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Pre-eclampsia (PE) is an important cause of acute renal failure and an important risk marker for subsequent chronic kidney disease. In normal pregnancy, there are marked changes in the renin-angiotensin system (RAS) including considerably elevated angiotensin II (ang II) levels. However, vascular resistance decreases markedly during normal pregnancy, suggesting that pregnant individuals are less sensitive to ang II than non-pregnant individuals. In contrast, during PE decreased circulating components of the RAS with enhanced sensitivity of ang II infusion have been reported. Patients with a history of PE have an increased risk of microalbuminuria with a prevalence similar to subjects with type 1 diabetes mellitus. Women with gestational or chronic hypertension were at a high risk of end-stage renal disease (ESRD) vs. normotensive ones, but the risk is much greater for women who had PE or eclampsia than those who had gestational hypertension only. A previous episode of PE should suggest long-term follow-up, especially with respect to hypertension and microalbuminuria within 6-8 weeks of delivery, and should require a nephrological consult if these disorders do not resolve. Pregestational diabetes was also associated with long-term increased risk of ESRD and death. Lastly, women who have PE and give birth to offspring with low birth weight and short gestation have a substantially increased risk for having a later kidney biopsy. For all these reasons, short and long-term evaluation of kidney function should be suggested in women with previous complicated pregnancy., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Background: Augusta-Priolo (SR), Gela (CL), and Milazzo (ME) cities, located in Sicily Region (Southern Italy), are included among the areas at high environmental risk in Italy and the national legislation classifies them among the polluted sites of national interest for environmental remediation. In the past, these areas had high contamination from industrial complexes., Objectives: assessment of reproductive health through the analysis of data from the birth reports of all hospital of Sicily Region in 2007-2013., Design and Setting: geographical population study; analysis of reproductive health through analysis of pregnancy outcomes occurred in Sicily from women of childbearing age (10-55 years; excluding women who remain anonymous) with record linkage with population data (neighbouring municipalities and whole region, considered as not exposed areas)., Main Outcome Measures: sex ratio, stillbirth rates, proportion of multiple births, low birth weight, very low birth weight, gestational age <37 weeks, proportion of small for gestational age., Results: in the period 2007-2013, an average annual number of 43,000 births (51.4% males) occurred. Sex ratio was not significantly modified in comparison with local and regional values. Several indicators in each area were similar when compared with the local reference population or with regional population. Stillbirths were significantly higher only in Augusta-Priolo area vs. the local population (OR: 2.26; CI95% 1.07-4.80), and slightly higher vs. regional population. Multiple births were significantly higher in Augusta-Priolo area (OR: 1.19; CI95% 1.01-1.41) and in the town of Siracusa (OR: 1.15; CI95% 1.01-1.316) when compared with regional population, and slightly higher vs. local population. Prematurity was significantly higher only in the area of Milazzo compared to the regional population (OR: 1.20; CI95% 1.02-1.41), and slightly higher compared to the local population. No excess of low birth weight (<2,500 grams) and small for gestational age (almost 37 weeks) babies was observed in these areas., Conclusions: according to this study, pregnancy outcomes were not clearly affected in these areas although some modifications were noted in Augusta and in Milazzo. The surveillance of reproductive health is of paramount importance to understand the effects of air pollution on morbidity and mortality in these areas.

The SESPIR Project (Epidemiological Surveillance of Health Status of Resident Population Around the Waste Treatment Plants) assessed the impact on health of residents nearby incinerators, landfills and mechanical biological treatment plants in five Italian regions (Emilia-Romagna, Piedmont, Lazio, Campania, and Sicily). The assessment procedure took into account the available knowledge on health effects of waste disposal facilities. Analyses were related to three different scenarios: a Baseline scenario, referred to plants active in 2008-2009; the regional future scenario, with plants expected in the waste regional plans; a virtuous scenario (Green 2020), based on a policy management of municipal solid waste (MSW) through the reduction of production and an intense recovery policy. Facing with a total population of around 24 million for the 5 regions, the residents nearby the plants were more than 380,000 people at Baseline. Such a population is reduced to approximately 330.000 inhabitants and 170.000 inhabitants in the regional and Green 2020 scenarios, respectively. The health impact was assessed for the period 2008-2040. At Baseline, 1-2 cases per year of cancer attributable to MSW plants were estimated, as well as 26 cases per year of adverse pregnancy outcomes (including low birth weight and birth defects), 102 persons with respiratory symptoms, and about a thousand affected from annoyance caused by odours. These annual estimates are translated into 2,725 years of life with disability (DALYs) estimated for the entire period. The DALYs are reduced by approximately 20% and 80% in the two future scenarios. Even in these cases, health impact is given by the greater effects on pregnancy and the annoyance associated with the odours of plants. In spite of the limitations due to the inevitable assumptions required by the present exercise, the proposed methodology is suitable for a first approach to assess different policies that can be adopted in regional planning in the field of waste management. The greatest reduction in health impact is achieved with a virtuous policy of reducing waste production and a significant increase in the collection and recycling of waste.

