (ranging from 69.6% to 99.1%). The participants expressed their satisfaction with using this medication, which may represent a valuable and safe option for preventing and adding on treating children with RRIs. These statements reflected their personal opinions based on daily clinical practice. CONCLUSIONS: The results of this Delphi consensus represented an input for further evidence-based studies highlighting the effectiveness of low-dose medications for both the prevention and treatment of RRIs.

Comparison of "IN-REC-SUR-E" and LISA in preterm neonates with respiratory distress syndrome: a randomized controlled trial (IN-REC-LISA trial).

BACKGROUND: Surfactant is a well-established therapy for preterm neonates affected by respiratory distress syndrome (RDS). The goals of different methods of surfactant administration are to reduce the duration of mechanical ventilation and the severity of bronchopulmonary dysplasia (BPD); however, the optimal administration method remains unknown. This study compares the effectiveness of the INtubate-RECruit-SURfactant-Extubate (IN-REC-SUR-E) technique with the less-invasive surfactant administration (LISA) technique, in increasing BPD-free survival of preterm infants. This is an international unblinded multicenter randomized controlled study in which preterm infants will be randomized into two groups to receive IN-REC-SUR-E or LISA surfactant administration. METHODS: In this study, 382 infants born at 24+0-27+6 weeks' gestation, not intubated in the delivery room and failing nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV) during the first 24 h of life, will be randomized 1:1 to receive IN-REC-SUR-E or LISA surfactant administration. The primary outcome is a composite outcome of death or BPD at 36 weeks' postmenstrual age. The secondary outcomes are BPD at 36 weeks' postmenstrual age; death; pulse oximetry/fraction of inspired oxygen; severe intraventricular hemorrhage; pneumothorax; duration of respiratory support and oxygen therapy; pulmonary hemorrhage; patent ductus arteriosus undergoing treatment; percentage of infants receiving more doses of surfactant; periventricular leukomalacia, severe retinopathy of prematurity, necrotizing enterocolitis, sepsis; total in-hospital stay; systemic postnatal steroids; neurodevelopmental outcomes; and respiratory function testing at 24 months of age. Randomization will be centrally provided using both stratification and permuted blocks with random block sizes and block order. Stratification factors will include center and gestational age (24+0 to 25+6 weeks or 26+0 to 27+6 weeks). Analyses will be conducted in both intention-to-treat and per-protocol populations, utilizing a log-binomial regression model that corrects for stratification factors to estimate the adjusted relative risk (RR). DISCUSSION: This trial is designed to provide robust data on the best method of surfactant administration in spontaneously breathing preterm infants born at 24+0-27+6 weeks' gestation affected by RDS and failing nCPAP or NIPPV during the first 24 h of life, comparing IN-REC-SUR-E to LISA technique, in increasing BPD-free survival at 36 weeks' postmenstrual age of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT05711966. Registered on February 3, 2023.

Prediction of fetal base excess values at birth using an algorithm to interpret fetal heart rate tracings: a retrospective validation.

OBJECTIVE: To evaluate whether a standardised algorithm to interpret fetal heart rate (FHR) tracings during the entire length of labour can predict umbilical artery base excess at birth, and to investigate its inter- and intra-observer reproducibility. DESIGN: Retrospective study. SETTING: Obstetrics and gynaecology department at a tertiary referral centre in a university hospital. POPULATION: Group 1: 152 consecutive, generally low-risk, labouring women. Group 2: mixed group of 30 women who delivered a fetus with pH < 7.00 and 30 women who delivered a fetus with pH ≥ 7.00. METHODS: Intrapartum FHR tracings were retrospectively and blindly evaluated by two independent assessors using an algorithm proposed by Ross and Gala to predict fetal base excess at birth. MAIN OUTCOME MEASURES: The accuracy in predicting the base excess values of newborns was expressed as the proportion of FHR tracings in which the operator was able to correctly calculate the actual base excess at birth (approximation of ± 2 mmol/l). Inter- and intra-observer reproducibility were estimated using the Pearson correlation coefficient. RESULTS: In the group of 152 low-risk labouring women, the two assessors correctly predicted the umbilical artery base excess in 73.1 and 76.3% of cases, respectively. Inter-observer (Pearson correlation coefficient = 0.75) and intra-observer (Pearson correlation coefficient = 0.80 and 0.82 for the first and second assessor, respectively) reproducibility was very good. In the 30 fetuses that were acidemic, the first and second observers correctly predicted base excess values in 23 (76.7%) and 21 (70%) cases, respectively (inter-observer reproducibility, Pearson correlation coefficient = 0.72). CONCLUSIONS: The algorithm proposed by Ross and Gala may be a valuable tool to estimate changes in umbilical base excess during active labour, with a high inter- and intra-observer reproducibility.

