Near-infrared spectroscopy measure of limb peripheral perfusion in neonatal arterial thromboembolic disease.

AIM: In critically ill neonates, peripheral perfusion and oxygenation assessment may provide indirect information on circulatory failure in limb arterial thromboembolic emergencies. Aims of our study were: 1) to evaluate the changes on tissue oxygenation index, oxyhemoglobin, deoxyhemoglobin and blood volume obtained by near-infrared spectroscopy (NIRS) on the infants legs; 2) to compare them with ultrasonographic data. METHODS: Tissue oxygenation index (TOI), oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb) and blood volume (BV) differences were assessed by NIRS on the calf of 8 newborn infants (median weight 1995, range 585-3010 g; median gestational age 32.5, range 26-40 wks). An ultrasonographic scan of the arterial system was performed before the NIRS measurements, to validate the site of arterial occlusion. RESULTS: A t-test for independent samples showed lower values in the affected limb for all NIRS measurements. TOI measurements displayed lower values in the thromboembolic limb (mean 44.79±12%) versus unaffected (mean 47.95±17.08%) (P=0.0001). Mean (SD) peak systolic velocity in the patent artery below the occlusion decreased from 108±25 cm/s in the normal limb to 25.6±28 cm/s in the thrombus site (P=0.02). CONCLUSION: In neonatal intensive care units, measurement of limb peripheral perfusion and oxygenation seems to be clinically useful in arterial thromboembolic emergencies.

Retrospective analysis of post-hemorrhagic ventricular dilatation in very low birth weight infants, short and long-term outcome.

AIM: The aim of this paper was to study the evolution of ventriculomegaly, the treatment and the developmental problems of a group of very low birth weight infants (VLBWI) born between 1985 and 1999 who met Levene's percentiles for post-hemorrhagic ventricular dilatation (PHVD). METHODS: A retrospective hospital-based study of a cohort of 66 VLBWI who fulfilled the diagnostic criteria for PHVD was performed. Measures of neurodevelopmental outcome were evaluated by analyzing neurosensorial patterns as well as mental and behavioral adjustment up to pre-school age in 35 survivors. RESULTS: The PHVDs initially (1985-1989) were due to a grade 4 intraventricular hemorrhage (IVH) (71.4%), and in the latter period (1995-1999) to IVH grade 2 (36.4%), grade 3 (31.8%) and grade 4 (31.8%). Acetazolamide has been used since the 90's in neonates with progressive PHVD. The 90s were characterized by an increasing incidence of tiny babies and rapidly-progressive PHVD. Taps were more frequent in the arrested dilatation group. Similarly, taps and acetazolamide were administered to newborns with persistent, slowly-progressive ventricular dilatation (PHVD > 4 weeks). The highest correlation was found for gestational age with the mental and psychomotor developmental indexes. Delayed performance and/or mental retardation were diagnosed in 71.4% of the survivors. CONCLUSION: Acetazolamide and lumbar puncture, associated with other risk variables (severity of IVH, PHVD evolution and associated parenchymal lesions) are harmful in terms of development, but they have a role in the short-term arrested and slowly progressive PHVD of the surviving babies, and not in the mortality incidence. Our retrospective data demonstrated that lower gestational age at birth increased the risk of lower mental and psychomotor developmental indexes.

Home oxygen therapy in infants with bronchopulmonary dysplasia: assessment of parental anxiety.

