Point of view of the Italians pediatric scientific societies about the pediatric care during the COVID-19 lockdown: what has changed and future prospects for restarting.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is currently rare in children and they seem to have a milder disease course and better prognosis than adults. However, SARS-Cov-2 pandemic has indirectly caused problems in pediatric medical assistance. In view of this we wanted to draw a picture of what happened during health emergency and analyze future prospects for restarting. METHODS: We involved the Italian pediatric scientific societies institutionally collected in the Italian Federation of Associations and Scientific Societies of the Pediatric Area (FIARPED); We sent a questionnaire to all scientific societies about the pediatric care activity during the COVID-19 emergency and future perspectives for the phase of post-containment. RESULTS: The analysis of the questionnaires showed significant decrease of:admission, outpatient visits and specialist consultancy activities during the COVID-19 emergency, primarily linked to the fear of infection. Instead it was increased the serious degree of diseases admitted. Most of scientific societies maintained the relationship with chronic patients through some form of telemedicine, reporting a strong positive opinion about this modality. Finally showed the need to give life a new approach for hospitalizations and outpatient visits through a greater use of telemedicine, educational programs on families and a more decisive role of family pediatricians. CONCLUSIONS: Our study highlighted many aspects that can be improved in pediatric care. We think that It will be necessary a new shared strategy to improve the management and continuity of care for pediatric patients, primarily developing a network of collaboration between families, family pediatrician and hospitals and by enhancing the use of new methods of telecommunications.

First-time fathers' coping strategies at elective cesarean delivery: A quantitative study.

BACKGROUND: Considerable studies have been undertaken to assess fathers' feelings and experiences during labor and delivery of their partner, however, investigation describing first-time fathers' coping strategies at elective cesarean delivery remains under explored. AIM: To assess and determine the Coping Strategies of first-time fathers at elective cesarean delivery, by looking at both first-time and second time fathers, separately. STUDY DESIGN: A quantitative design was utilized in this investigation. SUBJECTS: A total of 52 fathers, of whom 28 first-time fathers, whose partner had planned elective cesarean section, and 54 fathers, of whom 25 first-time fathers, whose partner had scheduled induction of labor at term. OUTCOME MEASURES: The Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1990) was the main tool used to explore by Task-, Emotion- and Avoidance-oriented coping subscales, the feelings and experiences of the expectant fathers relative to the labor and delivery of their partners. RESULTS: Findings indicated that Avoidance-oriented coping values were significantly higher in first-time fathers at elective cesarean section compared to those at in first-time fathers at scheduled induced vaginal delivery (50.93 ±â€¯12.80 vs 40.71 ±â€¯9.38, p < 0.001), presenting with the highest percentile (82° centile). In addition, the Avoidance-oriented coping subscale significantly correlated with the subscales assessing Avoidance through Social interaction (rho = 0.90, p < 0.001) and Avoidance based on distraction (rho = 0.63, p < 0.001). CONCLUSION: Findings revealed that first-time fathers at elective cesarean section presented significantly higher Avoidance-oriented coping strategies, through Social interaction and based on distraction, in comparison to first-time fathers whose partner had scheduled induction of labor at term.

Prepregnancy Body Mass Index shift across gestation: primary evidence of an association with eating disorders.

Objective: Previous studies indicated that gestational weight gain-related disorders share many similarities with feeding and eating disorders (EDs).Design: To examine the association of prepregnancy Body Mass Index (BMI), defined according to 2009 Institute of Medicine (IOM), and its shift across gestation with symptoms of feeding and EDs, defined by EDE-Q.Setting: This prospective cohort study took place at the Division of Perinatal Medicine of Policlinico Abano Terme, Italy, from Jannuary 2015 to October 2015.Population and sample: The sample included 655 healthy at term puerperae.Main outcomes measures: We correlated gestational BMI in different women categories to EDE-Q Global score and Restrain, Eating concern, Shape concern, and Weight concern subscales, by Spearman's correlation test.Results: Among 655 women, 59 (9.0%) were categorized as underweight, 463 (70.7%) normal weight, 98 (15.0%) overweight, and 35 (5.3%) as obese in prepregnancy period. At the end of gestation, underweight women category disappeared, normal weight women lightened to one third, overweight women tripled, and obese women doubled. At the same time, EDE-Q global scores increased from normal weight (0.25 ± 0.41), to overweight (0.47 ± 0.58), and to obese (0.72 ± 0.70) puerperae. In addition, EDE-Q global scores were significantly correlated with gestational BMI increase in Global score (rho = 0.326; p < .001) and in the four subscales: Restrain (rho = 0.161; p < .001), Eating concern (rho = 0.193; p < .001), Shape concern (rho = 0.335; p < .001), and Weight concern (rho = 0.365; p < .001), respectively.Conclusions: It was found that the shift of woman BMI across an uncomplicated pregnancy is a warning indicator of unhealthy eating and feeding symptoms.