Sport, free time and hobbies in people with spinal cord injury.

STUDY DESIGN: Prospective, multicenter follow-up (F-U) observational study. OBJECTIVES: To investigate the changes in participation and sports practice of people after spinal cord injury (SCI) and their impact on perceived quality of life (QoL). METHODS: The questionnaire investigated the health status and management of clinical conditions and attendance of social integration, occupation, autonomy, car driving, sentimental relationships and perceived QoL in a SCI population 4 years after the first rehabilitation hospitalization. RESULTS: Respondents were 403, 83.4% male; 39% was tetraplegic. At F-U, 42.1% worked and studied, 42.2% still held their jobs or studies, and 69% drove the car. In all, 77.2% had bowel continence and 40.4% urinary continence. The results showed that for the 68.2% of respondents, the attendance of friends, relatives and colleagues during their free time was the same or increased compared with the time before the injury, whereas 31.8% showed a decrease. The amount of time the 52.1% of respondents left home was the same or increased compared with before the trauma, whereas 50.6% of the respondents said that the time they were engaged in hobbies was either the same or increased. CONCLUSION: SCI people who perceived their QoL as being higher, and whose attendance, autonomy and time was increased in respect to hobbies, were mainly men with an age range between 36 and 40 years, unmarried, paraplegic and with A-B Asia Score. Regarding the amount of time dedicated to practicing sports, the only difference was the most of that respondents, who indicated a decrease, were women.

Timing of oral feeding changes in premature infants who underwent osteopathic manipulative treatment.

BACKGROUND: The delayed transition from gavage-to-nipple feeding is one of the most significant factors that may prolong hospital length of stay (LOS). Osteopathic manipulative treatment (OMT) has been demonstrated to be effective regarding LOS reduction, but no investigations have documented its clinical validity for attaining oral feeding. OBJECTIVES: To assess OMT utility regarding the timing of oral feeding in healthy preterm infants. DESIGN: Preliminary propensity score-matched retrospective cohort study. SETTING: Data were extrapolated from the neonatal intensive care unit (NICU) of Del Ponte Hospital in Varese, Italy, during the period between March 2012 and December 2013. INTERVENTIONS: Two propensity score-matched groups of healthy preterm infants aged 28+0 to 33+6 were compared, observing those supported with OMT until hospital discharge and control subjects. MAIN OUTCOME MEASURES: Days from birth to the attainment of oral feeding was the primary endpoint. Body weight, body length, head circumference and LOS were considered as secondary endpoints. RESULTS: Seventy premature infants were included in the study as the control group (n = 35; body weight (BW) = 1457.9 ± 316.2 g; gestational age (GA) = 31.5 ± 1.73 wk) and the osteopathic group (n = 35; BW = 1509.6 ± 250.8 g; GA = 31.8 ± 1.64 wk). The two groups had analogous characteristics at study entry. In this cohort, we observed a significant reduction in TOF (-5.00 days; p = 0.042) in the osteopathic group with a greater effect in very low birth weight infants. CONCLUSIONS: These data demonstrate the utility and potential efficacy of OMT for the attainment of oral feeding. Further adequately powered clinical trials are recommended.

Molecular and genomic characterisation of cryptic chromosomal alterations leading to paternal duplication of the 11p15.5 Beckwith-Wiedemann region.

