State of the art and recommendations. Kangaroo mother care: application in a high-tech environment.

UNLABELLED: Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow-up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents' role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability. CONCLUSION: Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.

Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care.

UNLABELLED: The hallmark of Kangaroo Mother Care (KMC) is the kangaroo position: the infant is cared for skin-to-skin vertically between the mother's breasts and below her clothes, 24 h/day, with father/substitute(s) participating as KMC providers. Intermittent KMC (for short periods once or a few times per day, for a variable number of days) is commonly employed in high-tech neonatal intensive care units. These two modalities should be regarded as a progressive adaptation of the mother-infant dyad, ideally towards continuous KMC, starting gradually and progressively with intermittent KMC. The other components in KMC are exclusive breastfeeding (ideally) and early discharge in kangaroo position with strict follow-up. Current evidence allows the following general statements about KMC in affluent and low-income settings: KMC enhances bonding and attachment; reduces maternal postpartum depression symptoms; enhances infant physiologic stability and reduces pain, increases parental sensitivity to infant cues; contributes to the establishment and longer duration of breastfeeding and has positive effects on infant development and infant/parent interaction. Therefore, intrapartum and postnatal care in all types of settings should adhere to a paradigm of nonseparation of infants and their mothers/families. Preterm/low-birth-weight infants should be regarded as extero-gestational foetuses needing skin-to-skin contact to promote maturation. CONCLUSION: Kangaroo Mother Care should begin as soon as possible after birth, be applied as continuous skin-to-skin contact to the extent that this is possible and appropriate and continue for as long as appropriate.

State of the art and recommendations. Kangaroo mother care: application in a high-tech environment.

UNLABELLED: Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low-income settings, the original KMC modelis implemented. This consists of continuous (24 h/day; 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding and, adequate follow up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC modelin all types of settings was discussed at the 7th International Workshop on KMC Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents'role, modification of the NICU environment, performance of care in KMC, and KMCin case of infant instability. CONCLUSION: Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.

Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context.

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six "COVID-19 maternity centres" were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards.

16p11.2 microdeletion syndrome: a case report.

BACKGROUND: The recurrent ∼ 600 kb 16p11.2 microdeletion is among the most commonly known genetic etiologies of autism spectrum disorder, overweightness, and related neurodevelopmental disorders. CASE PRESENTATION: Our patient is a 2-year-old white girl from the first pregnancy of a non-consanguineous healthy young white couple (father 33-years old and mother 29-years old). Our patient and her parents' DNA were analyzed by comparative genomic hybridization-array platform. Comparative genomic hybridization-array analysis highlighted a ∼ 600 kb deletion in 16p11.2 region. It has a segregant nature, since it was found in the mother and in her 2-year-old daughter. The microdeletion was confirmed by fluorescence in situ hybridization analysis. CONCLUSIONS: The presented clinical case is worthy of note since the observed microdeletion is often associated with a clinical phenotype tending to overweightness, but the proband (female) was hospitalized due to poor height and weight development, and anorexia. Moreover, the segregant nature of the observed genomic abnormality has to be noted, as well as the phenotypic variability between the mother and daughter. The case described here enriches the phenotypical spectrum linked to the 16p11.2 microdeletion. For these reasons, in the presence of a suspected genetic pathology it is fundamental to study the proband from the clinical point of view, to extend the clinical observation to the parents, and to provide a good family anamnesis. In this way, it is possible to reveal the presence of a familial genetic pathology whose phenotypical outcomes can be highly variable among the members of a family.

Nipple care, sore nipples, and breastfeeding: a randomized trial.