Maternity blues: a risk factor for anhedonia, anxiety, and depression components of Edinburgh Postnatal Depression Scale.

Background: Women undergo adaptive physical and psychological changes during pregnancy, which make them vulnerable to psychological disorders.Methods: This study used a prospective observational design and included concurrent validation analysis of the 16-item Maternity Blues Scale (MBS) Dutch version to determine the direction and magnitude on the Edinburgh Postnatal Depression Scale (EPDS) symptoms, including three factors, anhedonia, anxiety, and depression in 320 puerperae early after childbirth.Results: We found a statistically significant correlation between MBS and EPDS global scores (0.22, p < .001). Moreover, Negative affect was significantly correlated with the EPDS global score (0.23, p < .001), anhedonia (0.12, p < .05), and anxiety (0.25, p < .001); Positive affect with the EPDS global score (0.14, p < .05) and depression (0.13, p < .05); and Depression subscale with EPDS global score (0.15, p < .05), anhedonia (0.12, p < .05), and anxiety (0.12, p < .05), and depression (0.12, p < .05). In addition, the subgroup of women (n = 33, 10.3%) with EPDS > 12 presented significantly higher global MBS score (2.51 ± 0.38 versus 2.26 ± 0.38, p = .01), with negative affect (2.88 ± 0.67 versus 2.62 ± 0.38, p=.04), positive affect (2.52 ± 0.69 versus 2.32 ± 0.38, p = .04), and depression (2.09 ± 0.75 versus 1.82 ± 0.36, p = .02).Conclusion: These findings together suggest that women with higher maternity blues scores may represent a distinct subgroup at increased risk of depression.

Influence of elective and emergency cesarean delivery on mother emotions and bonding.

BACKGROUND: Previous studies have indicated that mode of delivery could have a negative effect on bonding. AIMS: To assess feelings towards newborn infants in mothers who delivered by cesarean delivery, elective (ElCD) or emergency (EmCD). STUDY DESIGN: This observational prospective study took place at the Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy, from September 2014 to April 2015. SUBJECTS: The sample included 573 puerperae divided into three groups: women undergone ElCD (n=73; 12.73%), women undergone EmCD (n=81; 14.13%) and women who underwent vaginal delivery (VD) (n=419; 73.12%). OUTCOME MEASURES: The instrument used was the Mother-to-Infant Bonding Scale (MIBS; Taylor et al., 2005), a self-report test to measure mother's feelings towards her baby. High scores indicate worse mother-to-infant bonding and a score≥2, established as cut-off, indicates an altered bonding. RESULTS: The mean MIBS global score was 0.50±1.05 in the VD mothers, 0.67 (±1.14) for ElCD mothers and 0.92 (±1.05) for EmCD mothers, resulting significantly higher in EmCD mothers (p<0.001). The percentage of altered bonding (Score≥2) in the three groups was of 11.21% (n=47) in VD, 17.80% (n=13) in ElCD and 23.45% (n=19) in EmCD, significantly higher in EmCD women (p<0.006). In addition, EmCD mothers scored significantly higher Joyful (0.074±0.26 vs 0.185±0.39; p<0.005) and Disappointed (0.063±0.25 vs 0.123±0.36; p<0.008) subscales. CONCLUSIONS: It was found that EmCD negatively affects mother bonding and opening emotions, and originates in mother feelings like sadness and disappointment for the unplanned delivery evolution.

Body image in breastfeeding women with depressive symptoms: a prospective study.