Introduction: Escitalopram (ESC) is considered one of the most effective selective serotonin reuptake inhibitors (SSRI) for the treatment of major depression disorder. However, little is known on its potential risk of inducing major malformations (MM) and/or perinatal complications (PC). Aim of the present study is to provide a review of the available literature on the safety profile of ESC during pregnancy and breastfeeding and to compare data with the maternal and neonatal outcomes of 8 cases of the DEGRA Center., Methods: MEDLINE and PubMed databases were searched for English language articles by using the following keywords: "escitalopram", "selective serotonin reuptake inhibitors", "major malformations", "perinatal complications", "pregnancy", "breastfeeding". We also reported 8 cases of women treated with ESC during their pregnancy and breastfeeding at the Clinic of Affective Disorders in Pregnancy and Postpartum of the United Hospital of Ancona (DEGRA Center)., Results: Although some cases of MM have been reported in the literature after maternal exposure to ESC during early pregnancy, the rate of MM is substantially in the range of those reported in unexposed women. ESC exposure seems to be significantly associated with some PC such as lower rates of live births and higher rates of newborns with low birth weight. On the contrary, no short-term adverse effects in newborns were reported in the 5 studies evaluating the safety of ESC during breastfeeding. Data coming from DEGRA Center are consistent with the literature: all pregnancy were full term, all newborns were healthy and obtained normal APGAR score; no MM or miscarriage were reported. Only one case of mild withdrawal syndrome was reported in a newborn who was also exposed to benzodiazepines and paroxetine late in pregnancy. Two infants exposed to ESC also during the lactation did not reported any adverse effects at short-term., Conclusions: Data coming from published studies and from our cases seem to support the notion that ESC might be considered safe during pregnancy and breastfeeding, particularly as far as MM is concerned. As well as other SSRI it could be associated with an increased risk of PC. Nevertheless, given the few cases here analysed and the paucity of the studies so far published, no definitive conclusions should be drawn.

Vitamin D deficiency rickets in infants attributable to inadeguate vitamin D intake and decreased exposure to sunligh continue to be reported in the United States and other Western Countries. The American Academy of Pediatrics raccomend that all infants, children and adolescent have a minumin intake of 400 UI of vitamin D per day. We describe a case of deficiency-related rickets in two moroccan twins aged 10 months.

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.

To have access to central vein, for the infant in NICU,often have a role, for their, life-preserving. The increase of survival in the VLBW, and specially in the ELBW,is guaranteed, in the first days of the life also by a safe vascular access, in fact we can, in this way, to supply with parenteral nutrition to all the requirements that these special patients have. In the first approach to the seriously ill newborn, the umbilical vessels, are the first choice to use,we have the way more fast, stable and easy, to guarantee: the emergency therapy, monitoring and caloric requirements. After 6-7 days, however, specially in the ELBW, it is important to find a more stable vascular access, through we can to provide high osmolarity solutions without complications, to supplement the MEF (Minimal Enteral Feeding) with parenteral nutrition optimizing energy intake and caloric. At this time, for the preterm baby is more safe and easy choice the central venous catheter peripherally inserted (PICC). The Authors assess the medical nurse aspects related to this method starting from the choice of vase, the techniques of cannulation and dressing, then linger on the management and prevention of complications. We will, finally, show our data on PICC related to 212 preterms admitted in our NICU with weight <1500 gr and/o E.G. <30 ws.; from the year 2006 to 2009, that correspond to the our precence to the Vermont Oxford Network (VON).

Smoking during pregnancy, either active or passive, can have many negative effects on the fetus and the neonate, particularly low birth weight (less than 2500 gr), premature birth (before 32 weeks) and increased perinatal mortality and morbidity. Furthermore, smoking while breastfeeding reduces the volume of milk available owing to prolactin inhibition. In the light of this data, Italian health planning 2003-2005 determined the importance of increasing awareness in women in fertile age regarding the risks of smoking, reducing the percentage of women who continue to smoke while pregnant and hence the number of underweight or premature neonates.