BACKGROUND: It is conceivable that a complicated recovery course in a high-risk premature infant managed at home generates apprehension and anxiety in parents. AIMS: We attempted to define the evolution of anxiety levels in a population of parents of low-birth-weight premature infants with bronchopulmonary dysplasia enrolled in a prospective home O(2) therapy program. STUDY DESIGN: In the immediate pre-discharge [mean postnatal age 95 (45-158) days], a questionnaire (State-Trait Anxiety Inventory form Y) was given to all parents of the premature infants [mean birth weight 1106 (0.610-1.770) kg; mean gestational age 27.1 (24-31) weeks] present for the discharge. Subsequently, the parents were assessed twice, initially after a week from the discharge of their infants and then at the end of the oxygen therapy phase [mean postnatal age 185 (60-361) days]. They included 10 mothers and 10 fathers, aged 33.5+/-0.5 and 37+/-0.2 years, respectively. RESULTS: Our results indicate that these parents present an increased state anxiety level upon hospital discharge of their oxygen-dependent premature infants, which decreases as the improvement of respiratory status and the cessation of oxygen-dependency become evident [mean+/-S.D. related to age (T) maternal values 47.1+/-7.0, 41.8+/-5.6, 39.1+/-4.7, respectively; mean+/-S.D. related to age (T) paternal values 42.2+/-8.5, 41.1+/-8.1, 40.5+/-8.2, respectively]. When assessed separately by parental gender, in the maternal group, state anxiety decreased significantly (ANOVA, p<0.05). CONCLUSIONS: These data indicate that although neonatologists generally define the discharge of prematures with chronic lung disease based upon the acquired stabilization of vital parameters, in the oxygen-dependent group, they should also pay special attention to the emotional support of the parents who we have identified as being at increased risk for pre-discharge anxiety.

Brain auditory activation measured by near-infrared spectroscopy (NIRS) in neonates.

This study presents a new measure of the hemodynamic changes to an auditory stimulus in newborns. Nineteen newborns born at 28-41 wk and aged 1 to 49 d were studied in waking and/or sleeping state, for a median time of 4 min 40 s before, 2 min 40 s during, and 3 min 5 s after an acustic stimulus (tonal sweep of frequency increasing from 2 to 4 kHz, intensity 90 dB SPL) originating 5 cm from the external auditory meatus. The emitter and detector optodes were placed over the left or right temporal region, corresponding to T3 or T4 EEG electrodes. The concentration changes in cerebral chromophores Delta[HbO2], Delta[Hb] and Deltaoxidized-reduced cytochrome aa(3) were recorded every 5 s. Changes in cerebral blood volume were calculated from the changes in total Hb x 0.89/large vessel Hb concentration. Increased oxyhemoglobin, Delta[HbO2], total Hb, Delta[Hb (sum)], and cerebral blood volume, DeltaCBV, were found in 13/19 neonates, with the exception of a neonate who only had increased in Delta[Hb], Delta[Hb (sum)] and DeltaCBV. During the stimulation phase there was a significant increase in DeltaCBV (t test, p = 0.00006) in the responsive newborns from a mean value of 0.006 (+/-0.02) mL/100 g in the pretest phase to 0.09 (+/-0.06) mL/100 g during the auditory stimulus. After the test DeltaCBV decreased to 0.04 (+/-0.07) mL/100 g (t test, p = 0.01), so did Delta[Hb (sum)] (p = 0.02). Hemodynamic responses of the subjects who showed increases in Delta[Hb (sum)] and Delta[HbO(2)] were analyzed to study the Delta[Hb]. The responder subjects could be classified into two groups according to Delta[Hb] changes: 8/13 (61.5%) showed an increase of Delta[Hb] (pattern A), while 5/13 (38.4%) showed a decrease (pattern B) (t test, p = 0.03). These two patterns did not show differences related to Delta[HbO(2)] and Delta[Hb (sum)]. The DeltaCBV changes in nonresponders presented a decrease during the test phase (t test, p = 0.04). CBV did not return to pretest values, suggesting a fronto-temporal brain pathway for storing unusual sounds. The increase in CBV followed the local increase in oxyhemoglobin and total Hb concentrations due to a greater use of oxygen in the homolateral temporal cortex of the newborns.

Effect of postpartum anxiety on the colostral milk beta-endorphin concentrations of breastfeeding mothers.

