Piccolipiù, a multicenter birth cohort in Italy: protocol of the study.

BACKGROUND: The fetal and infant life are periods of rapid development, characterized by high susceptibility to exposures. Birth cohorts provide unique opportunities to study early-life exposures in association with child development and health, as well as, with longer follow-up, the early life origin of adult diseases. Piccolipiù is an Italian birth cohort recently set up to investigate the effects of environmental exposures, parental conditions and social factors acting during pre-natal and early post-natal life on infant and child health and development. We describe here its main characteristics. METHODS/DESIGN: Piccolipiù is a prospective cohort of expected 3000 newborns, who will be recruiting in six maternity units of five Italian cities (Florence, Rome, Trieste, Turin and Viareggio) since October 2011. Mothers are contacted during pregnancy or at delivery and are offered to participate in the study. Upon acceptance, their newborns are recruited at birth and followed up until at least 18 years of age. At recruitment, the mothers donate a blood sample and complete a baseline questionnaire. Umbilical cord blood, pieces of umbilical cord and heel blood spots are also collected. Postnatal follow-up currently occurs at 6, 12, and 24 months of age using on-line or postal self administered questionnaire; further questionnaires and medical examinations are envisaged. Questionnaires collect information on several factors, including mother's and/or child's environmental exposures, anthropometric measures, reproductive factors, diet, supplements, medical history, cognitive development, mental health and socioeconomic factors. Health promotion materials are also offered to parents. DISCUSSION: Piccolipiù will broaden our understanding of the contribution of early-life factors to infant and child health and development. Several hypotheses on the developmental origins of health can be tested or piloted using the data collected from the Piccolipiù cohort. By pooling these data with those collected by other existing birth cohorts it will be possible to validate previous findings and to study rare exposures and outcomes.

Children's nocturnal awakenings and sleep duration during the first two years of life in the NASCITA cohort study.

PURPOSE: Previous studies have analyzed the characteristics and prevalence of sleep disturbances among Italian children. Less attention has been paid, however, to the factors involved in sleep disturbances in the first two years of life. The goals of the present study were, therefore: 1) to provide a developmental trajectory of Italian infants' night awakenings and duration during the first two years of life and 2) to analyze which factors affect night awakenings the most over time. METHODS: Data for this study were collected in the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, pediatricians asked parents to report if the child had any sleep disturbances, especially frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings. RESULTS: 2973 toddlers, out of 5054 initially enrolled newborns, were included in this study; 875 (29.4 %) of whom presented frequent awakenings in at least one visit (peak of prevalence of 19.8 % at 12 months). Bed-sharing (adjusted OR 2.53; 95%CI:2.05-3.12) and living in the northern Italy (aOR 2.25; 95%CI:1.80-2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95%CI 0.45-0.89). A short sleep duration (<11 h/day) was reported for 801 (26.9 %) at 12 months, for 743 (25.0 %) at 24 months of age; in 383 cases, the short sleep duration was reported at both time points. An association was observed between frequent awakenings at 12 or 24 months and short sleep duration (OR 1.23; 95%CI 1.05-1.44 -ꭓ2 6.25, p = 0.012). CONCLUSIONS: The current study identified some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, effective, early interventions must be defined and integrated into pediatric care practices.

Testing ethylglucuronide in maternal hair and nails for the assessment of fetal exposure to alcohol: comparison with meconium testing.

BACKGROUND: The deleterious effects exerted by prenatal ethanol exposure include physical, mental, behavioral, and/or learning disabilities that are included in the term fetal alcohol spectrum disorder. The measurement of ethylglucuronide (EtG) in alternative biological matrices, including neonatal and maternal hair, neonatal meconium, and maternal nails, is receiving increasing interest for the accurate evaluation of the in utero exposure to alcohol. OBJECTIVE: To evaluate the correlation between EtG in maternal hair and nails with EtG in neonatal meconium to further explore the suitability of these biomarkers in disclosing prenatal exposure to ethanol. METHODS: A total of 151 maternal hair strands (0-6 cm), nail clips (2-6 mm), and corresponding neonatal meconium and nails samples were obtained from neonatal wards of 4 Mediterranean public hospitals: Rome, Florence, and Belluno in Italy and Barcelona in Spain. Hair, nails, and meconium were analyzed for the presence of EtG by validated liquid chromatography mass spectrometry assay. Meconium was also analyzed for the presence of fatty acid ethyl esters (FAEEs) as a complementary biomarker of potential in utero exposure to alcohol. RESULTS: Eighteen newborns resulted in utero exposed to maternal alcohol consumption by FAEE testing in meconium with EtG values between 0.5 and 1.5 nmol/g. Unfortunately, none of these cases were confirmed by the presence of EtG in maternal hair and nails samples, which resulted all negative to this biomarker. DISCUSSION AND CONCLUSIONS: The results confirm that FAEEs and EtG in meconium are the best biomarkers to assess in utero exposure to maternal alcohol. EtG in hair and nails are not good biomarkers to disclose alcohol consumption lower than on daily basis and lower than 1-2 alcoholic units per day.

Assessment of prenatal exposure to ethanol by meconium analysis: results of an Italian multicenter study.