BACKGROUND: Beckwith-Wiedemann syndrome (BWS) is an overgrowth disorder with increased risk of paediatric tumours. The aetiology involves epigenetic and genetic alterations affecting the 11p15 region, methylation of the differentially methylated DMR2 region being the most common defect, while less frequent aetiologies include mosaic paternal 11p uniparental disomy (11patUPD), maternally inherited mutations of the CDKN1C gene, and hypermethylation of DMR1. A few patients have cytogenetic abnormalities involving 11p15.5. METHODS: Screening of 70 trios of BWS probands for 11p mosaic paternal UPD and for cryptic cytogenetic rearrangements using microsatellite segregation analysis identified a profile compatible with paternal 11p15 duplication in two patients. RESULTS: Fluorescence in situ hybridisation analysis revealed in one case the unbalanced translocation der(21)t(11;21)(p15.4;q22.3) originated from missegregation of a cryptic paternal balanced translocation. The second patient, trisomic for D11S1318, carried a small de novo dup(11)(p15.5p15.5), resulting from unequal recombination at paternal meiosis I. The duplicated region involves only IC1 and spares IC2/LIT1, as shown by fluorescent in situ hybridisation (FISH) mapping of the proximal duplication breakpoint within the amino-terminal part of KvLQT1. CONCLUSIONS: An additional patient with Wolf-Hirschorn syndrome was shown by FISH studies to carry a der(4)t(4;11)(p16.3;p15.4), contributed by a balanced translocation father. Interestingly, refined breakpoint mapping on 11p and the critical regions on the partner 21q and 4p chromosomal regions suggested that both translocations affecting 11p15.4 are mediated by segmental duplications. These findings of chromosomal rearrangements affecting 11p15.5-15.4 provide a tool to further dissect the genomics of the BWS region and the pathogenesis of this imprinting disorder.

Quality of life and aphasia. Multicentric standardization of a questionnaire.

AIM: It is important to assess aphasics' quality of life in order to plan a rehabilitation treatment. To date such a tool is still missing for Italian patients. This paper reports normative data of the Italian version of SAQOL-39, a British questionnaire aimed to assess aphasics' quality of life. It consists of 39 items, divided into 4 subdomains (Physical, Communication, Psychosocial and Energy). METHODS: Forty-two patients coming from 3 different Speech Therapy Services were enrolled. All patients completed speech therapy before examination. They were submitted to the Italian SAQOL-39 and 2 screening tests for aphasia: 1) Communication Assessment Scale according Goodglass and Kaplan; 2) Franchay Aphasia Screening Test (FAST). A receptive FAST score of 7 out of 15 was used as a cut-off score for SAQOL-39 administration. RESULTS: The Italian SAQOL-39 showed good internal consistency (full scale Cronbach's alpha 0.939). Cronbach's alpha for every subdomains ranged from 0.950 (Communication) to 0.720 (Energy). Fluent aphasics gave significantly higher scores than nonfluent ones on full scale, and all out of Energy subdomains. Furthermore gravity of aphasia correlated with both full scale and Communication subdomain scores. CONCLUSIONS: In authors' opinion, the Italian SAQOL-39 shares many psychometric features with the English one. This questionnaire seems to be suitable for clinical practice.

Cross-cultural adaptation and preliminary test-retest reliability of the Italian version of the Complexity Rehabilitation Scale-Extended (13th version).

BACKGROUND: In Italy, the lack of appropriate use of intensive rehabilitative services is an acknowledged issue, as demonstrated by periodic epidemiological surveys. Rehabilitation activities are planned without considering the clinical complexity, known to be one of the most fundamental factors able to outline the real patients' needs on recently clinical practice rehabilitation guidelines. Alternative diagnostic systems become, therefore, necessary. For this reason, we would like to propose the Rehabilitation Complexity Scale - Extended version (RCS-E) within intensive rehabilitation units in Emilia Romagna. AIM: This study aims at submitting an Italian translation, cross-cultural adaptation and preliminary reliability evaluation of the Rehabilitation Complexity Scale Extended (13th Version) (RCS-E). DESIGN: Face validity and test-retest reliability. SETTING: The study was conducted in three different rehabilitation units of the Emilia Romagna region, Northern Italy. POPULATION: Ten expert physicians and 51 Intensive (code 56) rehabilitation in-patients were recruited. METHODS: A cross-cultural adaptation of the scale was built from English into Italian, closely complying with international guidelines. Face validity and test-retest reliability were carried out to evaluate the comprehensibility and goodness of fit of the new scale. RESULTS: An overall positive judgement was obtained with the face validity test. No significant differences were observed between the original and the adapted scale scoring. Internal consistency measured on 51 patients by Cronbach's alpha was 0.702 for the scale. The estimated SEM was 1.211. ICCconsistency was 0.702. Split-Half reliability and the Spearman-Brown prophecy were 0.633 and 0.775, respectively. Test-retest reliability of the RCS-E measured with ICCagreement was 0.903. CONCLUSION: The adapted RCS-E provides a sensitive and reliable tool that appears to be suitable for measuring clinical complexity in Italian code 56 rehabilitation units. It is the first Italian version of the scale to be devised. CLINICAL REHABILITATION IMPACT: Further statistical validation will assess the Italian RCS-E as a possible instrument for guiding the patients' assignment to the rehabilitation settings that best suit their specific needs. These preliminary data represent the first step through this purpose.

