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Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

It has been long time since “traditional” risk factors for cardiovascular diseases (familial history, smoking habit, diabetes, dyslipidemia, arterial hypertension, ageing, and gender) have been recognized. They are used to provide risk charts to predict the onset of a fatal or non-fatal cardiovascular event (myocardial infarction or stroke) in the next ten years. However, this approach does not explain why a minority of subjects who are not affected by the above mentioned risk factors suffer from heart attack or stroke. Hence, in order to explain these exceptions, researchers have made their efforts to identify other new and previously unmentioned predisposing causes. Prematurity at birth and intrauterine growth restriction, expressed as low birth weight, have been recognized as belonging to these. The aims of this review are to explain the reasons of this recently reported association as well as cite the most recent scientific evidences supporting this theory.

Introduction: Late-preterm infants are physiologically and metabolically immature and have important risk of morbidity and mortality. Aim: To analyze the incidence of late prematurity and its associated morbidity and mortality at a level III hospital between 2011 and 2013. Methods: This was a descriptive and retrospective study of infants born between 34 + 0/7 and 36 + 6/7 weeks’ gestation and its associated morbidity and mortality. Medical records were reviewed. Results: In a 3-year period there were 8,458 births of witch 513 (6.1%) were late-preterm infants. Of these, 99/513 (19.3%) had 34 weeks’ gestation, 145/513 (28.3%) had 35 weeks’ gestation and 269/513 (52.4%) had 36 weeks’ gestation. Late-preterm birth rate was 5.7% in 2011, 6.9% in 2012 and 5.6% in 2013 (p = 0.08). In relation to birth weight, 269 (52.4%) of late-preterm infants had low birth weight. There was an association between gestational age and birth weight (p = 0.002). Of the 513 late-preterm infants, 177 (34.5%) were admitted to the Neonatal Intensive Care Unit (NICU) and more often at 34 weeks’ gestation (69/99, 69.7%) than at 35 (57/145, 39.3%) and 36 (51/269, 19.0%) weeks’ gestation (p < 0.001). Most frequent clinical diagnoses were hyperbilirubinemia (112/177, 63.3%), feeding difficulties (111/177, 62.7%), transient tachypnea of the newborn (71/177, 40.1%), hypoglycemia (38/177, 21.5%), intrauterine growth restriction (33/177, 18.6%). Average length of hospitalization was 12 days. Newborns of 34 weeks’ gestation were longer admitted than newborns of 35 and 36 weeks’ gestation (15.3 vs 9.8 vs 10.8 days; p = 0.002). There was one death due to sepsis after surgical correction of gastroschisis. Conclusion: The incidence of late-preterm birth remained stable between 2011 and 2013. Late-preterm hospitalization rate in the NICU was 34.5%. Hyperbilirubinemia, feeding difficulties and respiratory disease were the main diagnosis. Late-preterm of 34 weeks’ gestation were admitted more frequently and for longer periods than the remaining newborns. It’s important to pay particular attention to this group of infants.

Background: Multiple pregnancies have increased significantly over the past decades. Birth weight discordance (BWD) is a common problem between twins, but its association with an increased morbidity and mortality is still unclear. The aim of this study was to determine the frequency of BWD among twins and to evaluate its impact on perinatal morbidity. Methods: Retrospective study of 1,132 twins born in a tertiary perinatal center, over a period of 8 years (2003-2010), that were divided in two groups: concordant (intrapair birth weight difference ≤ 20%) or discordant (> 20%). The two groups were compared in terms of epidemiological and obstetric data, mode of delivery, perinatal morbidity and mortality. Results: During the study period, multiple gestation occurred in 2% of cases, of which 96% were twins. BWD was found in 212 (19%) twins. Multivariate analysis demonstrated that maternal age ≥ 35 years and hypoxic-ischemic placental infarction were risk factors for the occurrence of BWD. The discordant group showed a significantly higher incidence of congenital skeletal and central nervous system malformations, a higher rate of hospitalization in the neonatal intensive care unit and a longer duration of hospitalization. The percentage of those requiring assisted ventilation, pulmonary surfactant, parenteral nutrition and central venous catheters was significantly higher in the discordant group compared with the concordant one. The rate of stillbirth was significantly higher in the discordant group (3% versus 1%); mortality was also higher (3% versus 2%), but this difference was not statistically significant (p = 0.405). Conclusion: BWD was associated with increased prenatal mortality and neonatal morbidity. Diagnosis and management of pregnant women with this fetal condition in tertiary perinatal centers may improve the prognosis of these infants.

Aim: Italy is experiencing a continuous increase in female immigration and, as a consequence, the number of births by immigrant mothers. The objective of our study was therefore to compare indices for maternal-foetal wellbeing as regards immigrant as opposed to autochthonous pregnant women., Methods: An analysis was made of CEDAP data from 2001 to 2008 concerning parturients at Udine Obstetric and Gynaecological Clinic, DRG clinical data for 2008 and clinical records for 2008 of foreign parturients: the focus was on which geographical area they came from, hypertensive and metabolic symptoms during pregnancy, maternal serology, gestational period up to childbirth, weight at birth, Apgar index, duration of hospitalisation for the mother and infant., Results: The study covered 13,352 women of whom 2,139 were foreigners, while 363 of the latter gave birth in 2008. In terms of geographical area the largest group of immigrants came from Eastern Europe, followed by sub-Saharan African and Arab countries. The worst outcome of pregnancy was found in African women, who showed the highest incidence of chronic hypertension, pregnancy-induced hypertension and pre-eclampsia and they also developed gestational diabetes more frequently, although a high incidence was also seen for Eastern European and Arab women. Furthermore, African women were found to be HIV-seropositive more frequently, showed a greater tendency to preterm or severely preterm birth, with a significantly lower weight and Apgar at birth compared to all other immigrant women. As a result, African women and infants remained in hospital for a longer period., Conclusion: Monitoring, both pre-conceptional and during pregnancy, needs to be intensified, especially among African mothers, in order to reduce the maternal-foetal disadvantage when compared to other women.

