[The preterm infant in the nursery?]. / Il pretermine al nido?

We evaluated 250 newborns, GA less than or equal to 37 weeks, admitted to the Nursery of the Pediatric Department of Padua, between 1.1.1990 and 31.7.1991. We considered particularly three groups of newborns with 35, 36 and 37 weeks gestation respectively. Other 80 fullterm newborns were included in the study as control group. The postnatal adaptation (table 1) is regular in 96.2% of the fullterm newborns, and in 62.9% of the 35 wks. Jaundice is the main cause of irregular postnatal adaptation in the preterm newborns (22.8% in the 35 wks group, and 16% of the control group). When we considered the feeding modalities (table 2), we found that only the 21.7% of the 36 wks group and the 11.4% of the 35 wks group were breast fed, against the 86.3% of the control group. The discharge from the Nursery was earlier (less than or equal to 4th day of life) in the term groups and later in the preterm, who often stay in the Nursery for a longer period because of their feeding, growth and postnatal adaptation problems. These results could be certainly improved introducing the rooming-in method, which at the moment is not fully applied in our Nursery.

Unconjugated and conjugated bilirubin pigments during perinatal development. III. Studies on serum of breast-fed and formula-fed neonates.

The process of conjugation and secretion of bilirubin was studied in a group of healthy, full-term, exclusively breast-fed newborns and a control group of exclusively formula-fed infants by means of a reverse-phase high-performance liquid chromatographic analysis of bilirubins present in serum. The serum concentrations of unconjugated bilirubin, esterified bilirubin, and the proportion of diesterified bilirubin (as percent of esterified bilirubin) were not significantly different in breast- and formula-fed infants on the 3rd and 5th days of life. These data suggest that both bilirubin production and conjugation are not different in breast-fed and in formula-fed newborns.

Renal function in preterm twins with birthweight discordance.

To evaluate the development of renal function in fetal malnutrition conditions, we tested glomerular filtration rate and fractional sodium excretion (FENa) of premature twins at birth (less than or equal to 35 weeks gestational age) with birthweight discordance, divided according to birthweight (less than or equal to 10% group A; higher birthweight group B). Groups A and B of twins are comparable in fluid intake, biochemical serum tests (glucose, sodium, potassium, albumin, total protein, osmolality and hematocrit) and also in percent weight decrease at 24 h of life. Moreover, both creatinine clearance (CrCl) and FENa result respectively correlated directly (r = +0.63) and indirectly (r = -0.46) with gestational age of twins. Consequently, CrCl (8.3 +/- 4.3 vs 8.3 +/- 4.5 ml/min/1.73 m2) and FENa (3 +/- 2.8 vs. 2.7 +/- 2.8%) do not result different in relation to birthweight discordance of premature twins. In conclusion, at birth, gestational age is the main determinant of kidney function in premature twins with birthweight discordance.

Urinary beta-2-microglobulin excretion in prematures with respiratory distress syndrome.

Urinary concentrations of beta 2-microglobulin (beta 2M) were studied in 25 prematures (less than or equal to 35 weeks) with respiratory distress syndrome (RDS), divided into two groups (group 1: ventilation greater than or equal to 2 days; group 2: oxygenotherapy less than or equal to 4 days), to assess the value of beta 2M in the detection of tubular damage in relation to the severity and management of the respiratory disease. The data were compared with those obtained from 10 healthy controls, matched for birth weight and gestational age. Measurements of beta 2M were made on urine collected on days 1, 3, and 5 until the recovery phase of RDS was reached. Urinary beta 2M values for infants with RDS were increased on days 1 and 3, with respect to the controls, and significantly increased in the ventilated group (8,814 +/- 4,768 vs. 2,594 +/- 3,231 micrograms/l, p less than 0.005 and 7,624 +/- 6,264 vs. 2,762 +/- 2,316 micrograms/l, p less than 0.05, respectively). Serum sodium and creatinine, creatinine clearance, fractional tubular sodium excretion and renal function index on day 1 were similar in prematures with or without RDS. However, the ventilated newborns presented higher urinary sodium excretions. On the 5th day, no significant differences in urinary beta 2M were found among the groups. The elevated levels of urinary beta 2M in the acute phase of RDS and in the more severe lung disease indicate the existence of subclinical tubular dysfunction, probably secondary to hypoxic stress and to negative hemodynamic effects of ventilatory management.