Peripartal maternal apprehension and anxiety are associated with abnormal labour, dystocia and higher rates of fetal and maternal morbidity. Since colostral beta-endorphin (beta-EP) concentrations are twofold higher than circulating levels, we hypothesised that substantial maternal emotional distress in puerperium might induce consistent changes in colostral beta endorphin galactopoiesis. To test this hypothesis, we assessed the effects of postpartum maternal anxiety (State-Trait Anxiety Inventory-Y form, Spielberger CD, Palo Alto, CA, USA, 1983) on colostral milk beta-EP levels (beta-endorphin 125I RIA, INCSTAR Corporation-Stillwater, Minnesota, USA) in a population of healthy lactating mothers, on the fourth postpartum discharge day, 14 after at term vaginal delivery, 14 after premature (> or = 34 <37 gestational weeks) vaginal delivery, and 14 after elective cesarean section. The colostral milk beta-EP concentrations of mothers who vaginally delivered at term or prematurely were significantly higher on the fourth postpartum day (6.0+/-0.5 and 6.6+/-0.7 vs. 4.3+/-0.4 pmol/l, respectively; P <0.05) than colostral levels of mothers who underwent caesarean section. At the same time, while trait anxiety levels (T, age corrected values) were unaffected by route and mode of delivery, in mothers presenting increased colostral milk beta-EP galactopoiesis after vaginal delivery there was a statistically significant negative correlation (r-0.40; P <0.03) between colostral milk beta-EP concentrations and trait anxiety levels. These data indicate that the labour pain and the vaginal delivery process play a central role in increasing colostral opioid availability for the breastfed neonate; peripartal maternal anxiety is a negative psychobiological determinant in opioid galactopoiesis, and possibly in the postnatal development of several related biological functions of growing infants.

Is the CRIB score (clinical risk index for babies) a valid tool in predicting neurodevelopmental outcome inExtremely low birth weight infants?

The study aimed to assess how well the severity of clinical conditions in extremely low birth weight infants in the first 12 h of life, as measured by the CRIB (clinical risk index for babies), relates to hospital outcome and subsequent disability at 18 months of age. The CRIB was confirmed as a valid index of initial neonatal risk, even in extremely low birth weight infants, predicting hospital outcome (death or major brain lesions) more accurately than birth weight or gestational age. However, an adjustment of the CRIB score for gestational age might enhance its positive predictive value in relation to short-term developmental outcome in this particular population.

[Anxiety and memory in hospitalized adolescents; effect of the projection of a film]. / Ansia e ricordo in adolescenti ricoverati: influenza della proiezione di un film.

The purpose of our study was the evaluation of the effects of a film on the anxiety and memory of cronically ill adolescents (n. 25) versus healthy adolescents (n. 25). The chronic illness was: renal failure, renal transplantation (6 months before), scoliosis and Crohn's disease. The S.T.A.I.-Y test was administered before and after the film to evaluate the state-anxiety before and after the vision, only the trait-anxiety was evaluated before. The state and trait-anxiety was not abnormal, although the state anxiety was increased in the hospitalized adolescents before the vision (mean S.T.A.I.-Y = 43.2) and was decreasing (mean S.T.A.I.-Y = 37.32) after it. This result confirms the needs of a global paediatric health-care in order to minimise psychosocial traumas, associated with hospitalisation. The second goal of our research was the mood and memory correlation and the mood-congruency. We administered two memory tests (free and guided) using a recorder and a questionnaire. Our study presents a better free-memory in healthy subjects (16.6% vs. 5.16% in the hospitalized adolescents) and a better guided-memory in the healthy subjects (13.7% vs. 7.08% in the hospitalized adolescents). Our results can't confirm the mood-congruency theory, although the study conclusion is concerning a general decreasing of memory competence, following the repeated hospital admissions and the chronic illness.

Level of anxiety in parents of high-risk premature twins.