The purpose of this prospective study was to investigate the relationship between body image perception and breastfeeding in puerperae with postpartum depression symptoms. The participants (147 healthy puerperae) completed The Edinburgh Postnatal Depression Scale (EPDS) and the Body Uneasiness Test (BUT-A and BUT-B), investigating body image perception and specific worries about particular body parts or functions. One month after discharge, new mothers participated in telephone interview concerning postpartum lactation practices. The subset of puerperae with EPDS score >9 also participated in psychological EPDS and BUT 6-month follow up. Mothers with EPDS score >9 (28/147, 19.04 %) had significantly higher scores on BUT-A Global Severity Index (0.69 ± 0.64 versus 0.37 ± 0.31, p < 0.0001) and on BUT-B Positive Symptom Distress Index (0.74 ± 0.57 versus 0.41 ± 0.42, p < 0004). In addition, the mothers with symptoms of depression were more likely (1:2) to interrupt full breastfeeding in the first month postpartum. At the 6-month follow up, the subset of new mothers with depression symptoms maintained elevated BUT-A and BUT-B scores, while EPDS >9 persisted in one-third of these. In conclusion, mothers with symptoms of depression have longlasting negative body image perception, persistent depressive symptoms, and they interrupt early full breastfeeding.

Body image and breastfeeding practices in obese mothers.

PURPOSE: This study analyzed body image perceptions and breastfeeding practices in obese mothers. METHODS: Prospective, case-control study on 25 obese (BMI >30 kg/m(2)) and 25 normal-weight puerperae, matched for parity and delivery route. The participants completed the Body Uneasiness Test, a two-part, self-report questionnaire, investigating body image perception before they were discharged from hospital and participated in telephone interviews concerning breastfeeding practices. RESULTS: Obese women demonstrated body image dissatisfaction related to their obesity. On average, they reported significantly higher scores on Global Severity Index (p < 0.0001) and on all of the BUT-A subscales: Weight Phobia (p < 0.02), Body Image Concerns (p < 0.0001), Avoidance (p < 0.0001), Compulsive Self-Monitoring (p < 0.01), and Depersonalization (p = 0.002) than did normal-weight puerperae. Moreover, they also had higher BUT-B scores and the Positive Symptom Total was significantly higher (p < 0.002). Finally, while breastfeeding practices at discharge were similar in the two groups, the obese mothers were more likely to maintain full breastfeeding at 6 months (p < 0.04). CONCLUSIONS: Obese mothers have negative body image perceptions but they maintain full breastfeeding longer.

Coping strategies in low-risk pregnant women: the influence of low and late fertility.

OBJECTIVE: Socio-demographic factors were strongly associated with coping styles in pregnant women. We studied fertility postponement, a new increasing phenomenon in industrialized countries. METHOD: We studied coping (The Coping Inventory for Stressful Situations, CISS) in 341 healthy pregnant women, with a median age of 34 years (IQR 31-36), in their third trimester, living in Veneto, region of Italy which emerges for its low and late fertility. RESULTS: Task-oriented coping was the most frequently used coping styles (Median, IQR: 48, 44-53), followed by Emotion-oriented coping (Median, IQR: 44, 39-49). Avoidance-oriented coping with subscales Social Diversion and Distraction were used least frequently (Median, IQR: 44, 38-49; 21, 18-24, and 14, 12-16, respectively). Socio-demographic factors were not associated with coping styles, but maternal age was inversely correlated with task coping (Spearman coefficient rho = -0.13, p = 0.02). CONCLUSION: Fertility postponement leads to the selection and use of ineffective coping strategies in an effort to alleviate anxiety.

Early lactation failure and formula adoption after elective caesarean delivery: cohort study.

OBJECTIVE: To investigate the effects of elective primary and elective repeat caesarean deliveries on lactation at hospital discharge. DESIGN: Cohort study. SETTING: Four Italian teaching hospitals - Padua, Brescia, L'Aquila and Udine. INTERVENTIONS: Deliveries were classified as vaginal, elective caesarean (primary and repeat) or emergency caesarean. A total of 2296 (24.7%) infants born by caesarean section (CS), 816 of which (35.5%) classified as primary elective CS and 796 (34.7%) as repeat elective CS, were studied. Moreover, 30.2% of the elective CS deliveries took place before 39 weeks. MAIN OUTCOME MEASURES: Feeding modalities at discharge: formula, complementary and breastfeeding. RESULTS: At discharge, 6.9% of the vaginal delivery mothers, 8.3% of the emergency CS mothers, 18.6% of the elective CS mothers, 23.3% of the primary CS mothers and 13.9% of the repeat CS mothers were using infant formula exclusively. Multivariate analysis (OR; 95% CI) identified primary elective delivery (3.74; 3.0 to 4.60), lower gestational age (1.16; 1.10 to 1.23), and place L'Aquila versus Udine (1.42; 1.01 to 2.09) and of Brescia versus Udine hospitals (6.16; 4.53 to 8.37) as independent predictors of formula feeding at discharge. CONCLUSIONS: These findings provide new information about the risks of breastfeeding failure connected to elective CS delivery, particularly if primary and scheduled before 39 weeks of gestation.

