Higher protein intake strategies in human milk fortification for preterms infants feeding. Auxological and neurodevelopmental outcome.

Postnatal growth restriction and failure to thrive still remain a major problem in Extremely Low Birth Weight (ELBW) infants . The goal for the nutritional care of these infants is to achieve rate of growth similar to those of the fetus in utero at the equivalent gestational age. Human milk fortified remains the best food for all these preterms. Two groups of preterm of weight 580-1250 g and gestational age 23-32 wk, were fed with different protein intake in the human/maternal milk fortified ( 3,5 g Kg-1 per day and 4,8 g Kg-1 per day in the control and intervention group respectively).The feeding tolerance, intrahospital growth, neurological outcome and anthropometric data until 12 months of corrected age, were evaluated. The protein supplemented group (PSG) showed an intrahospital highter growth rate ( mostly in head circumference, p 0,02, and length growth, p 0,04) only in the preterms with 580-980 g and 23-30 wk. In the same preterms, Griffith Development Mental Score at 3 and 12 months corrected age showed higher score than in the control group in the Performance (p 0,04) and Hearing/Language (p 0,03) items. The auxological evaluation in the postdischarge period showed in the PSG group mean z-score values for length higher than those in the control group at 9 (p 0,04) months of corrected age.

Amendment to 2010 Italian guidelines for the establishment and operation of a donor human milk bank.

The present paper is an amendment to the recent Italian Guidelines of human milk banking published in 2010. Working Group on Guidelines (Panel) of the Italian Association of Human Milk Banks (AIBLUD) states, in accordance with the European Union Comission's Amending Directive of January 2011, that the hard plastic feeding bottles used in the collection, storage and pasteurization of the human milk should be Bisphenol A (BPA) free. Until new evidence are available polycarbonate feeding bottles should not be used for collection, storage and pasteurization of human milk. The paper summarizes the former and current European Commission Directives and shows the related amending changes to the 2010 Italian Human Milk Banking Guidelines.

Communication in the neonatal intensive care unit: a continuous challenge.

AIM: Communication between the healthcare team and the parents in Neonatal Intensive Care Unit (NICU) is very important, and may affect both trust in medical team and the health of premature babies. The aim of this study is to confirm that a good relationship with families can be obtained if all the healthcare team adopts a good common communication scheme. METHODS: We have implemented a communication strategy that works through three stages: (1) Training in Communication: a course about general problems with communication for medical and nursing staff. (2) Communicative Algorithm: various guidelines to follow during the most common scenarios in the NICU. (3) Communicative Case Sheet: a notebook used to record any problem or discomfort that occurs during communication. We applied the strategy for a 12 months trial period. RESULTS: A Systemic Counselling Institute of Medical Psychology tested families' satisfaction at the end of the period. The test showed that in 75% of cases, satisfaction with communication was very good and in the remaining 25%, parents perceived communication as good, but improvable. CONCLUSION: In NICU, communication between the members of the team and the newborn's parents may be improved by specific tools.

[The child of the diabetic mother]. / Il figlio di madre diabetica.

The prevalence of infants of diabetic mothers is estimated at 2-3% of all pregnancies in the Italy, with 60-90% of gestational diabetes. The perinatal mortality rate has decreased ten-fold over the past four decades; at present it is 2% mainly for congenital anomalies. The effects on the fetus and newborns depend on the degree of maternal diabetes. Macrosomia has served as a marker for evaluating morbidity and may be defined as occurring in an infant whose weight with reference gestation, exceeds the 97.5 percentile. This is mainly due to fetal hyperinsulinism secondary to hyperglycemia from inadequate maternal metabolic control. Insulin-requiring diabetes during organogenesis doubles or triples a woman's risk of producing a malformed infant (major risk for sacral dysgenesis). Hypoglycemia is a common complication of fetal hyperinsulinemia but is also caused by lower systemic glucose production rate. Hypocalcemia is recognized in these infants but the major problem and principal cause of death is respiratory distress syndrome which is identical to that found in premature infants and it comes from hyperinsulinemia retarding lung maturation through cortisol inhibition. Cardiomyopathy complicating the infants of diabetic mothers, shows a characteristic pattern with thickened intraventricular septum producing obstruction to flow.

[Neurologic risks caused by perinatal and neonatal problems in a provincial hospital]. / Rischio neurologico da problemi perinatali e neonatali in un ospedale di provincia.