Macrosomic infants (birth weight >4000 g) show increased risk for shoulder dystocia and associated injuries, hypoglycemia and respiratory distress. Higher risk is directly related to neonatal birth weight. High birth weight is also associated with increased risk of developing metabolic syndrome later in life. However the relation between birth weight and later-life metabolic syndrome in not linear, but "U" shaped.

Background: Adulthood antecedents of hypertension may be early detected since childhood. The aims of our research were: a) to identify the prevalence of pediatric hypertension (blood pressure >95th percentile according to previous Italian standards) in Sardinia and its local distribution (urban areas vs rural lands), and b) to detect the risk factors of high blood pressure., Methods: 839 adolescents were enrolled and their blood pressure, height, and weight were measured repeatedly over a 3-year period. A questionnaire was distributed to the patients in order to identify the risk factors of their high blood pressure as well., Results: Hypertensive subjects were 9.4% of the study sample. Isolated systolic hypertension was the most common type of hypertension (4.6%). Hypertensive males were more frequent in rural lands than in urban areas. Borderline subjects (blood pressure between 90th-95th percentile) were 10.3%. Among risk factors, a statistical significant relationship was found with overweight/obesity on the basis of body mass index (p <0.001), diet (p < 0.01), low weight at birth (p < 0.01), familial hypertension (p < 0.05), sedentary life (p < 0.05)., Conclusions: Pediatric hypertension in Sardinia is more common than generally reported in the literature. The number of borderline subjects is very high as well. Both excessive weight and diet are the main risk factors with respect to an early disposition that may be a fatal outcome in adult life.

Objectives: Aim of the present study was to test the hypothesis that the body composition of small for gestational age preterm infants, assessed at term equivalent age, was different as compared to that of small for gestational age full-term newborns., Methods: Growth parameters and body composition, assessed by means of an air displacement pediatric plethysmography system, was measured in 120 newborns (67 preterm and 53 full-term)., Results: Similar weight was found in preterm and full-term newborns at term equivalent age and at birth, respectively. On the contrary, percentage of total body fat mass was significantly higher in preterm newborns as compared to full-term newborns (14.3 +/- 4.7% vs. 5.7 +/- 3.8% respectively, P < 0.05). In the preterm group gestational age was negatively associated with total fat mass at term equivalent age. CONCLUSIONS. The preterm newborns, especially if born small for gestational age, appear to be at risk for developing an altered body composition, which is a risk factor for the development of the metabolic syndrome in adult life. Preterm infants, born small for gestational age, appear to develop a quantity of fat mass higher than the adipose tissue they would have accumulated if they had completed their intrauterine gestation. The gestational age and the nutritional management in the early postnatal life could play a key role in affecting the body composition in these vulnerable infants.

Obesity is an increasing condition spreading out in all of the world, independently by race, sex and age. Obesity in pregnancy represent a risk condition for both mother and her offspring. All of the studies are observational and show intervention strategies on weight gain improvement during gestational period, a current topic, but still controversial. Our study is based on nutritional dynamic monitoring during pregnancy in order to improve health and wellbeing status of both mother and her offspring, through an early and efficacy prevention.

Objective: To apply two different statistical methods to the live births of Lazio region in the years 2000-2003 and calculate updated estimate of the curves of percentiles of birth weight for gestational age., Design and Setting: The data analysed, including clinical-epidemiological and obstetric-neonatal information, have been extracted from birth certificates for the Italian region of Lazio for the period 2000-2003. Two methods of analysis, previously used in two Italian studies, have been applied. In the first method the observed distribution for each gestational week has been decomposed as a mixture of two normal distributions with homoscedastic components. The percentiles obtained, relative to the estimate of the component with the greater weight, have been then used in a third degree polynomial regression with gestational age as covariate, to estimate the final smoothed values. The second method assumes that, for a fixed gestational age, the position of the percentiles can be obtained as a polynomial function of Normal scores. Initially, for both sexes, the percentiles for every gestational age have been estimated using quantile regressions restricted to windows of three weeks. These have been subsequently smoothed by a polynomial model using the logarithm of the birth weight as the dependent variable and gestational age (up to the third degree), the z-score corresponding to the percentiles observed in the three week windows (up to the second degree), sex and the interaction between sex, gestational age and z-score as independent variables., Results: data relating to 157,335 single live births to Italian women resident in the Lazio region have been analysed. The raw curves of the birth weight percentiles for the preterm babies are very irregular for the more extreme percentiles because of the very low number of deliveries of live pre-term babies. The two methods have produced similar results. However, the first method was less influenced by extreme and potentially anomalous values. The second method tended to estimate percentiles beyond 41a week of gestation inferior to those of the previous weeks. A comparison has been made with the curves obtained in the two previous Italian studies and the new estimated percentiles tend to be inferior for the very preterm live births., Conclusions: this study has produced new curves of birth weight for gestational age. The analysis has been based on two different techniques, which have produced substantially similar results. For the tenth percentile, our estimates are lower than those obtained in previous studies suggesting a reduction in the late foetal mortality of babies who are not only pre-term but also of low weight. These results could be used in order to define new standards for birth weights in Italy.