Three years from the approval of the law safeguarding pregnant workers and the foetus (D.Lgs. 151/01), awareness of these provisions and management of pregnancy in relation to their job were assessed in 160 pregnant workers using a questionnaire. Respondents were 147 subjects, mean age 29.4 +/- 4.6 years, employed as blue-collar workers (n=26); white-collar workers (n =47); health workers (n=16); school workers (n=14); workers in shops (n=6); policewomen (n =3) housewives (n=25). Moreprovisions and most of them took advantage of maternal leave. Pre-term birth (16%) and low birth weight (9%) were the mostfrequent events. There were no neonatal diseases. Blue-collar, white-collar work and work in the home were not associated with pre-term births or low birth weight. Analysis based on the fathers' job characteristics did not yield significant associations either. Although the small size of our sample does not allow to draw firm conclusions, it is interesting to note that more than 10% of respondents were not aware of the provisions protecting workers' pregnancy.

There is growing evidence that periodontal disease represents a risk factor for preterm delivery and premature membrane rupture. To prevent an oral inflammatory process evolving into a full-blown form of periodontitis, with possible severe repercussions on pregnancy outcome following systemic spread, future mothers should receive regular professional oral hygiene care throughout pregnancy.

Nephrosclerosis is usually diagnosed in patients with essential hypertension with no or mild proteinuria and no urinary abnormalities. Microalbuminuria is considered to be a marker of high risk for progressive renal disease in patients with diabetes mellitus but there is still no solid evidences that this alteration entails an adverse renal prognosis in essential hypertension. Independently of hypertension, nephrosclerosis is associated with endothelial dysfunction and evidence is accruing that genetic factors and a low number of nephrons at birth are important determinants of this disease.

The second phase of the SIDRIA study provides important information regarding the family characteristics of Italian children (6-7 years old) and adolescents (13-14 years old), and the frequency of risk factors for asthma and allergies, allowing comparisons between study areas according to differences in latitude (North, Centre, South) and urbanization level (metropolitan areas, with at least 500,000 inhabitants, and other areas). Parental education level was higher in metropolitan and central areas. The frequency of children and adolescents born abroad, and the percentage of mothers and fathers employed were higher outside metropolitan areas and there was an increase from the South to the North of Italy. This trend was paralleled by an increase in maternal age at child's birth and in the frequency of low birth weight and day care attendance. The frequency of breastfeeding was greater in children than in adolescents; the opposite was registered for passive smoking, with a frequency of exposure higher in adolescents than in children, especially in the Northern and Central areas, even if the proportion of subjects having at least one parent who smokes was still high in both age groups. The prevalence of overweight children was striking, especially in the South where physical activity was less frequent and children had the unhealthy habit of consuming a lot of snacks and carbonated beverages. Frequency of exposure to traffic in the area of residence was particularly high, especially in the metropolitan areas.

Minimally invasive surgical techniques have been employed successfully for a wide spectrum of cardiothoracic procedures. These approaches were proven to be as safe and effective as traditional surgical techniques. Unfortunately, it remains a lack of adequate instrumentations and anatomic features, particularly in the pediatric pool of patients. We have employed a new surgical approach for closing a patent ductus arteriosus in low weight newborn (< 2.5 kg), performing a superior extrapleuric approach. This report demonstrates that this technique is safe and reproducible, and is our opinion that it may substitute the medical management of patent ductus arteriosus.

Numerous environmental factors such as smoking habits, alcohol intake, economic and social status, and by-product chlorination present in drinking water can determine adverse pregnancy outcomes like a low weight birth, small for gestational age or preterm delivery. In 1998 the Italian Ministry of University and Scientific Technological Research (MURST) has financed a multicentric study in order to evaluate the association between exposure to by-products chlorination in drinking water during pregnancy and adverse pregnancy outcomes at birth such as preterm delivery and low birth weight. We describe the socio demographics characteristics, personal habits and the health status during pregnancy and exposure to the VOX of 171 women recruited from the Research Unit of Rome and L'Aquila. A case control study with incident cases was performed. Exposure to Chlorination By Products (CBP) and confounding factors for studied outcomes, were assessed by a validated questionnaire. At the same time, collection and analysis of 124 tap water samples were carried out directly at women's home. No association was found between CBPs level and low birth weight or preterm delivery. We found an excess risk statistically significantly between preterm delivery and hypertension (OR = 5.06; IC 95% = 1.70-15.44) an excess risk statistically significantly between low birth weight and smokers (OR = 3.43, IC 95% = 1.15-10.26). The CBPs levels were rather low (range cases = 0.09-6.28 microg/L; range controls = 0.01-6.44 microg/L). The results confirm the literature data and the validity of the epidemiological method adopted. The low CBPs levels, under the Law level, are probably imputable to the good quality of sorgive waters. Considering the CBPs level temporal variability in chlorinated waters, is to be hoped a careful and continues surveillance of the CBPs spike levels for better exposure assessment.