The study intends to value results of follow-up of risk neonates hospitalized for the period 1980-88 at Neonatal Intensive Care Unit of Bufalini Hospital Cesena and the course with time of neurologic and neuropsychological alterations, reported to the birth-rate of territory in which operates the Neonatal Intensive Care Unit. The survivor infants attended in follow up have been 419: 63 of neonatal weight less than or equal to 1500 g (group A), 117 of weight 1501-2000 g (group B), 239 of weight greater than 2000 g (group C). The follow-up provided at first 12 months of life a pediatric examination together with motoscopic examination to Milani-Comparetti every two months, at 3 years--4 years and 6 months, 7 years a pediatric examination with evaluation of Intelligence Quotient (N.E.M.I.), at last two months of 1st Primary School evaluation of acquired scholastic learning capacities by reading test of Inizan and calculation test of Meljac. Diagnosis of cerebral palsy (C.P.) has been always placed at first 12 months of life. All the survivors have been executed pediatric checks as foreseen at first 12 months of life. The subjects with CP are 26 (%); of these 13 have an I.Q. less than or equal to 70. The risk to develop CP seems to depend strictly by hypoxic perinatal stress (21/26 infants). The type of CP seems to be conditioned by neonatal weight, in particular as regards spastic paraplegia (10/12 infants of weight less than or equal to 2000 g), but hemiplegia and tetraplegia are with equality distributed (7/14 infants of weight less than or equal to 2000 g).(ABSTRACT TRUNCATED AT 250 WORDS)

Leukaemoid reaction with megakaryocytic features in newborns with Down's syndrome.

A leukaemoid reaction was observed in 3 newborns with Down's syndrome. Thrombocytopenia was present in 2, requiring platelets transfusions in 1, and red cell transfusions were necessary in 2 patients. Blast cells characterization by specific monoclonal antibodies showed a prevalence of megakaryoblasts in all 3 cases. This feature was confirmed in 2 of them by the demonstration of platelet peroxidase (PPO) activity under transmission electron microscopy (TEM). A spontaneous remission of the leukaemoid picture was observed after 2-3 months. However, in 1 case a relapse of the myeloproliferative disorder with the same features of the blast cell population was diagnosed after 16 months. Chemotherapy with low-dose Ara-C, started because of a relevant clinical involvement, induced a complete remission.

[An intra-oral device for orojejunal feeding of low-weight neonates]. / Apparecchio endorale per nutrizione oro-digiunale nel neonato di basso peso.

An intraoral device has been experimented to stabilize oro-gastric or oro-jejunal feeding tubes in low birth weight newborns.

Early and late neutropenia in children treated with cotrimoxazole (trimethoprim-sulfamethoxazole).

The incidence of hematologic abnormalities was evaluated in 120 children with otitis media treated respectively with cotrimoxazole (trimethoprim-sulfamethoxazole) (group 1), cotrimoxazole plus folinic acid (group 2) and amoxicillin (group 3) in therapeutic doses for ten days. Only eosinophilia (an absolute count greater than or equal to 0.5 X 10(9)/l) (group 1 = 10%, 2 = 5%, 3 = 7.5%) and neutropenia (polymorphonuclear neutrophilic leucocyte count less than or equal to 1.5 X 10(9)/l) (group 1 = 35%, 2 = 17.5%, 3 = 13.3%) were noted. Early neutropenia (evident on the 5th day of therapy) occurred in all the treatment groups, thus it is not related to cotrimoxazole administration and in most cases neutrophil count reversed to normal in few days without drug discontinuation. Late neutropenia (evident after 10 days of treatment) appeared only in cotrimoxazole treated children (p less than 0.05). No superimposed bacterial infection was demonstrated in any case. Late neutropenia seems to be strictly related to the sequential blockage of folinic acid metabolism and can be prevented by the concomitant administration of folinic acid.

[Fat necrosis in the newborn infant associated with hypercalcemia and dyslipidemia (description of a case)]. / Adiponecrosi del neonato associata a ipercalcemia e dislipidemia (descrizione di un caso).

A case of subcutaneous fat necrosis (S.F.N.) with hypercalcemia and hyperlipemia in a newborn infant is reported. On the basis of previous reports it is impossible to definite the pathogenesis of hypercalcemia and hyperlipemia in subcutaneous fat necrosis. Moreover the Authors point out that in a newborn with S.F.N. plasma levels of calcium and lipids and, if it is possible, urinary prostaglandin E and serum PTH and 250HD3 should be determined.

Effect of long-term GH administration on pituitary-thyroid function in idiopathic hypopituitarism.

Twenty-four euthyroid children with idiopathic pituitary dwarfism were studied. The euthyroid state for seven of these patients was determined by negative physical examinations, normal plasma T4 assays and normal 131I uptakes. For the other children, thyroid function was evaluated with T3 and T4 assays and on the basis of the TRH test. Each of the children was treated with HGH in one of three different ways. The first group (five cases) was given a HGH dose, ranging from 12.4 to 17.2 IU/m2//week. The second and third groups (nine and ten cases, respectively) were treated with 10 and 20 IU/m2/week, respectively. Treatment was carried out for periods ranging from 6 months to 6 years. After no less than 6 months of treatment, and at intervals of 6 months (or some multiple of 6 months) plasma T3 and T4 assays, as well as a TRH test were performed in each patient. In some patients one of the indices was once beyond the upper or lower limit of the normal range (none of the children presented simultaneous abnormal levels of more than one index during the controls). This value, however, returned to within normal limits at the following control. There was no correlation between T3, T4 and TSH with the duration of HGH therapy. There was no significant difference between the groups of children treated with the different HGH doses. These data seem to demonstrate that the risk of inducing an alteration in thyroid function in hypopituitary patients during HGH treatment is very slight, and that the irregularly abnormal thyroid indices observed in some of the children during one of the controls might be an expression of their metabolic status at that moment.