Impaired lactation performance following elective delivery at term: role of maternal levels of cortisol and prolactin.

OBJECTIVE: Lactation performance depends on stress surrounding labor and delivery, and it is likely to be different in women who underwent elective cesarean delivery (ECD) or vaginal (VD). The aim of this study was to assess the relationship between cortisol and human prolactin (hPRL), following ECD and lactation performance, from the delivery room to the 6th month of life. METHODS: A total of 106 mothers were consecutively enrolled: 38 after ECD, 28 after emergency cesarean delivery (EmCD), and 40 after VD. RESULTS: Basal stress-, lactogenic-hormones, cortisol, and hPRL were comparable on day 3 postpartum in all the women. Multivariate analysis indicated that ECD has a negative impact (OR; 95% CI) on breastfeeding prevalence on the seventh day (0.14; 0.0-0.44, p=0.008) and at third month post partum (0.19; 0.05-0.71, p=0.05) in comparison to VD. In addition, hPRL levels proved to have a statistically significant role in early breastfeeding (1.01; 1-1.01, p=0.002). CONCLUSIONS: ECD is a risk factor for successful lactation performance. This information should be provided to mothers and caregivers for extra breastfeeding guidance.

Mother infant relationship and bonding myths and facts.

Mother-infant relationship has always interested researchers worldwide. This paper reviews the development of the concept of mother infant bonding through the years.

Psychological distress and early lactation performance in mothers of late preterm infants.

Late preterm infants are a vulnerable population susceptible to early breastfeeding failure and lactation-associated morbidities. We have found that late preterm gestation has a negative effect on mothers' psychological profiles in the puerperium, with the resulting levels of anxiety, depression, and psychological distress correlating negatively with their early lactation performance.

Elective cesarean delivery: does it have a negative effect on breastfeeding?

BACKGROUND: Cesarean delivery has negative effects on breastfeeding. The objective of this study was to evaluate breastfeeding rates, defined in accordance with World Health Organization guidelines, from delivery to 6 months postpartum in infants born by elective and emergency cesarean section and in infants born vaginally. METHODS: Delivery modalities were assessed in relation to breastfeeding patterns in 2,137 term infants delivered at a tertiary center, the Padua University School of Medicine in northeastern Italy, from January to December 2007. The study population included 677 (31.1%) newborns delivered by cesarean section, 398 (18.3%) by elective cesarean, 279 (12.8%) by emergency cesarean section, and 1,496 (68.8%) delivered vaginally. RESULTS: Breastfeeding prevalence in the delivery room was significantly higher after vaginal delivery compared with that after cesarean delivery (71.5% vs 3.5%, p < 0.001), and a longer interval occurred between birth and first breastfeeding in the newborns delivered by cesarean section (mean ± SD, hours, 3.1 ± 5 vs 10.4 ± 9, p < 0.05). No difference was found in breastfeeding rates between the elective and emergency cesarean groups. Compared with elective cesarean delivery, vaginal delivery was associated with a higher breastfeeding rate at discharge and at the subsequent follow-up steps (7 days, 3 mo, and 6 mo of life). CONCLUSIONS: Emergency and elective cesarean deliveries are similarly associated with a decreased rate of exclusive breastfeeding compared with vaginal delivery. The inability of women who have undergone a cesarean section to breastfeed comfortably in the delivery room and in the immediate postpartum period seems to be the most likely explanation for this association.

Breastfeeding success after laryngeal mask airway resuscitation.