Background: Advancements in minimally invasive surgery in newborns have allowed even the most complex neonatal procedures to be approached using these techniques. Other authors have demonstrated its efficacy in the treatment of the esophageal atresia with distal fistula., Methods: We report our experience based on the thoracoscopic repair of esophageal atresia with distal fistula in two newborns. Birth weights were 2.800 g and 2.300 g respectively. The patients were intubated endotracheally and placed in a left prone position. Four trocars were inserted: the first one of 5 mm was positioned in the fifth intercostal space for the camera, the other two of 3 mm were positioned in the fourth intercostal space on the anterior and posterior axillary line respectively for the operative instruments. The last trocar of 3 mm was inserted in the third intercostal space on the anterior axillary line for the lung retractor. CO2 was insufflated at a pressure of 8 mm Hg and a flow of 0.5 L/min. The fistula was first isolated then ligated and cut with scissors. The proximal esophagus was opened and an anastomosis was made over a 6F or 8F nasogastric tube with interrupted 4-0 Vicryl sutures. A tube chest was placed through the lower trocar site with the tip near the anastomosis., Results: These two procedures were free of neither intraoperative nor post-operative complications. Feeding by nasogastric tube was started after a mean of 4 days. Barium swallow made on day 7 demonstrated no leakage and no stenosis of the anastomosis. Total oral feeding was possible after 8 days. Mean hospitalization was 14 days., Conclusion: This initial report shows, as demonstrated by the experience since 1999 by other authors, that the thoracoscopic esophageal repair in the newborns is technically feasible and, thanks to a magnified vision, it allows to abtain a good isolation of the esophagus and of the tracheo-esophageal fistula respecting the anatomical structures. Moreover the advantages are in terms of exposure and esophageal length, avoiding the significant short and long-term morbidity associated with thoracotomy.

Background: The aim of this study was to evaluate the effect of antenatal maternal corticosteroid treatment on the frequency of neonatal outcomes and perinatal infectious morbidity among singleton pregnancies complicated by preterm delivery., Methods: A nonrandomized analysis was performed on 189 neonates of 24-34 weeks' gestation who were born at the Department of Obstetrics and Gynecology, University of Udine, between January 2000 to December 2001. The neonates were subdivided into 3 groups: 1) 143 neonates received 2 doses of corticosteroids in a 24-hour interval and repeated after 10 days; 2) 26 neonates received 2 doses; 3) 20 neonates did not receive any treatment. Data were analysed with the Fisher exact test. p<0.05 was considered significant., Results: The incidence of respiratory distress syndrome (RDS), neonatal mortality and intraventricular hemorrhage was respectively 43.4%, 3.2 % and 6.3 %. The rate of early-onset neonatal sepsis was 4.9% in the 1st group, 3.9% in the 2nd group and 5% in the 3rd group. There were no significant differences in the early-onset neonatal sepsis and the antenatal corticosteroids treatment., Conclusions: The single or the multiple courses of antenatal steroids did not apparently increase neonatal sepsis in patients with preterm delivery.

The authors studied the incidence and the determinants of cesarean section in ASL Naples 4. In addition while they analysed the reliability and completeness of birth certificates in order to verify their accuracy for statistical and epidemiological purposes. The results show an increase of cesarean section higher than national mean (from 1997 to 2000: 44.5-54.9%), rarely justified by real risk conditions. 41.1% of vertex deliveries required cesarean section. The most frequent indications were repeated cesarean section (40.6%) and fetal problems (39.3%) in the multiparous; fetal dystocia (27.8%) and fetal distress (17.1%) in the primiparous. The quality of the compilation of the certificates was unsatisfactory for completeness and reliability. Indeed, 14.9% of 1997 birth certificates and more than 70% in the following years did not reach the epidemiological services of ASL; moreover, the comparison with clinical records proved that 46.9% of presentations resulted abnormal on clinical records were vertex on the birth certificates.

Household and workplace exposure to environmental tobacco smoke (ETS) is associated with various deleterious health effects. We evaluated the health impact of ETS in Italy. We considered only those health conditions for which systematic quantitative reviews were available. We used relative risks from the reviews while data on the proportion of the Italian population exposed to ETS were derived from national statistics or from ad hoc studies. A total of 2.033 newborns per year are of low birth weight (< 2500 grams) in Italy (7.9%) because of maternal exposure to ETS during pregnancy. There are 87 sudden infant deaths (16.9%) due to post natal maternal active smoking. 21.3% of acute respiratory infections during the first two years of life are due to parental smoking (about 77.000 children); 27.000 cases of asthma (9.1%), 48.000 cases of chronic respiratory symptoms, 64.000 cases of middle ear effusions among children and adolescents are due to parental smoking exposure. The annual estimates of mortality from lung cancer and ischemic heart disease due to ETS exposure from the spouse are 221 and 1896, respectively. Workplace exposure is associated with 324 lung cancer deaths and 235 deaths from ischemic heart disease. Although these estimate are based on several assumptions and they have large uncertainties, the results underline the need and the urgency of public health measures to reduce ETS exposure in the household and in the workplaces in Italy.

Early pregnancy is characterized by nausea and vomiting which are the most frequent symptoms and the main reason for consulting the physician. This pathological aspect of pregnancy is not yet completely understood. The main doubts concern the etiology, the differential diagnosis and the management and follow-up of the patients. The question as to how and when to treat the symptom is still open. The purpose of this study is to examine, through a literature review, the problems and the appropriate medical approach regarding the severe cases or hyperemesis.

