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1. Body temperature at nursery admission in a cohort of healthy newborn infants: Results from an observational cross-sectional study

Author

Merazzi, D., Bresesti, I., Tagliabue, P., Valsecchi, M. G., De Lorenzo, P., Lista, G., Daniele, I., Restelli, R., Bollani, L., Maini, A., Bellan, C., Zappella, E., Colombo, L., Sorrentino, G., Ciraci, G., Lomazzi, M., Lombardo, I., Ferraresi, M., Pagani, L., Bernardo, L., Romani, M., Agosti, M., Martinelli, S., Miraglia, G., Palumbo, E., Menghi, V., Cavalli, C., Paternieri, A., Messina, D., Teani, M., Barachetti, R., Lazzari, F., Merazzi, D, Bresesti, I, Tagliabue, P, Valsecchi, M, De Lorenzo, P, Lista, G, Daniele, I, Restelli, R, Bollani, L, Maini, A, Bellan, C, Zappella, E, Colombo, L, Sorrentino, G, Ciraci, G, Lomazzi, M, Lombardo, I, Ferraresi, M, Pagani, L, Bernardo, L, Romani, M, Agosti, M, Martinelli, S, Miraglia, G, Palumbo, E, Menghi, V, Cavalli, C, Paternieri, A, Messina, D, Teani, M, Barachetti, R, and Lazzari, F

Subjects
Male, medicine.medical_specialty, Cross-sectional study, Hypothermia, Thermoregulation, Body Temperature, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Neonatal hypothermia, 030225 pediatrics, medicine, Humans, Delivery room, Newborn, 030212 general & internal medicine, Practice Patterns, Physicians', Obstetrics, business.industry, Delivery Rooms, Research, Infant, Newborn, lcsh:RJ1-570, lcsh:Pediatrics, Clinical Practice, Cross-Sectional Studies, Nurseries, Hospital, Italy, Infant Care, Cohort, Female, Observational study, Guideline Adherence, medicine.symptom, business
Abstract

Background Exposure to hypothermia is somehow unavoidable when a baby comes to life. This is the reason why any possible effort should be made by every caregiver involved during birth, from labour to transfer into the maternity ward, to reduce it. Hypothermia has widely shown to be related to several neonatal problems, and the risks are more relevant when the babies are born prematurely. Method An observational study was conducted in April 2016 to assess the current practises to avoid hypothermia at birth in 20 Italian neonatal units. Each unit introduced local improvements in clinical practice and the same observational study was repeated 1 year later. Results A total of 4722 babies were analysed. An overall increase in adherence to local and international recommendations emerged from our study. Significant differences between 2016 and 2017 were found in regard to neonatal temperature at nursery entry (36.3 °C vs 36.5 °C, respectively, p 60″ (48.1% vs 68.1%, respectively, p 60′ (56.3% vs 60.9, respectively, p = 0.03). Statistical correlations with the risk of hypothermia were found for delivery room (OR 0.88 (CI 95%0.83–0.94), p p Conclusion Periodical assessment of the delivery room practice has shown to be effective in improving adherence to the international recommendations. Relationship between neonatal hypothermia and several other variables including the delivery room and mother temperature underlines how neonatal thermoregulation starts immediately after birth. Hence, a multi-disciplinary approach is needed to provide the optimal environment for a safe birth.

Published
2020

2. Work environment, volume of activity and staffing in neonatal intensive care units in Italy: results of the SONAR-nurse study

