The error in neonatal intensive care: a multicenter prospective study.

AIM: During a nursing conference of the Northeaster Piedmont Neonatal Intensive and Subintensive Neonatal Units the error in pediatrics and neonatology was discussed and a follow-up work was proposed with the aim to understand how many, what type of errors and what kind of adverse event they cause in our clinical practice. METHODS: Through an anonymous "detection sheet" we detected the errors made between March 1 and April 30, 2010 in a NICU and 2 Subintensive therapies. The total number of patients was 166 for 2398 days of hospitalization. RESULTS: The total number of errors was 72, with a error of 0.43/patient. Forty-six patients had experienced at least 1 error (28% of patients) and more than a 16 (10% of our patients). There is a statistically significant correlation between days of hospitalization and the number of errors occurred (r=0.63 Sperman's correlation, P<0.01); 48% and 53% of the errors in the NICU and Subintensive CU were related to medication administration. CONCLUSION: The severe damage in the NICU was caused by errors more frequently related to vascular access while the only mistake that led to a serious incident in subintensive CU was determined by a monitoring error. Errors were most frequently attributed to inattention-distraction, less frequently have been attributed to a lack of experience or a state of excessive fatigue. The data of our study were made available to all staff in order to make operators more aware of the importance of working safely.

Dietary macronutrient intake during the first 10 years of life in a cohort of Italian children.

OBJECTIVE: To describe the longitudinal pattern of dietary energy and macronutrient intakes during the first 10 years of life in a sample of healthy Italian children. PATIENTS AND METHODS: Sixty-one healthy children were followed from birth to 10 years of age. At 1, 5, 8, and 10 years of age, anthropometric measurements were taken and nutritional habits evaluated using a standardized food frequency questionnaire. RESULTS: Compared to the Italian recommended dietary allowances, the children's diet was high in protein at any age, high in lipids from age 5 onward, and high in calories at 5 years of age. At 1 year, mean (SD) protein, carbohydrate, and lipid intake, expressed as percentage of total energy, was 20% (3%), 48% (7%), and 34% (5%), respectively. Afterward, the corresponding mean value ranged around 14% to 15%, 57% to 60%, and 29% to 32%. The mean glycemic load and overall glycemic index ranged around 143 to 150 and 58 to 59, respectively. A difference between boys and girls was found in the longitudinal pattern for the intake of energy (P < 0.0001) and glycemic load (P < 0.0001). The individual longitudinal dietary pattern varied over time for the intake of total energy (P < 0.0001), any macronutrient (P < 0.0001), and overall glycemic index (P = 0.05). CONCLUSIONS: Although the amount of energy intake was in accordance with the Italian recommended dietary allowances, children consumed a high-protein and high-lipid diet. Early and continuous dietary education of children and parents may provide support for adequate nutritional habits throughout their childhood.

[Bilateral periventricular nodular heterotopia in a couple mother-infant]. / Etereotropia nodulare periventricolare biventricolare in una coppia madre-neonato.

Bilateral periventricular nodular heterotopia in a couple mother-infant. Bilateral periventricular nodular heterotopia (BPNH) is a malformation of neuronal migration, recently recognized X-linked. We report a case of BPNH associated with mega-cisterna magna diagnosed by ultrasound imaging at 27 weeks' gestation and confirmed by MR at 11 days of life. Similar findings in the mother's MR underlines the recurrency of this malformation in the same family.

Dietary glycemic load and macronutrient intake in healthy Italian children.

The objective is of this study is to examine the relationship of dietary glycemic load (GL) and overall glycemic index (OGI) with macronutrients intake, body mass index (BMI) and insulin sensitivity in healthy children. The subjects comprised of 105 healthy non-obese eight-years old children, 60 boys and 45 girls. A Food Frequency Questionnaire (FFQ) evaluating dietary habits, GL and OGI. Insulin sensitivity was evaluated by the homeostatic model assessment (HOMA). GL was positively associated with dietary total (correlation coefficient, r=0.57) and starch (r=0.67) carbohydrates, daily consumption of pasta and white bread, cooked potatoes, bakery products and cookies, and negatively with dietary fats (r=-0.52). OGI was positively associated with daily consumption of white bread and cookies, and negatively associated with soluble carbohydrates (r=-0.35), and consumption of fibres, proteins, fruit, legumes and carrots. No significant association was found of GL or OGI with BMI or insulin sensitivity. In healthy children, GL and OGI may represent a useful indicator of quality of diet.

Precision of gestational age assessment in the neonate.

The precision of the Ballard scale for assessing gestational age (GA) was evaluated in a consecutive sample of 227 preterm and/or low-birth-weight neonates. Each newborn was rated independently by two neonatologists and the difference in GA estimation between them was computed. The estimated precision was not high, the 95% tolerance interval estimate being as large as 7.4 weeks. The precision of the neurologic and physical parts of the scale was poorer than that of the complete scale (95% of differences less than 10.5 and 9.2 weeks respectively), and more influenced by the type of delivery. These findings are not unexpected from statistical theory, and cast doubts on the use of only the physical part of the Ballard scale in assessing GA, since greater accuracy could be accompanied by reduced precision.

[Neonatal scrotal hemorrhage caused by post-traumatic hemoperitoneum]. / Emorragia scrotale neonatale da emoperitoneo post-traumatico.

The Authors describe a case of neonatal scrotal hematoma due to post-traumatic intra-abdominal hemorrhage. Differential diagnosis with testicular torsion and other causes of neonatal acute scrotum is considered and discussed.

[Closure of Botallo's ductus arteriosus with indomethacin. Considerations on 4 cases]. / Chiusura del dotto arterioso di Botallo con indometacina. Considerazioni su quattro casi.

Persistence of Patent Ductus Arteriosus (PDA) frequently occurs in preterm infants. In a remarkable number of cases, PDA may undergo spontaneous closure. In other cases, especially in patients with respiratory problems, a ductal left-to-right shunt may compromise the cardiac-respiratory function. Until a few years ago, surgery was the only possible therapy. Recently, pharmacological closure of the duct by means of Indomethacin, a powerful inhibitor of prostaglandin synthesis, was successfully carried out. The medical treatment, however, appears to be less effective if it is carried out on patients older than 2 weeks. It has also been reported that in patient with a very low birthweight and with lack of muscular tissue in the duct wall, closure of the duct may be transient. It is the purpose of this communication to report observations made on 4 preterm infants of 24-33 weeks gestational age, and with a weight range of 660 to 2.280 g. They received Indomethacin via naso-gastric tube, in a single dose of 0,3 mg/Kg, within 8 days of age. Successful closure of the PDA was obtained in all cases. The pharmacological treatment resulted also in reductions in ventilatory support requirements, reduced respiratory component of acidosis, reduced pCO2, increased pO2. A second administrations of Indo was necessary only in one case, and it was followed by permanent closure of the duct. Collateral effects, such as reduced diuresis and reduced number of platelets, were transient. Indo therapy was successful regardless of very low birthweight: in three cases, birthweight was under 1.000 g.(ABSTRACT TRUNCATED AT 250 WORDS)