[Assistance to the healthy newborn infant. II. The current situation in Veneto]. / L'assistenza al neonato sano. II. La situazione attuale nel Veneto.

We report the results of a research carried out giving all head physicians of the paediatrics departments in Veneto or of the neonatal sections a questionnaire in order to know how the lying-in woman and the healthy newborn are assisted. The principle information requested by the questionnaire are reported in Table n. 1. The structures of the labour and delivery rooms, regarding their present use, allow the continuous presence of the father during the delivery and the accomplishment of the rooming-in. On the contrary the assistance given to the mothers and the newborns is traditional in 80% of the cases, and they hard take measures able to favour suckling and a mother-child contact in the first hours of the delivery (fig. 2). The tendency to admit in the paediatrics department the newborn who presents problems even slight is not influenced by the apparatus equipped in the neonatal section, but it seems to be in proportion to the structure (number of the deliveries a year) and to the staff of the hospital. In conclusion we think that in our district not just logistical and structural limits but cultural and administrative obstacles slacken the accomplishment of a new neonatal assistance. Particularly we consider very important the administrative recognition of the activity carried out by the paediatricians in the neonatal section and in the puerpery, even if it is not linked to hospitalizations in the department.

[Assistance to the healthy newborn infant. 1. Experience of a new model of nursery care]. / L'assistenza al neonato sano. 1. Esperienze di un nuovo modello di assistenza al nido.

We propose an organizational model which provides proper assistance to the mother and newborn, promoting at the same time, an adequate structure for the child-parent relationship. We refer to the results obtained over a 2-year period, during which we gradually achieved a "rooming-in" situation and organized the assistance in the nursery to the newborns with minor pathology, and without substantial modifications either to structures or personnel. However providing a minimum of equipment and pediatrician and qualified paramedic personnel all the time. We noticed a statistically higher frequency of breastfeeding even after a time lapse (table 3), and a marked decrease of transfers to the neonatal pathology whit, especially among those neonates with minor pathology (tables 5 and 6). The fulfiment a direct connection with the family pediatrician and his services, through a complete and personalized exchange of informations, and a good degree of cooperation with the obstetrician, supported by the results discussed and evaluated together before (or him).

Efficacy and safety of the "integral" phototherapy for neonatal hyperbilirubinemia. Results of a follow-up at 6 years of age.

One hundred and ten full-term newborns were treated with integral phototherapy (IP) in the first week of life for hyperbilirubinemia (peak bilirubin concentration, 19.5 +/- 2.8 mg/dl). IP was provided by an apparatus which irradiated the infants over the entire skin surface with four visible blue light lamps placed around the body at a mean distance of only 20 cm. The irradiance of the lamps at the skin surface was 0.350 mW/sq cm, in the wavelength range between 425 and 475 nm. The IP resulted in a 48-hour bilirubin decline rate of 0.163 mg/dl/h. After a mean exposure of 78 +/- 32 h, the mean plasma bilirubin level was 8.4 +/- 0.8 mg/dl. One hundred and ten comparable nonjaundiced infants were studied as controls. At 6 years of age, both groups of subjects were called for a follow-up concerning growth, visual, and hearing functions, and neuro-developmental status. The follow-up was completed in 81 children of the IP group (73.6%) and in 89 of the controls (80.6%). There were no significant differences in the studied parameters between the two groups. The study concludes that IP appears to be an effective and safe treatment for jaundiced infants. IP employs less radiant energy from the lamp source than the traditional apparatus, but delivers this energy to a larger skin surface area.

HBIG efficacy in preventing HBV infection in infants.