Author

Corchia, C, Fanelli, S, Gagliardi, L, Bellù, R, Zangrandi, A, Persico, A, Zanini, R, SONAR-Nurse Study Group including Bellù, R, Bertino, E, Casati, M, Cazzaniga, A, Plevani, L, Mosca, F, Baracchetti, R, Villa, E, Tandoi, F, Boccacci, S, Martinelli, S, Coscia, P, Poggiani, C, Ferrari, D, Barera, G, Poloniato, A, Ruggeri, V, Burgio, G, Carrera, G, D'Alterio, R, Merazzi, D, Lomazzi, M, Coscia, A, Borgione, S, Anselmo, C, Galletto, P, Gancia, Gp, Parola, A, Sabatini, M, Gazzolo, D, Carli, G, Filippone, M, Lago, P, Heun, N, Visentin, S, Bertolini, A, Padovani, Em, Bellettato, M, Gasparin, B, Serra, A, Santuz, P, Ellero, S, Fantini, M, Contiero, Rm, Gallo, C, Mammoliti, Pm, Ancora, G, Faldella, G, Sandri, F, Stella, M, Biasini, A, Fioravanti, L, Dessì, S, Sigali, E, Vuerich, M, Cacciavellani, R, Bragetti, P, De Curtis, M, Lucchini, R, Parente, G, Massenzi, L, Calibita, G, Haass, C, Scapillati, E, Pietro, S, Dotta, A, D'Agostino, G, Picone, S, Messina, F, Napolitano, M, Salvia, G, Moschella, S, Orfeo, L, Chello, G, Carpentieri, M, Vacchiano, T, Vetrano, G, Rabuano, R, Simonetti, Dm, Quartulli, L, Rinaldi, M, Magaldi, R, Presta, G, Greco, F, Forziati, V, Acito, A, Gatta, A, Quitadamo, P, Rotondo, S, Laforgia, N, Grassi, A, Del Cuore, F, Lucente, M, Costabile, Cd, Nicolò, A, Arco, A, Marseglia, L, Pinna, G, Rosella, V, Giuffrè, M, Marchesano, G, Inferiore, N, Corso, G, Cannuscio, A, Gargano, G, Pedoni, S, Poloni, G, Di Leo, L, Crescenzi, F, Celi, F, Betta, P, Carlo Corchia, Simone Fanelli, Luigi Gagliardi, Roberto Bellù, Antonello Zangrandi, Anna Persico, Rinaldo Zanini, SONAR-Nurse Study GroupCorchia [.., Giacomo Faldella, ], Corchia, C., Fanelli, S., Gagliardi, L., Bellù, R., Zangrandi, A., Persico, A., Zanini, R., Giuffre, M., and SONAR-Nurse Study Group

Subjects
Cross-sectional study, Staffing, Workload, Critical Care Nursing, Pediatrics, 03 medical and health sciences, 0302 clinical medicine, Settore MED/38 - Pediatria Generale E Specialistica, Nursing, 030225 pediatrics, Intensive care, Critical care nursing, Surveys and Questionnaires, Neonatal, Intensive Care Units, Neonatal, Medicine, Humans, Surveys and Questionnaire, 030212 general & internal medicine, Location, Workplace, Cross-Sectional Studie, business.industry, Research, Nurse-Patient Relation, Infant, Newborn, Patient Acuity, Infant, Perinatology and Child Health, Newborn, Nurse-Patient Relations, Cross-Sectional Studies, Italy, Pediatric Nursing, Intensive Care Units, Workforce, Intensive care units, Nurse-patient relations, Patient acuity, Pediatrics, Perinatology and Child Health, Pediatric nursing, business, Human
Abstract

