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Pasteurella multocida is normally present in respiratory and digestive tract of many domestic and wild animals, but is a rare pathogen in neonatal infection. Here we describe for the first time a case of meningitis complicated by status epilepticus and right parietal lobe cerebritis. The patient showed a dramatic clinical onset characterized by septic appearance and prolonged seizures. Multidrug anticonvulsivant therapy was used to control the status epilepticus, but despite the aggressive treatment electrical crises were still evident 24 hours after the admission. Furthermore, a brain MRI, performed to investigate a persistent intermittent fever even if CSF became sterile, showed a focus cerebritis in the right parietal lobe, early stage of the cerebral abscess. Prolonged antibiotic therapy with steroids was requested to solve the cerebritis area. Interestingly, direct contact between the patient and domestic animals was denied by the family, but the father reported a contact with a rooster, killed and cooked few days before, suggesting, as previously described, that Pasteurella may also be transmitted through asymptomatic human carrier. The patient had a favourable outcome with no medium-term sequelae one month after discharge, but the severity of the clinical course and the unpredictable way of transmission highlight the importance of hygiene measures approaching infants.

Therapeutic hypothermia (whole body or selective head cooling) is becoming standard of care for brain injury in infants with perinatal hypoxic ischemic encephalopathy (HIE). Brain cooling reduces the rate of apoptosis and early necrosis, reduces cerebral metabolic rate and the release of nitric oxide and free radicals. Animal models of perinatal brain injury show histological and functional improvement due to of early hypothermia. The brain protection depends on the temperature and time delay between insult and beginning of treatment (more effective with cooling to 33 +/- 0.5 degrees C, and less than 6 hours after hypoxic-ischemic insult). Recent meta-analyses and systematic reviews in human neonates show reduction in mortality and long-term neurodevelopmental disability at 12-24 months of age, with more favourable effects in the less severe forms of HIE. The authors describe their experience in 53 term newborns with moderate-severe HIE treated with whole body cooling between 2001 and 2009, and studied with magnetic resonance imaging (MRI) and general movements (GMs) assessment. The creation of a network connecting the Neonatal Intensive Care Unit with the level I-II hospitals of the reference area, as part of regional network, is of paramount importance to enroll potential candidates and to start therapeutic hypothermia within optimal time window.

The frequency of early-onset neonatal sepsis without prophylaxis is 1-5/1.000 live births. Since year '70 the most frequent causative microorganism is the group B Streptococcus (S. agalactiae, GBS), followed by Escherichia coli. The mortality rate is now reduced to 4% due to the improvement of neonatal intensive care. In the USA, the incidence of GBS early-onset neonatal sepsis has been markedly reduced by the application of the guidelines released by the Centers for Disease Control (CDC). This strategy, however, is not effective on occurrence of late-onset neonatal group B streptococcal disease. In Italy, the application of CDC guidelines is not customary, and different, often complex, protocols of obstetrical-neonatological integrated approach are applied. The frequency of infectious risk has made the GBS a paramount problem for the neonatologist, even for the legal responsibility issues resulting from the multiplicity of possible options. To reach the best level of protection of the newborn against early-onset GBS infection, the working group of providers of prenatal, obstetric, and neonatal care of the functional area of Cuneo issued an integrated protocol, in order to perform the GBS screening with the optimal culture method suggested by CDC guidelines in the highest possible number of pregnant women, and to standardize the obstetrical and neonatal management.

Background At the request of the intensive neonatal care unit, in order to give the babies less fluid, we replaced the usual amino acid mixture TPH 6% with Primene 10%. After this change however, a greater frequency of acidosis has been reported from data sourcing from arterial blood gases (ABG) analysis. Purpose To thoroughly investigate the formulation of the two mixtures in order to understand if the cause of acidosis may lie in their different composition. Materials and methods We analysed all ABG data, the compositions of the two products and determined pH and the buffering capacity: 2 ml of glucose 50% (the acid component of total parenteral nutrition) were progressively added to 50 ml of the two products. Results 179 formulations containing Primene were prepared from August to November 2012 for 23 babies. We can identify three groups: 12 babies with birth weight >1500 g (A), 6 babies with birth weight 1000 – 1500 g (B1) and 5 babies with birth weight (A) pH 7.36, Base Excess (BE)-1.20, bicarbonate (HCO 3 ) 23.5 (B1) pH 7.36, BE-2.46, HCO 3 22.24 (B2) pH 7.29, BE-7.33, HCO 3 18 The differences between groups B1/B2 were statistically significant (P in vivo are bicarbonate precursors, responsible for alkaline reserve. Primene doesn’t contain acetate, but a greater amount of chloride ions and acid amino acids (glutamic and aspartic) and a smaller amount of basic amino acids (histidine and arginine). The measurement of the buffering capacity of the products showed the same trend of pH, pointing out a similar buffering capacity in vitro , despite a lower pH at the outset of Primene (5.23 against 5.66). Conclusions We assume that the absence of acetate and the presence of chlorides can lead the formulations containing Primene to have a different buffering capacity in vivo favouring the observed acidosis. The statistical analysis of clinical data highlights a significant difference between newborns (B1) and (B2), which thus have a reduced tolerance to chloride ion loads. From our experience it is not advisable to use Primene in pre-term babies weighing No conflict of interest.

Il contributo si concentra su un’indagine specifica di una rappresentazione femminile, minuziosa innovativa e particolare, tratta dalle Res Gestae di Ammiano Marcellino: questo ritratto viene studiato e interpretato in base alla sua incidenza sulle altre rappresentazioni di donne.