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.

Background: Advances in surgical techniques and immunosuppression have improved the results in organ transplantation. The quality of life in these patients is good in the most of cases and pregnancy, which means for them to resume a normal life, isn't an exceptional event, specially for kidney transplant recipients., Methods: Retrospective data regarding pregnancies observed at the Dept. of Nephrology and Dialysis of the S. Giovanni Battista Hospital in Turin, have been collected to value the pregnancy frequency and outcome (complications, miscarriage, therapeutic abortion), the mother follow-up as a function of transplant rejection risk, the newborn conditions, their hematological and immunological situation, and the children follow-up., Results: This study includes 9 pregnancy (6 at term and 3 abortions), observed since 1987 in 6 kidney transplant recipients. Congenital malformations or immunological diseases have not been observed; according to the literature, there was a high frequency of preterm delivery and intrauterine grow retardation. Complications during pregnancy were observed in 5 cases (83.3%)., Conclusions: The study confirms that kidney transplant recipients can carry a pregnancy through and give birth to healthy infants, but these pregnancies are to be regarded as being at high risk and require a multi-disciplinary approach.

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.

Severely preterm neonates (gestational age < or = 32 weeks) and/or very low birth weight (VLBW, with weight at birth < or = 1500 g) are 2% of all newborns, with a rising incidence due to the increase of multiple gestations and of pregnancies at advanced age. These neonates may be affected by severe neurological pathologies (6-10% of cases), but they often have minor disabilities (such as distractibility, hyperactivity, learning and social competence disabilities, deficit of motor development) difficult to be early diagnosed, and frequently recognized only at pre-school or school age. A review of the current knowledge about the effects of potential risk factors responsible for deficits of neurocognitive development in pre-school age and for postnatal distress of mothers, and their inter-correlations, is reported.

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.

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 aim of this prospective study was to evaluate the frequency of the hypertensive disorders of pregnancy and their effects on the newborn infants. The study was performed between January 1992 and December 1994 on the 4793 infants born at the Obstetric Divisions of the University of Messina. These 123 infants were born of hypertensive women and 4670 were control infants. Between the two groups of infants there were significant differences with regard to the incidence of nulliparity, prematurity, low Apgar scores at birth and low birth weight. The blood pressure and the haematic parameters were not different between the two groups of infants. Five of the infants born to hypertensive women were referred to the Division of Neonatal Pathology. The low frequency of infants born to hypertensive women observed by us suggests that in our population the hypertensive disorders of pregnancy are understimated. Moreover, the high incidence of preterm and LBW infants confirms that in infants born to hypertensive women the neonatal risks are consequent to fetal growth retardation.

The aim of this study is to evaluate how many blood transfusions can be saved by the treatment of anemia in preterm infants (eg < or = 33 weeks) with HUEPO. VLBW infants are at high risk of receiving blood transfusions, following the blood transfusion criteria most applied (45-50% of VLBW infants need blood transfusions). A review of the most recent studies shows that we can save a remarkable number and quantity of blood transfusions in the VLBW infants treated with HUEPO.

To evaluate the efficacy of a measure able to compare energy intake from parenteral and enteral nutrition we documented growth patterns in a group of VLBW infants treated with parenteral nutrition (PN). To analyze comparative energy intake from the two sources we expressed a percentage of both parenteral and enteral calories: the former (RCP%) related to an optimal value of 85 non protein calories and the latter (RCE%) to an optimal value of 150 total calories. Total energy intake was planned on the RCT% (RCP% + RCE%). We studied 75 VLBW infants with a mean BW of 1040 g and a mean GA of 29.5 weeks. The mean duration of PN was 25.8 +/- 10.4 days. The initial weight loss (10.2 +/- 5.3%), the time to regain BW (5.5 +/- 4 days) and the day of lowest weight (5.2 +/- 1.6 day of life) were in the normal range; the subsequent growth rate resulted 25.9 +/- 9.2 g/kg/die and did not change for different GA or BW. Growth pattern about head circumference and length were above the third percentile. The mean age of RCT% = 100% was 11.4 +/- 4.8 days of PN; this value was higher for the more premature infants. Severe metabolic abnormalities were not detected. Our observations show the efficacy of the RCT% as index of energy from both enteral and parenteral source during PN: the growth pattern seems to be quite satisfactory without any severe metabolic complication.

