[Epidemiologic data on breast feeding in Florence and the province. Survey carried out in 1364 children born between 1985 and 1987]. / Dati epidemiologici sull'allattamento al seno in Firenze e provincia. Indagine condotta su 1364 bambini nati tra il 1985 ed il 1987.

We have studied the breast-feeding frequency in Florentine Area. We investigate a group of 1364 children born between January 1985 and June 1987. We collected following data: 1) Kind of feeding at birth. 2) Duration of breast-feeding related with birth-weight, kind of delivery, mother's age, mother's working activity. 3) Growth in relation to feeding practices from birth to 3rd month. The percentage of infants breast-feed in the hospital was 81.6%, 50.5% at the end of third month, 21.9% at the end of sixth month. We have found that children weighing more than 3000 g at birth had an higher frequency of breast-feeding at birth and last longer than children weighing less than 3000 g (p less than 0.01). Maternal age had a clear effect on both the incidence and the duration of breast-feeding. Mother aged 30 years or more begin to breast-feed in lower percentage but they continue breast-feeding for a longer time. One of the factors that has a negative influence on breast-feeding at birth is caesarean section since it precludes early mother-infant contact and early initiation of breast-feeding. Mother's resume working has a negative influence on breast-feeding duration. With regard to growth in first three months of life related with different kind of feeding we have found no differences between breast-feeding and artificial-fed infants.

Proteolytic activity of maternal serum on newborn IgD-positive lymphocytes. Study with protease inhibitors.

We studied the effect of maternal serum on the surface IgD of newborn lymphocytes in the presence of protease inhibitors (epsilon-aminocaproic acid and Trasylol). Contact with maternal serum caused a significant reduction (p less than 0.000001) in the percentage of neonatal IgD-positive cells. The addition of either epsilon-aminocaproic acid or Trasylol significantly reduced this action of maternal serum (p l-ess than 0.00001 and p less than 0.0001), without difference between the effects of the two inhibitors (p greater than 0.05). We suggest, therefore, that activity of maternal serum is due, at least in part, to proteolytic enzymes, such as plasmin. The relative role of plasminogen and alpha2-macroglobulin in the incapacity of the newborn serum to reduce the number of IgD-positive lymphocytes is discussed.

Fetoneonatal hydrops from human parvovirus B19. Case report.

Authors report the case of a newborn who died just a few hours after the birth as a result of intrauterine Parvovirus B19 infection. Diagnosis of fetal hydrops was made by ultrasound examination at the 25th week of pregnancy. Etiology was established on the basis of specific antibody findings in the serum of the mother, the fetus (by cordocentesis), and the neonate; B19 virus was then observed in the fetus and the neonate tissues after death using the dot-blot hybridization assay and the polymerase chain reaction technique for viral DNA. The severe fetal anemia was treated with intrauterine transfusions, but achieved poor results. The pathogenesis of fetal hydrops and advisability of intrauterine treatment in such cases are discussed.

[Epidemiology of the cardiovascular malformations. II. Follow-up of 337 newborn in 1975-1980 at the Maternity of Florence (author's transl)]. / Epidemiologia delle malformazioni cardiovascolari. II) Follow-up di 337 nati nel periodo 1975-80 alla Maternità di Firenze.

337 newborn, in whom a cardiovascular malformation was diagnosed at birth by criteria previously reported, were followed for variable period of time from January 1975 to December 1980. They came from a population of 32,561 live births which occurred at the Maternity of Florence in the same period. The diagnosis was confirmed by angiography, surgical procedure or autopsy in the 15 per cent of the whole group. Fifty-nine babies (18 per cent) with one exception died within the first year of age. Signs and symptoms referable to the cardiovascular malformation at birth disappeared during the follow-up period in 33.8 per cent of cases. Total incidence lowered from 10.3 per thousand at birth to 6.8 at the end of the follow-up. The percentage of normalized babies correspond to the frequency with which ventricular septal defects close spontaneously in the first period of age and accounts for the disappearance of this malformation from the first place of relative incidence of cardiac malformations in adults.

Met-enkephalin-like immunoreactivity (MELI) and enkephalinase activity (EKA) in cord blood and newborns in the first hours of life.

Recently, the presence and the concomitant release with catecholamines of metenkephalin and other pro-enkephalin A deriving peptides have been demonstrated in the adrenal medulla of various mammals and man. As high amounts of catecholamines are released in the newborn at delivery, probably following the stress of parturition, a similar release of met-enkephalin and other pro-enkephalin A deriving peptides from the newborn chromaffin tissue may be hypothesized. In the present study we investigate the occurrence of met-enkephalin-like immunoreactivity and enkephalinase (quite a specific enkephalin degrading enzyme) in cord and newborn plasma at different hours after birth. Our results show the presence of high met-enkephalin-like immunoreactivity levels in cord and newborn plasma with respect to normal adult values. On the contrary, cord blood enkephalinase activity was lower than in adult subjects and further decreased during the first hours of life. A positive correlation was found between the two parameters. These data seem to indicate a release of met-enkephalin-like peptides from the newborns' sympathoadrenal tissue following the stress of delivery and in the first hours of life.

[An epidemiological study of congenital heart disease. I. Incidence of cardiovascular malformations in 11,584 live-born babies in the District of Florence (Italy) (author's transl)]. / Epidemiologia delle cardiopatie congenite. I. Incidenza della malformazioni cardiovascolari in 11.584 nati vivi nella Provincia di Firenze.

11,584 consecutive live-born babies in the Ostetric Clinic of Florence in the years 1975 and 1976 were examined for the presence of congenital heart disease. Diagnosis was made by necropsy, cardiac catheterization and operation in 20% of cases and by clinical observations in 80%. The 74% of babies who were diagnosed as affected by congenital heart disease at birth were eventually controlled. The incidence of congenital heart disease was 7.1% in 10,789 live-born of weight over 2500 g while it was 37% in 795 under such weight. Global incidence was 9.2%. The first essentials in epidemiological study of congenital heart malformations is to define the method which is used for diagnosis since this is the primary factor responsible for wide variations in incidence. It is suggested that the institution of a Regional Register of malformations would allow more accurate estimate of overall incidence of congenital cardiopathies.

Glycosilated fetal hemoglobin in neonates of diabetic mothers.

In diabetic patients, the correlation between glycosilated adult hemoglobin (HbA1c) levels and average glucose concentration over the preceding weeks is well known. We have, therefore, sought the possibility to identify newborns at risk measuring cord blood levels of fetal glycosilated hemoglobin (HbF1) in neonates of diabetic mothers. HbF1 was tested by the isoelectrofocusing method. Mean values of HbF1 have been proven to be higher in in infants born to diabetic mothers as compared to normal newborns. The highest levels were encountered in those babies whose mothers had shown a poor glycemic control during the last few weeks of pregnancy.

Circadian variability of blood pressure and heart rate in newborns and cardiovascular chronorisk.

At present, neonates are being given screening tests for relatively rare diseases, such as phenylketonuria. The time has come to give emphasis to assessing the risk for major handicapping diseases, such as coronary heart disease, stroke, and certain diseases of the kidney. Modern technology for blood pressure and heart rate monitoring and data analysis provides noninvasive means to determine when preventive measures are indicated.

Further steps toward a neonatal chronocardiology.

The study of 53 series of blood pressures at half-hour intervals from clinically healthy full-term newborns during the first days of life reveals various classifiers correlating with a history of high blood pressure: the circadian amplitude of diastolic blood pressure, the 50% range of systolic blood pressure and the standard deviation of heart rate.