Post-discharge nutrition of the very low-birthweight infant: interim results of the multicentric GAMMA study.

UNLABELLED: This report presents the interim results up to 12 mo corrected age (c.a.) of a multicentric, prospective, controlled study on very low-birthweight infants, randomized at 40 wk post-conception in two different groups of formula feeding: 80 Kcal/dL (group A) vs 70 Kcal/dL (group B) up to 55 wk of postconceptional age. Subsequently, all the babies were fed with a follow-on formula, with the introduction of solid foods at 6 mo c.a. Weight, length, head circumference and neurological conditions with psychomotor development (evaluated by the Griffiths' Developmental Scale) were measured at regular intervals and all of these parameters were satisfactory in both groups. For growth, in group A there was a greater increase in weight in boys at 55 wk and at 6 mo c.a., and small for gestational age (SGA) babies had a greater increase in length at 1 y of age, while head circumference caught up on growth from week 40 to week 55. Measured by the Griffiths' Developmental Scale, the SGA group fed 80 Kcal/dL had a better score at 6 mo; similarly boys fed 80 Kcal/dL had a better score at 6 and at 9 mo. CONCLUSION: Nutrition of very low birthweight infants post-discharge could have an influence on physical growth and on neurodevelopmental outcome. This interim report needs to be confirmed at the end of the study.

Oligosaccharides might stimulate calcium absorption in formula-fed preterm infants.

UNLABELLED: Among other components of human milk, oligosaccharides might contribute to the high efficiency of calcium absorption of breastfed infants. In adults, it can be shown that dietary oligosaccharides can improve calcium absorption. The present analysis was performed to evaluate a possible influence of dietary oligosaccharides on parameters of calcium metabolism in preterm infants. The concentrations of calcium and phosphorus in plasma and in spot urine samples as well as the plasma activity of the alkaline phosphatase were measured in preterm infants fed either a standard formula (n = 15) or a formula supplemented with dietary oligosaccharides (n = 15) at the end of a 4-wk feeding period. CONCLUSIONS: There was no influence of the different diets on the plasma concentration of calcium and phosphorus or on the plasma activity of alkaline phosphatase. In urine, there was a tendency towards higher calcium concentrations in the group fed the supplemented formula compared concentrations in the group fed the standard formula. The concentrations of phosphate were not significantly different and, as a consequence, there was a tendency towards a higher Ca/P molar ratio in the group fed the supplemented formula. The data indicate that the calcium absorption might be influenced by the dietary oligosaccharides. Thus, the possible effect of dietary oligosaccharides on calcium homeostasis should be included in the discussion concerning the consequences of the use of dietary oligosaccharides in preterm infant nutrition.

Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: three years' follow-up.