Sore and cracked nipples are common and may represent an obstacle to successful breastfeeding. In Italy, it is customary for health professionals to prescribe some type of ointment to prevent or treat sore and cracked nipples. The efficacy of these ointments is insufficiently documented. The incidence of sore and cracked nipples was compared between mothers given routine nipple care, including an ointment (control group), and mothers instructed to avoid the use of nipple creams and other products (intervention group). Breastfeeding duration was also compared between the two groups. Eligible mothers were randomly assigned, after informed consent, to one of the two groups. No difference was found between the control (n = 96) and the intervention group (n = 123) in the incidence of sore and cracked nipples and in breastfeeding duration. However, several factors were associated with sore nipples and with breastfeeding duration. The use of a pacifier and of a feeding bottle in the hospital were both associated with sore nipples at discharge (p = 0.02 and p = 0.03, respectively). Full breastfeeding up to 4 months postpartum was significantly associated with the following early practices: breastfeeding on demand, rooming-in at least 20 hours/day, non-use of formula and pacifier, no test-weighing at each breastfeed. The incidence of sore and cracked nipples and the duration of breastfeeding were not influenced by the use of a nipple ointment. Other interventions, such as providing the mother with guidance and support on positioning and latching, and modifications of hospital practices may be more effective in reducing nipple problems.

Congenital syphilis in Mocambique: the diagnostic complementary role of laboratory and radiological investigations.

Congenital syphilis has been and continues to be a principal public health problem in developing countries. Despite the wide experience acquired, physicians still have problems in diagnostic evaluation. We report 88 cases of congenital syphilis at Central Hospital of Maputo (Mocambique), emphasizing the role of serological and roentgenographic examinations, the 2 commonest diagnostic tools. X-ray examination was particularly important to confirm the diagnosis of congenital syphilis in 76.2 percent of sero-positive children and to sustain the diagnosis in another subgroup of seronegative children (4.5 percent). Periostitis was a constant finding in all positive x-ray examinations and was associated with osteochondritis in 47.7 percent and with osteomyelitis in 18.2 percent of cases. Serologic test for syphilis was positive in 95.4 percent of the study population and was essential to make the diagnosis in 19.3 percent of cases with negative x-rays examination. So, laboratory and, in a complementary way, roentgenographic findings allow to confirm the diagnosis of congenital syphilis in 100 percent of cases. Serological test in the mother is a useful examination as well, with a high percentage of positivity (78.4 percent); however in accordance to the present study it fails to add any new case of congenital syphilis already detected by serological and roentgenographic examination in the child.

[Diffuse neonatal hemangiomatosis: rapid clinical response to treatment with steroids]. / Emangiomatosi neonatale diffusa: rapida risposta clinica al trattamento steroideo.

A case of diffuse neonatal hemangiomatosis is reported with efficacy of steroid treatment and favourable outcome.

Infantile hypertrophic pyloric stenosis and cow's milk intolerance.

Two cases of infantile hypertrophic pyloric stenosis in infants who were exclusively breastfed are reported. In both cases dietetic management succeeded in avoiding surgery. In one case human milk was substituted with casein hydrolysate formula, while in the other cow's milk was excluded from the diet of the mother. A possible casual relationship between cow's milk intolerance and infantile hypertrophic pyloric stenosis is discussed.

[Hypertrophic stenosis of the pylorus. Correlations with allergy to milk proteins and atopy]. / Stenosi ipertrofica del piloro. Correlazioni con l'allergia alle proteine del latte e con l'atopia.

We performed a study concerning the relationship between hypertrophic pyloric stenosis (HPS), atopy and cow's milk protein allergy (CMPA). Familial history of atopy was documented in 17 (44.7%) of 38 infants having undergone Ramstedt pyloromyotomy for HPS, in 12 (23%) of 52 infants having undergone surgery for inguinal hernia and in 53 (26.9%) of 290 normal controls (significant differences between HPS and other groups). Moreover 9 (23.6%) of 38 infants with HPS presented personal history of eczema at follow-up compared with 3 (5.7%) infants having undergone surgery for inguinal hernia (p less than 0.01). A significant difference between HPS and other groups was also found when looking for familial history of CMPA: 26.3% vs % and 2.5% respectively (p less than 0.001). Eventually we discovered a higher than expected incidence of CMPA both in a retrospectively evaluated group of HPS and in 24 infants undergone Ramstedt pyloromyotomy and followed according to a standardized protocol for a mean period of 4 months (16.6%). The etiology of HPS remains obscure. Our data however suggest some relationship between HPS, atopy and particularly CMPA.