Background: Epidural analgesia effectively alleviates labor pain. However controversy exists about the effect of epidural analgesia on labor outcome. The aim of this study is to assess the effect of a low concentration local anesthetic (ropivacaine 0.08%) in labor epidural analgesia (LEA) on labor pain relief, on the incidence of cesarean sections and instrumental vaginal deliveries, and on neonatal outcome., Methods: In the period April 1998 - July 2000, 323 women in active labor with live, singleton and in vertex presentation fetuses at term of gestation were included in this prospective study. Women with pre-gestational and/or obstetric diseases or previous caesarean deliveries were excluded. One-hundred and five patients requiring - by written informed consent - LEA were allocated to receive standardised protocol of a low concentration local anesthetic (ropivacaine 0.08%) coadministered with opioid (sufentanil): ropivacaine group. The remaining 239 parturients who didn't require LEA were included in the control group., Results: The demographic characteristics of the two groups were similar; 12 (10.4%) patients receiving LEA delivered by cesarean section, 17 (14.8%) by vacuum extractor whereas 86 (74.8%) had a spontaneous delivery. The risk of cesarean section (adjusted for age, BMI, parity, neonatal weight and gynecologist) resulted lower, even if not significantly, in the ropivacaine group (OR 0.9; 95% IC: 0.6-1.3), while a significant increased instrumental vaginal delivery rate has been reported, although little numbers reduce statistical significance. Neonatal outcome was unaffected by the use of LEA., Conclusions: The conclusion is drawn that a lower concentration of ropivacaine (0.08%) in LEA produces good labor pain relief with no detectable adverse effects on mother and neonate, and without significantly increasing cesarean section rate.

Background: A knowledge of clinical physiognomy in pathologies related to multiple births is indispensable for improving maternal and feto-neonatal prognosis. This study is a contribution to the solution of this problem., Methods: A meta-analysis of data for multiple births at Department B of the Gynecology and Obstetrics Clinic at the University of Turi during the decade 1989-1998 was carried out, focusing on the arrangement and presentation of fetuses, the various types of birth, the gestational age at which birth occurred, the weight of neonates, neonatal mortality and maternal morbidity., Results: Out of 11,523 births, there were a total of 194 (1.68%) multiple births, including 190 sets of twins and 4 triplets. 154 (79.38%) premature births were reported; 20 occurred <32(nd) week (10.29%). There was a high incidence of podalic presentation (26.30%) and shoulder presentation (5.61%) among twins; 202 were delivered using a cesarian section (51.53%) and 190 by vaginal birth (48.47%), of which 172 (90.52%) spontaneously. Surgical birth was an important means of extracting fetuses rapidly from a pathological environment. two hundred and sixty-two neonates (66.84%) were LBW (<2500 g), including 28 (7.14%) VLBW (>1500 g). The perinatal mortality rate was 3.82%. Maternal complications mainly occurred during the placental state, in the immediate postpartum and in puerperio., Conclusions: The authors feel that a more careful medical and social assistance, preventive hospitalisation, early recognition of the risk, constant monitoring for the optimal timing of birth, and lastly, qualified medical assistance during labour (expert gynecologist, trained obstetric staff) with other medical personnel (anesthetist, neonatal specialist) represent winning strategies to solve the problems arising during multiple pregnancies.

Background: Embryo-fetal diseases are the consequence of prenatal (progenetic and metagenetic or environmental) and intranatal (of a traumatic, infective, toxic nature) pathological factors. In multiple pregnancies this complex etiopathogenesis also includes an altered didymous embriogenesis. This study aimed to evaluate the pathologies affecting the fetus in multiple pregnancy, a special biological situation leading to the potential onset of severe fetal and neonatal damage., Methods: The authors studied 205 patients with multiple pregnancies, including 199 bigeminal, 5 trigeminal and 1 quadrigeminal, admitted to the Department B of the Obstetrics and Gynecological Clinic of Turin University between 1989-1999. Possible embyro-fetal damage was examined using a chronological criterion: namely following the development of the multiple fetuses from the zygotic to the neonatal phase., Results: Pregnancies were biamniotic bichorionic in 54% of cases, biamniotic monochorionic in 45% and monochorionic monoamniotic in 1%. There were a total of 154 (79.38%) premature births out of 194 and neonatal birth weight was always SGA (small for gestational age). 66.84% of newborns were LBW (<2500 g) and 7.14% were VLBW (<1500 g). Fetal mortality (2.29%) was higher than early neonatal mortality (1.53%). Perinatal mortality (3.82%) was three times higher than in all neonates from the same period (1.03%)., Conclusions: The severe embryo-fetal and neonatal damage found in multiple pregnancies is a clinical reality that calls for adequate diagnostic and therapeutic measures, and above all specific medical and social prevention to limit maternal pathogenic risks.