Background Neonatal units’ volume of activity, and other quantitative and qualitative variables, such as staffing, workload, work environment, care organization and geographical location, may influence the outcome of high risk newborns. Data about the distribution of these variables and their relationships among Italian neonatal units are lacking. Methods Between March 2010-April 2011, 63 neonatal intensive care units adhering to the Italian Neonatal Network participated in the SONAR Nurse study. Their main features and work environment were investigated by questionnaires compiled by the chief and by physicians and nurses of each unit. Twelve cross-sectional monthly-repeated surveys on different shifts were performed, collecting data on number of nurses on duty and number and acuity of hospitalized infants. Results Six hundred forty five physicians and 1601 nurses compiled the questionnaires. In the cross-sectional surveys 702 reports were collected, with 11082 infant and 3226 nurse data points. A high variability was found for units’ size (4–50 total beds), daily number of patients (median 14.5, range 3.4-48.7), number of nurses per shift (median 4.2, range 0.7-10.8) and number of team meetings per month. Northern regions performed better than Central and Southern regions for frequency of training meetings, qualitative assessment of performance, motivation within the unit and nursing work environment; mean physicians’ and nurses’ age increased moving from North to South. After stratification by terciles of the mean daily number of patients, the median number of nurses per shift increased at increasing volume of activity, while the opposite was found for the nurse-to-patient ratio adjusted by patients’ acuity. On average, in units belonging to the lower tercile there was 1 nurse every 2.5 patients, while in those belonging to the higher tercile the ratio was 1 nurse every 5 patients. Conclusions In Italy, there is a high variability in organizational characteristics and work environment among neonatal units and an uneven distribution of human resources in relation to volume of activity, suggesting that the larger the unit the greater the workload for each nurse. Urgent modifications in planning and organization of services are needed in order to pursue more efficient, homogeneous and integrated regionalized neonatal care systems.

Published
2016

3. Do differences in delivery room intubation explain different rates of bronchopulmonary dysplasia between hospitals?

Author

Gagliardi, Luigi, Bellù, Roberto, Lista, Gianluca, Zanini, Rinaldo, Compagnoni, G., Mosca, F., Martinelli, S., Chirico, G., Santucci, S., Caccamo, M. L., Maccabruni, M., Stronati, M., Rondini, G., Agosti, M., Magni, L. A., Moro, G., Tagliabue, P., Barera, G., Merazzi, D., Cavazza, A., Brunelli, A., Battaglioli, M., Tandoi, F., Cella, D., Perotti, G. F., Pelti, M., Stucchi, I., Frisone, F., Avanzini, A., Bastrenta, P., Iacono, G., Pontiggia, F., Cotta-Ramusino, A., Strano, F., Fontana, P., Franco, M., Rossi, L., Calciolari, G., Citterio, G., Rovelli, R., Poloniato, A., Gancia, G. P., Costato, C., Germani, R., Barp, S., Crossignani, R., Siliprandi, N., Borroni, C., Ventura, M. L., Abbiati, L., Giardinetti, S., Leva, L., Fusi, M., and Bellasio, M.

Subjects
Male, Birth weight, medicine.medical_treatment, Gestational Age, Pediatrics, law.invention, Case mix index, law, Risk Factors, mental disorders, Intubation, Intratracheal, Medicine, Intubation, Birth Weight, Humans, Infant, Very Low Birth Weight, Bronchopulmonary Dysplasia, Mechanical ventilation, business.industry, Pediatrics, Perinatology and Child Health, Obstetrics and Gynecology, Delivery Rooms, Infant, Newborn, Gestational age, General Medicine, Perinatology and Child Health, medicine.disease, Respiration, Artificial, Bronchopulmonary dysplasia, Italy, Anesthesia, Ventilation (architecture), Small for gestational age, Female, business, Infant, Premature
Abstract

To investigate whether the wide variation in the frequency of bronchopulmonary dysplasia (BPD) between hospitals is due to differences in delivery room intubation rates.Data on 1260 infants of birth weight1500 g and 23-31 weeks gestational age, born in 1999-2002 and surviving to 36 weeks, were collected; 196 (15.6%) developed BPD defined as oxygen need at 36 weeks postmenstrual age. Generalised estimating equations and conditional logistic models adjusting for centre, gestational age, propensity score for intubation, and other potential confounders were used.Rates of BPD, delivery room intubation and mechanical ventilation for24 h differed significantly between hospitals. Centres with high delivery room intubation rates had higher ventilation and BPD rates. Hospitals ventilating more often also did so for a longer time. Although delivery room intubation was associated with BPD in unadjusted analyses, neither delivery room intubation nor brief (24 h) mechanical ventilation were risk factors for BPD in multivariate analyses adjusting for gestational age, case mix and other pre- and perinatal factors, indicating no causal effect or unmeasured confounding. Significant risk factors for developing BPD were low gestational age, prolonged ventilation (24 h: adjusted OR (aOR) 2.4;7 days: aOR 14.9), male sex (aOR 1.7), being small for gestational age (SGA; aOR 4.3) and late-onset sepsis (aOR 2.2). After taking into account these variables/procedures, centre differences remained significant but explained only about 5% of variance.Differences in BPD frequency between hospitals are explained by differences in procedures, chiefly mechanical ventilation, rather than by differences in initial management or case mix. Delivery room intubation and brief mechanical ventilation did not increase BPD risk.