We attempted to define parental anxiety in a population of parents of high-risk premature twins (mean birth weight 1,493 +/- 227 kg; mean gestational age 33 +/- 3.5 weeks), admitted to III level NICU. We specifically examined the following factors; gestational age of the twins, whether or not the twins had ventilatory support, pulmonary sequelae, major malformations or intra-ventricular hemorrhage, parental gender and highest level of education obtained by the parent. In the immediate pre-discharge period and a month later, a questionnaire (State-Trait Anxiety Inventory) was given to all parents of premature twins presenting for the discharge. The parents of 30 twins entered the study twice, at the discharge of their first twin (mean postnatal age 40 +/- 32 days), and one month later. They included 15 mothers and 11 fathers, aged 33 +/- 5.5 and 33 +/- 4.2 years, and at the second evaluation 11 mothers and 10 fathers, respectively. As case-controls we examined parental anxiety of fifteen consecutive singleton high-risk prematures, with equal gestational age, discharged immediately after. Our results indicate that the parents of high-risk twin and singleton prematures present an elevated, lasting state-trait anxiety level. Pre- and post-discharge parental anxiety is more elevated (not significant) in twinning with respect to the prematurity alone. When assessed separately by parental gender, in both these groups an increased (not significant) anxiety was persistently found in the mothers. We recommend that, although neonatologists generally define the discharge of the high-risk premature based upon the acquired stabilization of vital parameters, they pay special attention to the twin group we have identified which is at increased risk for predischarge parental anxiety.

[Study of the reliability of a parenteral questionnaire used in a pediatric follow-up of 18-month-old children]. / Studio di validazione di un questionario ai genitori di bambini con età intorno ai 18 mesi utilizzato nei follow-up pediatrici.

We are conducting a validation study of questionnaire to the parents according to the Griffiths Mental Developmental Scale, used in pediatric follow-up of obstetric studies among the Italian population. The questionnaire concerns the child's gross and fine motor and language development, swallowing, respiratory, hearing and vision problems, and hospital admissions within the first 18 months of life. The purpose of this study is to examine the degree of agreement between parental and professional assessment of normal and high-risk infants development at 18 months of life.

[Follow-up of the preterm child at 1 year of correct age: assessment of development risk]. / Follow-up del bambino nato pretermine a 1 anno di età corretta: valutazione del rischio di sviluppo.

Longitudinal follow-up of preterm neonates after discharge from Intensive Care satisfies the family's need for support and ensures an ongoing link with the hospital concerned, but must be based on a specific, sensitive and predictive screening program. We report a prospective cohort study in a tertiary neonatal intensive care unit (NICU) using the Perinatal Risk Inventory (PERI)1, at discharge. Of 87 consecutive newborn referred to the tertiary NICU at the Pediatrics Department of Padua University in 1993 (gestational age > or = 25 weeks, weight at birth < 1500 g), 65 (75%) survived: 54 cases complied with the Fitzhardinge '80 criteria and were followed up to at least 1 year (corrected age). A further 18 neonates with neonatal cerebral problems were also considered. The PERI at discharge was combined with neonatological and neuro-evolutional evaluation and examination of neuro-sensorial development indicators at the corrected ages of 0, 3, 6 and 12 months. PERI scores were: < or = 7 in 36; 8-11 in 22; > 11 in 14. The cut off point at 7 to 11 increases the sensitivity, the specificity and the predictive values of the test. At 1 year (corrected age), 6 patients (8.3%) had a diagnosis of spastic diplegia and 2 (2.7%) had spastic hemiplegia. The relative risk of cerebral paralysis was 4.5 in the neonates with IVH 4 degrees, odds ratio 6.7, and 3.6 in the 16 patients with bronchopulmonary dysplasia (BPD), odds ratio 4.7. 72 patients were selected for follow-up by the Fitzhardinge '80 criteria, whereas with the PERI (cut off point 7) only 44 neonates would have been selected. This confirms the need for new criteria in recruiting preterm neonates for longitudinal follow-up to quantify neurological risks, particularly in view of the socioeconomic impact of the problem.