Background: To evaluate the influence of maternal education on exceeding and missing weight of newborns in respect to 50th percentile., Design: observational study. Length: five years., Setting: obstetric and Gynecology Division Care. Neonatology Division Care., Subjects and Measurements: 66 male and 57 female newborns having birth weight of around the 50th percentile; missing or exceeding weight was evaluated in respect of the 50th percentile of the relative week of birth. Parents were selected on the basis of the following criteria: mother: age 30-35, BMI before pregnancy 20-25, no habit for smoking or alcohol, first pregnancy, urban living area, no hypertension, normal glucose tolerance, normal thyroid function, regular pregnancy course, Caucasian race, Italian nationality, regularly married; father: BMI 20-25, no habit for smoking or alcohol, urban living area, steady job, just higher, equal or lower education level than wife's. Mothers underwent OGTT, measurement of thyroid function and recording of blood pressure and educational level., Results: No relationship was observed between mother's education and exceeding weight both in male and in female newborns, while negative relationship was found between mother's education and missing weight both in male and in female in respect of the 50th percentile (Linear regression)., Conclusions: Our data show that low maternal education exerts an influence in reducing but not increasing birth weight.

Background: There is a very wide range of genitourinary disorders which can follow vaginal birth, including slight and occasional problems as well as serious disorders which could affect a woman's social and sexual life, for example the effects of dyspareunia on a woman's sexual identity, social marginalization as an inevitable result of symptoms like urinary incontinence, urgency and fecal incontinence. The aim of this study was to identify elements which may be of use in understanding the pathogenetic mechanisms of these disorders., Methods: Three weeks after birth 537 mothers underwent a clinical genitourinary evaluation including: collection of data regarding pregnancy development and birth, genitourinary history (urinary problem data collected in accordance with the proposal of the International Continence Society), an objective genitourinary examination with a PC-test and identification of possible antagonist abdominal-diaphragmatic muscular synergies, instrumental tests in cases of post-partum urinary incontinence., Results: Maternal age at birth, parity, weight before pregnancy and at term, weight increase, gestational age, duration of the second stage of labour, development and characteristics of birth, perineal condition and neonatal weight were the variables considered as risk factors while genuine stress urinary incontinence, urge incontinence, frequency, urgency, dysuria and inability to interrupt urination were the disorders whose dependence on the various risk factors were to be studied. The analysis of the association of the various pairs of variables recorded both positive and negative correlations, whether the population taken was that of all puerperae or that of only primiparae., Conclusions: Maternal age at birth, parity and duration of the second stage of labour, even if not always separable from other co-existing risk conditions, are the main responsible risk factors in the pathogenesis of urination disorders in puerperium. These results once again confirm the fundamental role of birth in the pathogenesis of female pelvic statics anomalies and of the genitourinary disorders which are their most evident chemical demonstration.

Background: Meconium ileus (MI) is a form of neonatal intestinal obstruction due to an abnormal thickened meconium within the terminal ileum. The aim of this retrospective paper is to review our experience with neonates affected from MI treated at our institute over a twenty year period., Methods: This report deals with 23 neonates with MI: 14 newborns had uncomplicated MI due to obstruction of the terminal ileum with meconium pellets, while 9 presented with complications (intestinal atresia, volvulus, pseudocyst, peritonitis)., Results: A water soluble contrast enema (Gastrografin) was attempted in 12 cases with a success rate of 7/12 (58%). The remaining sixteen neonates underwent laparotomy, with 4 treated by resection and primary anastomosis, 7 by enterostomy (chimney or double-barrelled) and 5 managed with T-tube enterostomy. Survival rate was 93% in uncomplicated MI and 67% in complicated forms., Conclusions: On the basis of personal experience the authors suggest that the treatment of choice for uncomplicated MI is Gastrografin enema, with T-tube enterostomy to be reserved for enema failure. The surgical treatment of the complicated forms depends on the intra-abdominal findings; nowadays chimney or double barrelled enterostomy is to be reserved in cases where peritonitis, late diagnosis, prematurity or associated anomalies complicate the disease.

To assess the relationship between birthweight and the child's development at 18 months of age, we sent a postal questionnaire to the parents of 861 singleton children, born in the framework of the Italian Study of Aspirin in Pregnancy, 18 months after delivery. A total of 623 (72.4%) were returned. There were 94 children weighing < 2500-1500 g at birth and 19 < 1500 g. Children with weight and height less than the 10th percentile at 18 months were significantly more frequent in the low birthweight group (p < 0.01). Motor problems were about six times more common in children with birthweight less than 2500 g than in those with birthweight > or = 2500 g (p < 0.001). A larger proportion of children with birthweight < 2500 g than > or = 2500 g had respiratory problems (15% vs 11%, p = ns). Finally admission to hospital was more common in children with birthweight less than 2500 g (p < 0.01). This study confirms the differences in growth and development for children in low and normal birthweight groups.

Objective: Lead crosses the placenta and can cause permanent neurological impairment by prenatal poisoning. Blood lead levels higher than 10 mcgr/dl in children age 1 to 2 years may be toxic. In 1991 the CDC (Centers for Disease Control and Prevention) published "Preventing Lead Poisoning in Young Children" with the new guidelines defining the value of 10 mcgr/dl as the security limit. Since no blood lead levels in childhood have been collected in Italy this study reports blood lead levels in newborns and 4 month old infants in the Piemonte Region., Design: The study was carried out on a random sample of 55 mother-infant couples attending the Mauriziano Hospital in Turin. The cohort was divided into urban versus rural residence. In every subject attending the study lead, ALA-d and Zn-PP were measured on venous blood specimens in three different moments., Results: Even though our study refers to a small population our data were reassuring. The mean lead values found in the cohort in the three different stages were all below 10 mcgr/dl. ALA-d and Zn-PP resulted also in normal ranges. No statistical difference emerged between urban and rural coming subjects., Conclusions: In consideration of the results obtained we cannot confirm the necessity of a general screening programme for lead poisoning in our population. We assert the utility of a selective screening on the basis of a questionnaire as already experimented in some states of the U.S.A.