[Practical strategies for promoting breastfeeding in neonatal intensive care]. / Strategie pratiche di promozione del latte materno in TIN.

Strategies for promoting the use of human milk in NICU Human milk has several advantages in the nutrition of very-low-birthweight (VLBW) and high risk infants admitted to neonatal intensive care unit (NICU). Limited data available demonstrate that at discharge from NICU breastfeeding rate is relatively low. In a recent italian study (Davanzo R et aL; Pediatric and Perinatal Epidemiology 2009) only 30.5% of VLBW infants were exclusively breast fed and among the exclusively breastfed infants only 10% sucked directly at the breast. Strategies to promote breastfeeding and the use of human milk in NICUs are needed. They are well known, yet limitedly applied. Among them current literature lists: (1) access at anytime for both parents to NICU; (2) specific knowledge of the science of lactation and multidisciplinary breastfeeding training as provided by the Baby Friendly Hospital Training package; (3) peer support in hospital; (4) kangaroo mother care; (5) breastmilk expression using simultaneous pumping with an electric pump particularly in the first 2 weeks. On the contrary, pharmaceutical galactagogues and cup feeding have little benefit.

Recomendações para a implementação do cuidado mãe canguru para bebês de baixo peso ao nascer / Recommendations for the implementation of Kangaroo Mother Care for low birthweight infants

A boa qualidade da atenção ao recém-nascido de baixo peso pode reduzir a mortalidade neonatal em países de baixa renda, mas as tecnologias usadas nos países ricos são inapropriadas...

Are data on the prevalence and duration of breastfeeding reliable? The case of Italy.

Many countries produce data on the prevalence and duration of breastfeeding, but are they reliable? We reviewed 16 studies on breastfeeding in Italy published after 1990. They report a prevalence of breastfeeding at and around birth ranging from 66% to 91%, decreasing to 17-52% at 4 mo and 28-36% at 6 mo. Most studies refer to a non-representative sample of the Italian population. Two studies used standard definitions of breastfeeding, but their results are difficult to interpret or cannot be generalized. Five other studies used non-standard definitions that undermine the interpretation of results. The remaining nine studies used no definition at all. All studies used a recall period different from 24 h, or from the whole hospital stay for breastfeeding at discharge, making the interpretation of results even more difficult. We conclude that the published information gives an inaccurate picture of the prevalence and duration of breastfeeding in Italy, leading to unjustified optimism and inaction. The actual figures may be lower, as shown by preliminary data from a small Italian region: using standard definitions and methods during a 9-mo monitoring period, exclusive breastfeeding averaged 35% at discharge and 23% at about 4 mo of age.

Recommendations for the implementation of Kangaroo Mother Care for low birthweight infants. International Network on Kangaroo Mother Care.

Good quality care of low birthweight infants could reduce neonatal mortality in low-income countries, but the technologies used in rich countries are inappropriate. Kangaroo Mother Care does not need expensive and sophisticated equipment, and for its simplicity it can be applied almost everywhere, including peripheral maternity units of very low-income countries. Kangaroo Mother Care (KMC) can also contribute to the humanization of neonatal care and to better bonding between mother and baby in both poor and rich countries. A group of health professionals with experience in KMC met in a workshop to discuss its effectiveness, safety, applicability and acceptability in different settings: from first and second level maternity units in settings with very limited resources, to second and third level units in settings with limited resources, to second and third level maternity and neonatal care units in settings with ample resources and infant mortality rates <15/1000. The paper summarizes the recommendations of this group of health professionals for the implementation of KMC in these various settings, together with suggested research priorities.

Neonatal and post-neonatal onset of early congenital syphilis: a report from Mozambique.