BACKGROUND: Positive pressure resuscitation by laryngeal mask airway (LMA) may expose the neonate to gas leak and gastric air insufflation, influencing postnatal gastrointestinal adaptation and breastfeeding success. METHODS: Term neonates admitted to regular nursery of the Department of Pediatrics of Padua University (Italy), from January 2005 to December 2005, after positive pressure resuscitation by LMA (Group A, 50) were compared with neonates who required positive pressure resuscitation by endotracheal tube (ETT) (Group B, 13) and to non resuscitated control neonates, matched for gestational age, (Group C, 100). RESULTS: Gestational age and birth weight were comparable among Group A, B, and C neonates. In addition, their ages at the first feeding and those of the first meconium emission were comparable. Diversely, LMA-, and ETT-resuscitated neonates presented a reduced exclusive breastfeeding rate at discharge and an increased hypoglycemia occurrence during postnatal adaptation. Moreover, ETT-resuscitated neonates presented a lower Apgar's score at 1 min, a significant increased regurgitation rate, and a delayed urine emission in comparison to LMA-resuscitated neonates. CONCLUSION: LMA- and ETT-positive pressure resuscitation impair postnatal gastrointestinal adaptation and breastfeeding success at discharge with equal frequency and to similar degree in term neonates. Regurgitation reflex is instead, enhanced after ETT-resuscitation.

Breastfeeding the 'healthy' near-term infants after laryngeal mask airway or traditional resuscitation methods.

BACKGROUND: The influence of delivery room resuscitation practice on neonatal breastfeeding pattern is largely not data driven, and clinical experience is insufficient to indicate the impact of available management methods. AIM: This cohort observational study investigated weather laryngeal mask airway (LMA) rather conventional positive pressure resuscitation devices, face mask (FM), or endotracheal-tube (ETT) would influence breastfeeding pattern in the near-term infants triaged to regular newborn nursery. METHODS: We identified through 18,641 birth records (from 2002 to 2006), 921 (4.9%) records of near-term infants of 34-36 6/7 weeks' gestation, 710 (77.1%) triaged to regular newborn nursery. Among those, 52/710 (7.3%) required positive pressure resuscitation at birth, inclusive of LMA (29, 55.7%), bag-face mask (FM, 19, 36.5%), and endo-tracheal tube (ETT, 4, 7.6%), respectively. Fifty non-resuscitated near-term infants were used as controls. RESULTS: Anthropometrical and clinical characteristics of resuscitated near-term study groups were comparable to controls. LMA was more frequently employed at birth to resuscitate near-term infants triaged to regular newborn nursery (OR; 95% CI 17.16; 5.34-55.14), whereas ETT was less frequently utilized (OR; 95% CI 0.11; 0.02-0.55). Although LMA and ETT resuscitation methods did not influence breastfeeding rate at discharge with respect to controls, FM resuscitation was associated with both the lowest breastfeeding rate (OR; 95% CI 3.20; 1.07-9.57) and the more frequently formula-feeding (OR; 95% CI 7.23; 1.58-32.92), and bottle-feeding use (OR; 95% CI 4.20; 1.30-13.49) at discharge. CONCLUSION: LMA is an effective and safe alternative to more conventional forms of airway management in near-term infants needing resuscitation at birth. Other studies are needed to clarify the potential advantages of the LMA on breastfeeding.

Impact of anxiety in the puerperium on breast-feeding outcomes: role of parity.

OBJECTIVE: : Studies in animals indicate that stress and anxiety can depress lactation, but there is much less information available concerning humans. We aimed to determine whether maternal anxiety in puerperium, potentially exacerbated by the primiparity inexperience, has a negative impact on breast-feeding outcomes. SUBJECTS AND METHODS: : The state-trait anxiety inventory Y form (Spielberger, 1983) was administered to a total of 204 mothers, 101 primiparae, and 103 pluriparae on the third to fourth day postpartum. RESULTS: : We found that primiparae had state anxiety (T) scores significantly higher than pluriparae (44.57 +/- 5.85 vs 43.28 +/- 7.10, P = 0.03). Increased state anxiety levels impaired breast-feeding success. In addition, in the logistic regression analysis model used to assess factors predictive of breast-feeding longer than 3 months, maternal state anxiety was the most significant risk factor (odds ratio 0.99; 0.88-0.98, P < 0.01). CONCLUSIONS: : In the puerperium, anxiety, potentially exacerbated by primiparae inexperience, is associated with impaired lactation. Alleviating maternal anxiety could be beneficial for stimulating breast-feeding in more vulnerable women.