The Italian distribution of birth weight has been computed using information routinely collected by the Italian Central Institute of Statistics on about 1,150,000 births in the period 1984-1985. Individual records include data on birth weight for single/multiple births for 28th-42nd gestational weeks and for delivery modalities for 23rd-27th gestational weeks, according to sex. This analysis shows, from a large national data-set, distribution of weight at birth from a Southern European population, providing to obstetrics and perinatologists curves of fetal growth more directly representative of the population under their care.

Background: In order to study the risks involved with advanced maternal age, pregnancy and delivery of all the women after forty (n = 551) who attended the Obstetrical and Gynecological Clinic of the Palermo University from January 1, 1981 to December 31, 1990 have been examined., Materials and Methods: A control group, consisting of women aged 21 to 26 (n = 7980) who attended the Clinic during the same time period, was used for comparison. Each group was analysed for the following parameters: pregnancy complications, time and outcome of deliveries, rate and indications for cesarean section, neonatal outcomes., Results and Conclusions: The results show no significant differences in the factors analysed between the two groups observed, except for an increased rate of abortions and Cesarean sections in the study group and an increased rate of premature rupture of membranes in the control group.

The authors report their experience in the Division of Neonatology of the Catholic University of Rome about the choice of milk alimentation and mineral and vitamin supplementation before discharge and during the subsequent follow-up, with particular reference to very low-birthweight preterm infants (< 1500 g). Basing on empirical experiences, the authors emphasize the importance in current practice of post-conceptional age, with special regard to the kind of milk to choose after discharge and the time and terms of the weaning. Furthermore they stress nutritional, immuno-allergic and psychological advantages of human milk before and after hospital discharge, particularly related to the presence of long-chain polyunsaturated fatty acid (LCP), recently known to be essential on retina and brain development in the preterm infant. When breast milk is not available, the authors confirm the efficacy, before discharge, of preterm infant formulas and subsequently of infant formulas and after of follow-up formulas. The authors hope that the directions proposed by the American Academy of Pediatrics in 1983 will be modified in order to recommend cow-milk only after the first year of life of the infant. They finally suggest specific mineral and vitamin supplementations (iron, calcium, phosphorus, fluoride; vitamins K, D, E and folic acid), to be started after hospital discharge.

Fungal pathogens have become increasingly important as causes of mortality and in newborn infants, especially preterm with very law birth weight, admitted to a neonatal intensive care unit. We report here the cases of 26 neonates (19 VLBW) with systemic fungal infections. Average birth weight and gestational age were 1405 +/- 977 g (range 595-4180 g) and 29 +/- 5 weeks (range 24-41 weeks) respectively. 24 newborn infants required endotracheal intubation and mechanical ventilation and 6 were affected by a severe congenital malformation. An umbilical e/o central intravascular catheter was inserted in all infants and each of them received antibiotics (one or more courses). The Candida species isolated were: C. albicans (n. 23; 88.5%), C. parapsilosis (n. 2; 7.6%) and C. glabrata (n. 1; 3.8%). Frequently encountered symptoms and signs in our neonates included: vasomotor instability with peripheral hypoperfusion (92%), gastro-intestinal disturbances (69%), respiratory distress and increasing ventilatory requirements (65%). Other symptoms were less frequent. 20 newborn infants had leucocytosis, 19 thrombocytopenia, 14 presented both signs. Factors found to be frequently associated with fungal infection included: use of broad-spectrum antibiotic therapy, presence of central venous or umbilical artery catheter, endotracheal intubation and mechanical ventilation, surgical abdominal intervention. After antifungal systemic therapy, clinical cure and microbiological eradication were achieved in 81% of cases, only 1 out of 11 deaths was directly attributed to Candida infection. In our experience the association of amphotericin B+ 5 glucytosine proved to be an effective and well-tolerated therapy for the treatment of severe fungal infections in neonates. A high index of suspicion, especially in premature infants (VLBW), a rapid diagnosis and early initiation of antifungal therapy still remain the essential features in treating neonatal fungal infections.

The offspring of the diabetic mother is more significantly affected by RDS (Respiratory Distress Syndrome) than the healthy pregnancy's one in the same conditions. The RDS is one of the most important cause of perinatal morbidity and mortality. The etiology of this syndrome is recognized in the modified carbohydrates metabolism, in the apposite effect of insulin versus the cortisol action, and in the slower adsorption of the alveolar fluid following the Cesarean section. In fact the diabetic mother is frequently submitted to this intervention to end the pregnancy and especially in last years when the CS was of first choice at 35 weeks in the diabetic mothers. Actually the RDS appears in the 13% of the offspring of mothers affected by pregestational diabetes and in the 5% of the offspring of gestational diabetic mothers. Here we refer about the prevalence of RDS in a population of 55 diabetic mothers.

Background: An increasing number of women in childbearing age are submitted to surgical treatment of obesity; for this reason pregnancy represents a frequent event in operated patients., Methods: In this study pregnancy in patients with morbid obesity submitted to jejunoileal bypass (JIB) and gastric bypass (GB) are reviewed from the literature and the analysis of our experience with biliopancreatic diversion (BPD) is reported., Results: In 113 pregnancies after JIB reviewed from the literature, the results seem to be debated either about the course of pregnancy or about maternal and neonatal status. The data of literature concerning the pregnancies following GB are less debated but rather slight. One hundred and fifty-two pregnancies after BPD have a complete documentation concerning maternal conditions, modality of outcome and neonatal situation., Conclusions: Pregnancy occurred in the obese women represents an increased maternal-fetal risk. The excess weight loss, the weight maintenance and the reduced weight changes during pregnancy are an advantage in the operate women who, in any case, need accurate controls of the nutritional status during the whole gestational period. Keeping these cautions pregnancy following surgical treatment of obesity represents an event not only possible but even with less problems than in pregnancy in obese women.