Systemic Candida Albicans infections in premature newborns are characterized by high morbidity; early diagnosis and immediate treatment are therefore necessary. In this study we report the cases of fourteen newborns admitted to our Newborn Care Unit in a three-year period, in whom candidiasis was diagnosed. The mycetes was isolated from blood, liquor, peritoneal fluid, urine, oesophageal aspirate. Treatment was undertaken immediately with fluconazole, administered through the parenteral route or locally into peritoneal cavum and oesophageal stump. Duration of treatment varied from five to twenty-one days. All cases underwent complete negativization of cultures and no systemic or local side effects.

The incidence and the evolution of ROP in 324 infants with birthweight < or = 2500 g is report. The highest incidence was among the 750 and 1250 g birthweight infants. 5 infants < 750 g survived without signs of ROP. When present the ROP was within the 3rd stage and had a favourable outcome: spontaneous resolution without cicatricial lesions.

A population study on 314 very low birth weight infants (VLBW) was carried out in 1987 in the Lazio Region of Italy to investigate the relation between the availability at birth of neonatal intensive care and infant mortality. Fifty-two percent of VLBW infants did not survive the first year of life. The mortality Odds Ratios, adjusted for four potential confounding variables, did not show a beneficial effect of Maternity units with neonatal intensive care (level 3) compared with those with special (level 2) and normal care (level 1). The overall high crude mortality rate together with the homogeneity of odds ratios among the different levels of care suggest that, when a regionalized perinatal care system is missing, as in Lazio region, the availability of neonatal intensive care, per se, does not improve the survival on this group of infants.

This study was designed to verify the effectiveness of parenteral nutrition (NP) and continuous nasogastric feeding (AOG) in providing a good caloric intake and a good growth in the very low birth weight infants during the first 60 days of life. The study included 108 preterm babies with birth weight less than or equal to 1500 g: 26 received parenteral nutrition, 82 nasogastric feeding. Infants in NP showed a smaller postnatal weight loss and regained birth weight earlier than the AOG group. Caloric intake greater than 120 kcal/kg/die was achieved in 10.2 days of life in the NP group and in 14.1 days in the AOG group. Full enteral feeding was achieved later in the NP than in the AOG group (25.7 days vs 20.7 days). Weight gain at 60 days of life was better in the NP group (23.2 g/die vs 18.2 g/die), while there was no difference in the head circumference gain. The study shows the efficacy of NP in providing a good caloric intake in the very low birth weight infants in the first weeks of life.

Osteopenia is a metabolic bone disease which affects a great deal of preterm infants. X-Ray evaluation is still the main step of the diagnostic and follow-up procedures. The Authors prospectively studied 77 newborn infants with birth weight less than 2500 grams, to identify specific clinical and biochemical features of the osteopenic infants. From the 2nd to the 12th week of life clinical, biochemical and radiological signs of osteopenia were looked for, every 2 weeks: the diagnosis of osteopenia was made on the basis of X-Ray. 26 osteopenic subjects with ga less than or equal to 32 weeks and/or bw less than or equal to 1500 grams were compared with 20 controls with ga less than or equal to 32 weeks and/or bw less than or equal to 1500 grams and with 31 control infants with ga greater than 32 weeks and bw greater than 1500 grams. Wider anterior funtanels, their progressively increasing dimensions, and craniotabe (with the "ping pong ball" sign) were the most characteristic features, as well as the increasing pattern of alkaline phosphatase activity, of the osteopenic babies. The Authors suggest a specific clinical and biochemical score to make the correct diagnosis and a non invasive follow-up in the osteopenic subjects and to avoid dangerous X-Ray exposure to babies that are not osteopenic.

The aim of the present work is to observe non-neurological morbidity in low-birth-weight-neonates during the first year of life, to define their predominance and to establish whether any correlation between the observed pathologies, gestational age and/or birth weight is evident. Respiratory infectious diseases were the most frequent cause of morbidity starting during the first months life. Anemia and osteopenia were significantly related to gestational age, both occurring with high frequency in babies born before 31 weeks of gestational age. In this gestational age group of neonates birth weight did not influence the incidence of the pathologies studied. On the contrary, morbidity was inversely related to birth weight when neonates of greater gestational age were considered. Candidiasis was significantly more frequent in newborn babies weighing at birth less than 2000 grams. Follow-up programs of low-birth-weight neonates give the opportunity to establish nutritional schedules fit for infants born prematurely and to provide precocious diagnosis and therapy apt to minimize infectious respiratory diseases, so often occurring in these babies.