Previous studies have confirmed the superiority of HBIG versus ISG and multiple dose versus single dose of HBIG (Beasley) and the time of first HBIG administration in preventing HBV infection. In all studies many treated infants became HBsAg or anti-HBs positive after the HBIG stopped. The present study was undertaken to evaluate the efficacy of multiple dose HBIG therapy in preventing HBV infection, and to establish the optimal dose, the frequency of the dose, the time of administration during the first year of life and to control the occurrence of HBsAg or active anti-HBs during the first two years of life. Seven infants of mothers positive for HBsAg and HBeAg, or positive for HBsAg but negative for HBeAg and anti-HBe, or with hepatitis B in the last trimester of pregnancy, received HBIG at high titer at dose of 0.5 ml/kg from first day until near 5 months of life and then 0.5-0.3 ml/kg until 12 months of life. The interval between the administration was established on the basis of the anti-HBs titer lower than 32. It was not a fixed interval but variable in different cases. Passive anti-HBs antibodies were almost always above 32 during the treatment period with HBIG. All patients remained negative for HBV markers and for liver enzyme tests during the period of the study. HBIG, administered in the first year of life at high dose and at intervals depending upon serum anti-HBs titer (32) systematically controlled, is efficient in preventing the hepatitis B infection in infants at high risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Vertical transmission of HBV from mothers HBsAg positive, anti-HBe positive.

Vertical transmission of HBV from HBsAg carrier mothers to their infants occurs frequently and very early in life. The HBsAg titer, the presence of HBeAg and acute HBV infection in the mother are usually considered facilitating factors; on the contrary anti-HBs and anti-HBe titer would be effectively protecting. However anti-HBc does not prevent HBsAg infection at all. In order to obtain information on the rate of HBV transmission in conditions considered at lower risk, we identified a group of pregnant women who were asymptomatic chronic HBsAg carriers and followed their children for several months after birth with clinical and laboratory examinations. All the 13 mothers were positive for HBsAg, anti-HBe, anti-HBc and negative for anti-HBs and HBeAg. All infants were controlled monthly in the first year of life and then at 16, 20, 24 months. The relatives controlled in the same period proved negative for HBV markers. All infants were negative for antigens at the birth and positive for anti-HBe and anti-HBc. These antibodies disappeared after 3-7 months after birth, indicating maternal transmission. All infants remained negative for HBsAg, HBeAg, anti-HBe and liver enzyme tests during the period of observation (24 months). These observations indicate that in our population the transmission of HBsAg from chronic carrier mothers to their children is not a frequent occurrence; probably the presence of anti-HBe has been protective.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and aortographic assessment of the complications of arterial catheterization.

Catheterization of the umbilical artery for the treatment of critically ill neonates provides a convenient method for monitoring blood gas tension and chemistry. The most important complications are thrombotic. Thirty eight aortographs were carried out in infants who underwent umbilical artery catheterization. 17/38 of the aortographs were pathological. Bacterial cultures were positive in 11/17, but only 4 coincided with pathological aortographs. Clinical signs indicating complications due to the presence of the catheter wwere observed in 10 cases. Post-mortem examination of eight subjects--three of whom had pathological aortographs--during the course of the investigation revealed only one case of thrombosis. This baby was considered to have died as a direct result of a thrombotic complication. In our experience the clinical signs of vascular complications and evaluation of the peripheral circulation in the ipsilateral leg remain the most important ways of assessing the indication for catheter-withdrawal.

Umbilical vessel catheterization; the immediate risks with the venous route.

Seven cases of heart arrest or pronounced bradycardia during 308 correct catheterizations of the umbilical vein in the first hours of life are reported. The indications for the catheterization were: 1. unsuccessful catheterization of the umbilical arteries in newborns with respiratory distress or post-asphyxia syndrome; 2. exchange transfusions for severe neonatal hyperbilirubinemia or sepsis; 3. monitoring the central vein pressure in severely compromised shocky newborns. Cardiac massage was always effective, at least temporarily, in restoring the heart activity. However, only three infants survived. Two of them had normal follow-up reported at 6 and 12 months respectively. The immediate risks and the necessary precautions for carrying out umbilical vein catheterization in severely ill newborns in the first hours of life are stressed.

Effect of phototherapy on hepatic excretory function in newborns as measured by bromsulphalein clearance.

BSP clearance from the plasma was studied during phototherapy in a group of jaundice newborns. This therapy did not have any influence on the plasma dye disappearance c curve. The obtained results are consistent with the hypothesis that this therapy causes the photodegradation of bilirubin, and that the increased excretion of unconjugated bilirubin is not mediated by a generalized enhancement of the hepatic output.