The Authors studied some mortality indices in the neonatal intensive and subintensive care unit of the University of Catania in order to assess the degree of efficiency of perinatal assistance. This Unit is the largest in southeastern Sicily and admits only outborn newborns from the city of Catania, the Catania province and other provinces. Comparison of the 1991-92 and the 1993-94 data revealed a marked reduction in the mortality rate, however this fall was only marginal in newborns of, or under 1,000 g. There was a marked decrease in the mortality rate from respiratory distress, especially in ventilated newborns receiving additional surfactant. Comparison of the data showed that in both study periods the mortality rate was much higher in newborns over 6 hours of life, in those presenting hematic pH values under 7.25 at admission and in those coming from other provinces. These results underline that it is essential for the political authorities to boost neonatal assistance in the delivery room and to ensure adequate transport of distressed newborns.

The purpose of this study is to verify if the increase of renal resistance, along with the consequent reduction of glomerular filtrate, and the activation of renina-angiotensin system, could be attributed to not only neonatal acute hypoxia but to other factors as well. These factors could provoke an increase in renal vascular resistance (R.V.R.), a reduction of renal blood flow (R.B.F.) and renal glomerular filtrate (R.G.F.) condition. These components are present in angiotensin as well as in endothelin (ET1), a potent peptide from vascular endothel with vasoconstricting action and whose secretion increases during hypoxia. The Authors have studied and compared two groups of newborns. The first group of newborns was affected by perinatal asphyxia or hypoxia of variable seriousness. It included 24 newborns with gestational age between 37 and 41 weeks and with a birth weight between 3.200 gms and 3.500 gms. The second, control group, was made of an identical number of newborns of the same gestational age with a weight adequate to the birth age. The dosage of the ET1 was evaluated on the plasma, using the RIA method. The diagnostic criteria for this evaluation included clinical and biohumoral evidence (tab. 1). Between the two groups, group 1 with anoxic syndrome showed the more intense increase of ET1. This increased is due to either an increase value of plasmatic creatinine that is present in normal situations or in physiopathologic role played by the ET1 in course of acute renal failure after asphyxia.

Objectives: During a survey regarding infant health in 7 regions, diffusion and length of time of breast-feeding nowadays in Italy were studied., Materials and Methods: By OMS Epi methodology, 210 children sampled from each area of study and specialized health workers carried out the interviews at home using a specific questionnaire. The mothers were questioned about the length of time they breast fed their child., Results: 76% of mothers said they breastfed, 32% said they did it for less than 3 months and 44% for more. In each area, the percentage of breastfeeding was 70% or more. This percentage changed only if the birth weight was very low or the mothers' instruction was high, but this is probably because the most cultured mothers answered easier they breast fed longer., Discussion: It seems that mothers are pro-breastfeeding and, in each region, just a quarter of them don't practise it. Besides, about half women breastfed for more than 3 months. This study doesn't permit us to know why some women don't breastfeed or why they wean their children too early. For this reason, we need to curry out further studies.

The authors monitored newborns in the Intensive Care Unit and the equipment with culture exams for a period of 6 months in order to evaluate the incidence of microbic infections and eventual clinical manifestations in relation to risk factors and to test the efficacy of the prophylactic and therapeutic measurements adopted. The results evidenced a positivity in the culture exams of 24.4% at the 1st control, 14.3% at the 2nd and no positive results at the 3rd. Only two newborns presented sepsis that was resolved without any consequences. Aimed antimicrobic therapy was begun at the 1st clinical and/or haematochemical sign that could suspect the onset of infection. A careful control of the microbic flora, the use of aimed antibiotic therapy and respect of the hygienic conditions permitted us to obtain an excellent control of the infections the morbidity, mortality, the days of hospitalization and the onset of bacterial resistance.

The alleged connection between fetal magalosomia and the increased risk of maternal and perinatal morbidity justifies the lively discussion that has developed about the management problems caused by a big unborn child. The aim of this study is to offer a contribution to the definition of the more or less peculiar problems associated with labour and delivery in a pregnant women with a megalosomic fetus. The study was retrospectively carried out on a sample of 45 women who, during the period 1190-1993, delivered a fetus weighing at least 4 kg. This sample was statistically compared with a numerically identical standard sample, selected at random. The main characteristics of labour and delivery were examined in the two groups under study. The most considerable differences observed concern the length of the labour, greater in the sample than in the standard group, and the frequency of dystocic events, similarly more considerable in the pregnant women with a megalosomic fetus. Maternal and perinatal outcomes, in spite of the small number of cesarean sections performed, were anyway very good in both the examined groups. In our experience, the risks associated with fetal megalosomia were rather limited, but this is not a reason to minimize beyond measure the problem we are talking about.

Early-onset infection findings caused by Group B Streptococcus occur within 24 hours of birth (60 per cent of cases) but they may appear anytime during the first 5 days of life. In our experience early-onset infection affects both preterm and term neonates. The Authors report the usual clinical signs described for bacterial infections. Unusual findings are also reported: among 34 infants with early-onset infection, the congenital diaphragmatic hernia was associated with GBS septicemia in two neonates; beads of perspiration were the first only clinical finding in one neonate too. Two cases of late-onset infection are also reported.