During the 1975-1984 period, 93 infants weighing 1500 g or less were transferred to the Magenta Perinatal Center Hospital. The survival rate at discharge was 82.9% for infants transferred in utero and 63.5% for infants transferred postnatally (p less than 0.05). The incidence of major neurological sequelae was 3.1% and 23.3% respectively (p less than 0.02). This experience confirms that the high risk pregnancies should be referred to the Perinatal Center for optimal care of the mother, fetus and newborn infant.

In 7675 deliveries performed at the University of Messina between November 1, 1983 and October 31, 1988 we determined the incidence and obstetric factors specifically associated with the birth of very low weight infants (less than or equal to 1500 gm) (VLBW). Our purpose was to characterize these factors in order to determine what may be done to limit delivery rate of VLBW. Information obtained concerning the mothers' included socioeconomic status, age, parity, previous obstetric history, any maternal conditions affecting the pregnancy, route of delivery (vaginal or operative). The incidence of infants under 1500 gm was 1.1 per cent of live births. The etiologic analysis showed that preterm labor is more frequent cause of VLBW. In women under 17 years of age the incidence of VLBW was 5.2 per cent as opposed to 1.1 per cent in the total population. Absence of prenatal care was shown in 40.8 per cent of VLBW. The previous obstetric history reported 1 or more abortions in the 53 per cent and 1 or more perinatal deaths in 17 per cent of VLBW. The clinical implications of these results are discussed.

Alterations in thyroid function are quite heterogeneous in VLBW preterm neonates. The case of a 1160-g newborn is reported, affected by severe RDS and persistent bradycardia during the first week of life, who later developed symptoms and signs of low-output cardiac failure. ECG showed low QRS. Echocardiography revealed small pericardial effusion. Therapy with L-thyroxine led to rapid improvement of clinical conditions and to normalization of ECG and echocardiographic pattern. Levels of thyroid hormones should be monitored in VLBW infants, since their deficiency may play a role in compromised clinical conditions.

During pregnancy because of physiologic hemodiluition and changes in various plasma protein levels, plasma viscosity is decreased compared to the non pregnant condition. Specifically the whole blood viscosity profile throughout pregnancy follows that of the hematocrit. However some pathological condition like pregnancy induced hypertension and intrauterine growth retardation are characterized by an increase of plasma viscosity. In order to evaluate the effect of plasma viscosity on placental perfusion, in 41 patients affected by pregnancy induced hypertension and with no iron deficiency we compared maternal hemoglobin and hematocrit to the birth weight. High maternal hemoglobin and hematocrit levels were associated to an increased frequency of low weight for date newborns (less than or equal to 10th centile), although the relationship with the hemoglobin levels is stronger (p less than or equal to 0.02) than the one with the hematocrit (p less than or equal to 0.05). In contrast, high weight for date newborns (greater than or equal to 90th centile) were not related to maternal hemoglobin and hematocrit parameters. We found that maternal hemoglobin and hematocrit, indicators of plasma viscosity, are useful in predicting low birth weight, but not high birth weight. We speculate that hypoxia due to the modification of microcirculation is a very important factor in determining the low birth weight; in contrast the oxygen is not the only factor involved in determining the high birth weight.

One hundred twenty-seven children born between September 1st 1980 and August 31st 1985 weighing less than or equal to 1500 g at birth and submitted to intensive neonatal care were followed-up to the age of 12-36 months of corrected age with a follow-up program to assess their neuromotor and cognitive development. The incidence of cerebral palsy (CP) in the population in question was 15.7% at 12 and 24 months and 14.6% at 36 months. A peak CP rate was observed among those born in 1982 with a steady decline in the number of CP cases among those born in the last years of this study. The group of children with a birth weight of 1001-1500 g (VLBWI) was more heavily affected by CP than those whose weight was less than or equal to 1000 g (ELBWI). Statistical analysis revealed a significant correlation between neuromotor development and the following factors relative to the perinatal period: type of birth, sex, respiratory distress requiring assisted ventilation, acidosis, ultrasound, neurological examination at the 40th week of gestational age.