BACKGROUND: This study estimated in 7 Italian cities the prevalence of prenatal exposure to ethanol by determining fatty acid ethyl esters (FAEEs; palmitic, palmitoleic, stearic, oleic, linoleic, linolenic, and arachidonic esters) and ethyl glucuronide (EtG) in neonatal meconium samples. METHODS: A total of 607 meconium samples were obtained from neonatal wards of 7 public hospitals: Verona and San Daniele del Friuli in the northeast of the country, Reggio Emilia in the middle east, Florence and Rome in the center, and Naples and Crotone in the southwest of the peninsula. Meconium biomarkers were assessed by a validated methodology using liquid chromatography-tandem mass spectrometry and the results categorized using the accepted cutoff of 2 nmol/g total amount of 7 FAEEs and 2 nmol/g EtG, to differentiate between heavy maternal ethanol use during pregnancy and occasional or no use at all. RESULTS: On the basis of the above-reported cutoffs, the overall prevalence of newborns prenatally exposed to maternal ethanol was 7.9%: 0% in Verona, 4.0% in San Daniele del Friuli, 4.9% in Naples, 5.0% in Florence, 6.2% in Crotone, up to 10.6% in Reggio Emilia, and 29.4% in Rome. Low maternal education level and younger maternal age were associated with biomarker scores over the cutoff. There was also a significant correlation between the highest percentage of prenatal exposure in the capital and certain maternal sociodemographic characteristics. CONCLUSIONS: These results indicate considerable variability in the prevalence of fetal exposure to ethanol in different Italian cities, as determined by the objective measurement of biomarkers in meconium. These data, together with previous ones obtained in Barcelona, Spain, indicate that gestational ethanol exposure is widespread, at least in parts of Europe.

The mother-child attachment bond before and after birth: The role of maternal perception of traumatic childbirth.

The quality of the mother-child attachment bond is a relevant factor for the psychosocial well-being of a child. However, some variables could affect this relationship, such as a perceived traumatic childbirth experience. The aim of this study was to explore the mediating role of the childbirth experience on the relationship between prenatal and postnatal attachment. A predictive study was conducted on 105 pregnant women aged 26 to 44 years. The data was collected at two different times: at week 31-32 of gestation (T1) and three months after childbirth (T2). The quality of maternal prenatal attachment has a significant and direct effect on postnatal mother-child attachment. Moreover, the quality of prenatal attachment represents a protective factor for the quality of childbirth experience, promoting a higher quality of postnatal attachment bond. Our results highlight the importance of supporting women throughout the perinatal period, starting from pregnancy to after childbirth.

Behavior of the Newborn during Skin-to-Skin.

BACKGROUND: Early skin-to-skin contact (SSC) significantly increases the breastfeeding rate in healthy term infants. OBJECTIVE: This study aimed to confirm previously described behavioral sequences during SSC. METHODS: We recorded live and videotaped infant behavioral sequences during SSC in a cohort of healthy term infants, whose outcome was then evaluated. RESULTS: We studied 17 mother-infants dyads. While the majority of infants (59%) had behavioral phases that have been previously reported, some of them had alternative sequences. We observed the infant's massage of the mother's breast with its hand during SSC, which had not been previously reported. We found no correlations between behavioral sequence during SSC, breastfeeding, and neonatal outcome. Moreover, maternal pain stimuli did not affect the neonatal SSC behavioral sequence. CONCLUSION: Our study confirms that immediate and undisturbed postpartum SSC is characterized by specific behavioral phases whose sequence may vary without affecting the suckling rate at the end of SSC, breastfeeding success, or the short-term neonatal outcome.

Peripartum cardiomyopathy presenting with predominant left ventricular diastolic dysfunction: efficacy of bromocriptine.

Management of patients with peripartum cardiomyopathy (PPCM) is still a major clinical problem, as only half of them or slightly more show complete recovery of left ventricular (LV) function despite conventional evidence-based treatment for heart failure. Recent observations suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. However, no evidence exists regarding its effect on LV diastolic dysfunction, which is commonly observed in these patients. Tissue Doppler (TD) is an echocardiographic technique that provides unique information on LV diastolic performance. We report the case of a 37-year-old white woman with heart failure (NYHA class II), moderate LV systolic dysfunction (ejection fraction 35%), and severe LV diastolic dysfunction secondary to PPCM, who showed no improvement after 2 weeks of treatment with ramipril, bisoprolol, and furosemide. At 6-week followup after addition of bromocriptine, despite persistence of LV systolic dysfunction, normalization of LV diastolic function was shown by TD, together with improvement in functional status (NYHA I). At 18-month followup, the improvement in LV diastolic function was maintained, and normalization of systolic function was observed. This paper might support the clinical utility of bromocriptine in patients with PPCM by suggesting a potential benefit on LV diastolic dysfunction.

Acute hypoxic encephalopathy in the full-term newborn: correlation between Magnetic Resonance Spectroscopy and neurological evaluation at short and long term.

PURPOSE: To determine which brain metabolite ratios have the strongest correlation with poor neurological outcome in newborns with perinatal asphyxia, whether the correlation is stronger with basal ganglia (BG) and whether a combined approach using Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) can be used to evaluate the severity of neonatal asphyxia. MATERIALS AND METHODS: Twenty newborns with perinatal asphyxia were studied within the first week from the hypoxic insult with MRI and MRS. The MRS variables were compared with the assessment of general movements (GMs). The brain metabolite levels measured by MRS were N-acetylaspartate (NAA), creatine (Cr), choline (Cho) and lactate and the ratios NAA to Cr, Lac to Cr, Cho to Cr, mI to Cr. RESULTS: High lactate levels and low NAA levels were found in the newborns with the worst outcome; the levels in newborns with good outcome were within normal limits. CONCLUSIONS: Correlations between NAA/Cr and Lac/Cr ratios, general movements and outcome at 6 months are stronger in the basal ganglia regions than in the frontal border zone. The presence or absence of lactate may indicate the severity of the brain insult and the combination of MRS, MRI and evaluation of general movements may assist in localising and predicting a long-term brain injury.