A prospective case-control study is presented to assess an allergy prevention programme in children up to 36 months of age. Infants born at three maternity hospitals were followed from birth: 279 infants with high atopic risk (intervention group) were compared with 80 infants with similar atopic risk but no intervention (non-intervention group). The intervention programme included dietary measures (exclusive and prolonged milk feeding diet followed by a hypoantigenic weaning diet) and environmental measures (avoidance of parental smoking in the presence of the babies, day care > 2 years of life). Mothers in this group who had insufficient breast milk were randomly assigned to one of two coded formulas: either a hydrolysed milk formula (Nidina HA, Nestlé) or a conventional adapted formula (Nan, Nestlé). Other environmental measures remained the same as for the breastfeeding mothers. The non-intervention group were either breastfed or received the usual Italian milk feeding and weaning diet, without environmental advice. The main outcome measures were anthropometric measurements and allergic disease manifestations. Normal anthropometric data were observed both in the intervention group and in the non-intervention group. The incidence of allergic manifestations was much lower in the intervention group than in the non-intervention group at 1 year (11.5 versus 54.4%, respectively) and at 2 years (14.9 versus 65.6%) and 3 years (20.6 versus 74.1%). Atopic dermatitis and recurrent wheezing were found in both the intervention group and the non-intervention group from birth up to the second year of life, while urticaria and gastrointestinal disorders were only present in the non-intervention group in the first year of life. Conjunctivitis and rhinitis were present after the second year in both the intervention group and the non-intervention group. Relapse of the same allergic symptom was less in the intervention group (13.0%) than in the non-intervention group (36.9%). In comparison to the non-intervention group, there were fewer intervention group cases with two or more different allergic symptoms (8.7 versus 32.6%), and they were more likely to avoid steroid treatment (0 versus 10.8%) and hospital admission (0 versus 6.5%). Babies in the non-intervention group fed with adapted formula were more likely to develop allergies than breastfed babies in the same group. In the intervention group the breastfed infants had the lowest incidence of allergic symptoms, followed by the infants fed the hydrolysed formula (ns). Infants in the intervention group fed the adapted formula had significantly more allergies than the breastfed and hydrolysed milk fed infants, although less than their counterparts in the non-intervention group. Of the affected subjects in the intervention group, 80.4% were RAST and/or Prick positive to food or inhalant allergens. Total serum IgE values detected at birth in the intervention group were not predictive, but at 1 and 2 years of age, IgE values more than 2 SD above the mean in asymptomatic babies were found to predictive for later allergy. In breastfed babies the total IgE level at 1 and 2 years of age was lower than in the other two feeding groups. Of the various factors tested in the non-intervention group, the following were the most important in the pathogenesis of allergic symptoms: (i) formula implementation begun in the first week of life; (ii) early weaning (< 4 months); (iii) feeding beef (< 6 months); (iv) early introduction of cow's milk (< 6 months); and (v) parental smoking in the presence of the babies and early day care admission (< 2 years of life). All the preventive measures used in this study (exclusive breastfeeding and/or hydrolysed milk feeding, delayed and selective introduction of solid foods, and environmental advice) were effective at the third year of follow-up, greatly reducing allergic manifestations in high atopic risk babies in comparison with those not receiving these interventions

Influence of different types of post-discharge feeding on somatic growth, cognitive development and their correlation in very low birthweight preterm infants.

UNLABELLED: The influence of appropriate post-discharge nutrition on somatic growth and cognitive development of very low-birthweight infants in the first year of life is currently a major topic in infant nutrition. Appropriate intakes of proteins, iodine and the addition of LC-PUFAs (arachidonic acid (AA), docosahexaenoic acid (DHA)) in the "right" quantities improve cognitive development and are conducive to a good correlation between somatic growth and neurodevelopment. CONCLUSION: When mother' milk is not available post-discharge, in addition to more proteins and minerals, formula for low-birthweight infants should contain AA and DHA, since the endogenous production of these important compounds from the precursors can be reduced in the first months of life, chiefly in the very low-birthweight infants.

Hydrolysed proteins in preterm formula: influence on plasma aminoacids, blood fatty acids and insulinaemia.

The data from the present investigation differ from those of the previous study. The new version of hydrolysed protein formula did not induce changes in insulinaemia or in the insulinaemia/glycaemia ratio in pre- and postprandial samples when compared with the intact protein formula. The investigation also confirmed that branch chain aminoacids regulate insulin secretion and that the length of chain is insulinotropic for fatty acids, while the degree of unsaturation is not able to reduce insulin secretion in the newborn baby. This could be caused by stimulation of insulin output activated by the C20:5 n 3; the effects of fatty acids are probably related more to the variable composition of cell membrane than to the fatty acids circulating levels.

Allergic manifestations in very low-birthweight infants: a 6-year follow-up.

The incidence of allergic manifestations was evaluated from birth until 6 y of age in 83 very low-birthweight infants (VLBWIs). In the same period 98 full-term babies were followed from birth to 24 mo of life. All the subjects were examined by paediatricians to establish the presence of atopic dermatitis (AD), gastrointestinal disturbances (GD) and asthma (AS). The incidence of total allergic manifestations (31.3%) in VLBWIs was significantly lower than that (52%) in 24-mo-old infants, born at full term. The incidence of allergies in VLBWIs did not differ at all at the subsequent checks, up to 6 y of age. AD (33.7%) was the most common symptom, statistically higher in full-term infants than in VLBWIs (7.2%). GD had a similar distribution (8.2% in full-term infants vs 7.2% in VLBWIs). AS (16.8%) was significantly higher in VLBWIs than in those born full term (10.2%). In the various VLBWI subgroups analysed, AD was more prevalent in babies weighing >1000 g and in babies >30 wk of age; the incidence of GD was higher in infants weighing <1000 g and in SGA infants, and AS was more prevalent in infants weighing <1000 g, in infants <30 wk of age and in babies appropriate for gestational age. A family history of allergy was related to a major incidence of allergies.