Background: Increased prevalence of hypertension, ischaemic heart disease and stroke has been reported in subjects with impaired growth during fetal life and infancy. Blood pressure could mediate this relation. Indeed, reduced growth in fetal life and infancy has been associated with a raised blood pressure in children and adults. However, there is controversy about the relative importance of intrauterine environment and extrauterine adverse environment which can act throughout the life course. We therefore studied the relation between birth weight, which is known to be an indicator of fetal growth, and blood pressure in children and their parents. This association could thus be assessed in childhood before the external environmental influences became important, and in adulthood., Methods: Seven hundred and fifteen healthy schoolchildren (379 boys) aged 3-12 years from primary schools, and 448 parents (252 women) aged 20-44 years, born at term, without hypertension or diabetes, were studied. Blood pressure and birth weight were measured. Birth weight was taken from the hospital records. Data were analysed by tabulation of means and linear regression and correlation techniques. Mean systolic and diastolic blood pressure were calculated according to birth weight and current weight as fourths of their distributions., Results: There was a significant inverse relation between birth weight and systolic blood pressure both in children and adults. Current weight standardised regression coefficient showed a change of -2.68 mm Hg (95% Cl - 2.0 to 3.26, p = 0.027) for each Kg increase in birth weight in children, and -3.82 mmHg (95% Cl -3.21 to -4.39, p = 0.011) in adults. Within each current body weight group the reduction in mean systolic blood pressure from the lowest to the highest birth weight group was larger in adults (10.4 mmHg) than in children (4.1 mmHg). Adults but not children showed also an inverse relation between birth weight and diastolic blood pressure. Weight standardised regression coefficient was -3.0 mm Hg (95% Cl -2.45 to -3.62, p = 0.036)., Conclusions: Blood pressure in inversely related to birth weight in childhood. This relation becomes stronger in adulthood. Therefore, reduced growth during fetal life may be linked with an increased risk of developing hypertension and cardiovascular disease.

In this study we compared the pregravidic body mass index (Quetelet index) with some variables recorded during pregnancy (caloric intake; weight increase, neonatal birth weight) in a group of patients consumers of a typical mediterranean diet. We studied the dietary habits of 100 pregnant women with gestational ages between 13 and 38 weeks. Each woman has been provided with daily, for seven consecutive days. The data have been analyzed evaluating, for each dietary componene, the caloric, proteic, glucidic, lipidic and microelements share. Our results showed degree of pregravidic obesity. However also in overweight patients that used diets with caloric intake as low as about 1600 Kcal/day, the neonatal weights were always within the normal range, confirming the adequacy of the "mediterranean diet" to the specific nutritional needs in pregnancy. Neonatal weight was better correlated to the pregravidic IQ than to the caloric intake.

Macrosomia remains an important cause of perinatal morbidity and mortality and maternal morbidity, which arise mainly from birth injury and asphyxia and increased rate or cesarean section respectively. In spite of many attempts to identify the patients at risk for fetal macrosomia, the perfect prediction has not yet emerged. In the last years, many papers have reported methods for ultrasonographic determination of fetal weight. It should be emphasized that most of these reports have cautioned that sonographic predictive accuracy declines as fetal weight increases toward 4000 g. In our study, sonographic prediction of diagnosis of macrosomia was performed in 73% of cases. In addiction, in case with a correct sonographic diagnosis of macrosomia, a higher incidence of primary operative delivery was reported, and when operative delivery for failure to progress was performed, the time of labor was shorter in patients with ultrasound diagnosis of macrosomia. The proportion of babies with apgar score greater than 7 at 1 minute, the incidence of shoulder dystocia and birth trauma was similar in the patients with and without prenatal ultrasound diagnosis of macrosomia. This study does not justify the use of elective cesarean section as a method of preventing persistent infant morbidity. An accurate antenatal diagnosis of macrosomia with ultrasound has been shown to offer an important usefull in the clinical management of labor and delivery.

Newborns admitted to any Intensive Care Unit (ICU) are more at risk for nosocomial infections. The author analyzed the incidence of nosocomial bacteriaemias occurred in the neonatal ICU of Trento, especially focusing on the relationship between weight at delivery, incidence of infections and mortality. The incidence of bacteriaemiae during the observation period (1.189-31.12.93) accounted for 3.5%, and 2.8% were classified as nosocomial. The most frequently involved organism was the Staphylococcus PCN (62% of bacteriaemiae). High risk newborns weighted < 1500 g; 10.7% were affected by nosocomial bactaeriaemia, representing the 56.1% of all the observed bacteriaemiae. A strong association (p < 0.05) was also observed between bactaeriaemiae and mortality, in newborns weighting less than 1000 g. Since low and very low birth weigh infants are particularly at risk for infections, special attention should be paid to the invasive techniques and a systematic reporting and documentation of epidemiology of infections, in order to monitor impact of modifications in caring techniques is warranted.

Serum levels of type I procollagen were measured on 118 samples from cord blood or from healthy infants aging from 1 to 90 days of life. Significant variations (P = 0.001) were noticed in the values of the marker in the whole period under investigation. We observed a decrease of PICP from cord blood to the end of the first day of life with a sharp rise on the 5th day lasting until the 30th day which then became stable till the end of the third month. Our results show a peculiar pattern of PICP levels during the first month of life which has to be taken into account to evaluate normal values of the marker in this period of life.