Congenital syphilis (CS) has been and continues to be a principal public health problem in developing countries. Despite the wide experience acquired, physicians still have problems in diagnostic evaluation. We report 145 cases of CS at the Central Hospital, Maputo, emphasizing the differences in clinical features and in the results of serological and X-ray examinations between the neonatal and post-neonatal age groups. In the post-neonatal age group, the clinical expression of CS is mostly overt. It is commonly recognized that manifestations of CS in the neonatal age group are often poor or negative, yet a relevant percentage of CS that we report were fully symptomatic. In the neonatal age, the Venereal Disease Research Laboratory (VDRL) test in the mother and characteristic osteochondritic lesions on X-ray examination of the long bones help to make the diagnosis; in the post-neonatal age group, the VDRL test in the child is more often positive than in the mother and X-ray examination shows most periostitic lesions.

PIP: Even though congenital syphilis (CS) has been and remains a key public health problem in developing countries, physicians continue to have trouble diagnosing it. Experience with 145 cases of CS reported over the period May 1989-May 1990 at the Central Hospital in Maputo are discussed with particular emphasis and attention given to differences in clinical features and in the results of serological and X-ray examinations between neonatal and post-neonatal age groups. 51% of the newborns were diagnosed with CS on the basis of clinical features of systemic congenital infection; the diagnosis of remaining cases was based upon history or isolated and nonspecific signs such as fever, low birth weight for gestational age, or skin lesions. Condition characteristics were mostly overtly expressed among the post- neonates. While it may be commonly recognized that manifestations of CS among neonates tend to be poor or negative, analysis of the data found a relevant percentage of subjects to be fully symptomatic. The Venereal Disease Research Laboratory (VDRL) test in the mother and characteristic osteochondritic lesions on X-ray examination of the long bones help make the diagnosis at neonatal age. Among post-neonates, the VDRL test in the child is more often positive than in the mother and X-rays show most periostitic lesions.

Social class, prenatal care, maternal age and parity: a study of their interrelation in six Italian centres.

"Multiple Correspondence Analysis was used to describe the complex structure formed by those sociodemographic variables, whose association with the occurrence of prenatal and neonatal deaths and diseases has been most frequently stressed in literature: social class, prenatal care, maternal age and parity. The study regards 41,537 women included in a multicentre survey of perinatal preventive medicine, which was carried out, between 1973 and 1979, in six Italian centres...." It is found that "in all centres there are distinct groups of women characterized by a set of unfavourable factors closely interrelated: low social class implies lower prenatal care, higher occurrence of precocious or belated childbearing and higher number of pregnancies, often unintended." (SUMMARY IN FRE AND ITA)

Smoking habit in pregnancy and sociodemographic background in six Italian centres.

Studies carried out in foreign countries (US and UK, mainly) indicate that maternal characteristics, such as age, parity, social class, and prenatal care, are related to child's growth, mortality, and morbidity, as well as to cigarette smoking. These characteristics may act as confounding variables in the analysis of the effects of maternal smoking on babies in fetal and neonatal periods. Until now there has been a lack of information on the subject, because even the most recent available data concern women over age 14 regardless of obstetric history. This paper deals with smoking habits, before and during pregnancy, of 37,664 women included in a multicenter survey of perinatal preventive medicine (MPPI), which was performed in 6 Italian centres (Trieste, Milan, Parma, Rome, Naples, Bari) between 1973 and 1979, with the financial support of the Italian National Research Council. The results of the MPPI and other surveys are compared and the association between maternal smoking habits and sociodemographic background is investigated by multiple correspondence analysis. As to Italy, unlike UK and US, in the 1970s women of high social status show the highest prevalence of the smoking habit. Moreover, in pregnancy, the large majority gives up smoking, or at least reduces it, mainly in high socioeconomic levels, so that the proportion of pregnant women who keep on smoking over 10 cigaretts per day is very low (0.5-3.8%) and poorly related to sociodemographic factors. Therefore, it seems unlikely that these may exert serious confounding effects on the relationships between smoking in pregnancy and perinatal outcome.