Pro- and pre-biotics administration in preterm infants: colonization and influence on faecal flora.

Prolonged administration of probiotic in preterm babies induce a rise of specific IgA and IgM antibodies against probiotic. This fact explains why presence of living germs in stools almost disappeared in spite of continuous administration. However some positive influences were observed: decreased ratio of aerobic/anaerobic. Increased ratio of gram +/gram - germs. Prebiotic administration induces after 28 days a significant increase of faecal bifidobacteria and frequency and consistency of stools were more similar to those observed in subjects fed with human milk.

Stroke rehabilitation pathways and procedures in Italy.

AIM: Rehabilitation pathways and procedures after first stroke vary widely. We wanted to determine in what ways first stroke rehabilitation in Italian rehabilitation centers are similar and in line with the Italian Ministry of Health guidelines and international reports. METHODS: Data from the study, Cerebral Ictus and Rehabilitation: Clinical Indicators and Outcomes, of the Italian Cooperative Research (ICR(2)), on 997 inpatients in 18 rehabilitation centers were analyzed and the rehabilitation procedures were compared. To do this, we compared the variables: onset admission interval, length of stay, intensity of treatment and discharge destination. Statistical analyses were performed using the Kruskal-Wallis test, the post hoc Mann-Whitney U test and the chi squared test. RESULTS: Major differences among the centers were found for onset of admission, length of stay, intensity of treatment and discharge destination, whereas the clinical characteristics and the functional outcomes of the study population were similar. CONCLUSIONS: Our results emphasize the importance of better integration between the acute treatment phase and the rehabilitation teams in reducing the onset admission interval of first acute stroke patients. To define optimal intensity of treatment and length of stay, randomized multicenter studies will be needed.

Aphasia quality of life: reliability of the Italian version of SAQOL-39.

AIM: In recent times there has been an increasing interest in assessing the quality of life (QOL) in stroke clinical trials. To our knowledge, an Italian tool suitable for this purpose is still missing. So we adapted to Italian language the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39), that is a British questionnaire recently validated with aphasic subjects. The aim of this paper is to validate our version of SAQOL-39. METHODS: To determine the matching of our version, we requested a native English speaker to translate the Italian version into English. Twelve patients (7 male, 5 female; mean age 66.4 years) were submitted to our test. All subjects were interviewed twice by 2 raters, at 24 h of distance. Neither examinator knew results of the other interview. Statistical analysis was performed by determining Cronbach's a and the intraclass correlation coefficient (ICC). RESULTS: Comparing the original SAQOL-39 to the English translation of our Italian version, we found only a low percentage (10%) of minimal semantic variations. As for test-retest reliability, ICC for global score was 0.898 (ICC(2,39)). ICC range for SAQOL-39 subdomains was 0.816 to 0.969. Cronbach's a for full scale scores was 0.916 (subdomains ranged 0.767 to 0.976). Results seem good as for usefulness, reliability and acceptability of the Italian version of SAQOL-39, like the original version of this test. CONCLUSIONS: Our Italian version of SAQOL-39 seems suitable for clinical use. A multicentric study aiming to compare our data to original English ones is in progress.

High-flow nasal cannula: transient fashion or new method of non-invasive ventilatory assistance?

Respiratory failure in the premature infants remains a difficult challenge. An alternative to the use of nasal continuous positive airway pressure (NCPAP) as a non-invasive modality to support respiratory distress in premature infants has been the recent introduction of high flow nasal cannula (HFNC) devices in many neonatal units. There has been increased use of HFNC presumably because of anecdotal reports and experience that it is easy to use, and well tolerated by the infants, while experiencing decreased nasal septumerosion. The paucity of evidence regarding its efficacy and safety, would support a caution approach to the use of HFNC. Particular concern has focused on the imprecise regulation and generation of pressure that may occur at higher flows especially in the smallest of infants.