Published
2011

4. Survey on retinopathy of prematurity (ROP) in Italy

Author

Borroni, C, Carlevaro, C, Morzenti, S, De Ponti, E, Bozzetti, V, Console, V, Capobianco, S, Tagliabue, Pe, Italian ROP study Group, Dolcino, D, Gazzolo, D, Fabiani, F, Pedretti, S, Mangili, G, Iacono, G, Rossi Brunori, P, Nascimbeni, G, Spallino, L, Merazzi, D, Magaldi, R, Rinaldi, M, Priolo, E, Capris, P, Gambaro, S, Daniele, I, Osnaghi, S, Araimo, G, Piozzi, E, Mazza, M, Ilardi, L, Chiesi, C, Roversi, Mf, Cavallotti, B, Malguzzi, S, Salvia, G, Sarnelli, Mg, Ganguzza, O, Guagliano, R, Barillà, D, Bollani, L, Cagini, C, Germini, C, Gatta, A, Laborante, A, Fogli, L, Caroni, G, Anselmetti, G, Soldi, A, Ferrero, L, Maestri, Ma, Gregorutti, V, Boiti, C, Miani, F, Sonetti, P, Pignatto, S, Gusson, E, and Mansoldo, C.

Subjects
Male, congenital, hereditary, and neonatal diseases and abnormalities, Pediatrics, medicine.medical_specialty, genetic structures, Birth weight, Posterior ROP, Gestational Age, Intensive Care Units, Neonatal, Sepsis, Intensive care, retinopathy, medicine, Birth Weight, Humans, Retinopathy of Prematurity, Prospective Studies, Erythropoietin, Extremely preterm infants, business.industry, Research, Incidence (epidemiology), Retinopathy of prematurity (ROP), Infant, Newborn, Plus-disease, Gestational age, Retinopathy of prematurity, Laserterapy, medicine.disease, eye diseases, Intraventricular hemorrhage, Italy, Relative risk, Multivariate Analysis, Female, Laser Therapy, sense organs, business, Intracranial Hemorrhages, Retinopathy
Abstract

Background This study aims to investigate the incidence and the relative risk factors of retinopathy of prematurity (ROP) and posterior-ROP (P-ROP): ROP in Zone I and posterior Zone II, as well as to analyze the occurrence of surgical treatment of ROP and to evaluate the short term outcome of the disease in Italy. Methods It is a prospective multicenter observational study; all infants with a birth weight (BW) ≤ 750 g and/or a gestational age (GA) ≤27 weeks born between January 1st 2008 and December 31st 2009 in 25 III level Italian neonatal intensive care units were eligible for the study. Results 421 infants were examined: 265 (62.9%) developed ROP and 102 (24.2%) P-ROP. Following the multivariate analysis erythropoietin-therapy (p

Published
2013
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5. Survey of neonatal respiratory care and surfactant administration in very preterm infants in the Italian neonatal network

Author

Bellù R, Gagliardi L, Tagliabue P, Corchia C, Vendettuoli V, Mosca F, Zanini R, Condò M, Turoli D, Weissmann G, Vanzati M, De Nisi G, Villa E, Moro G, Guerrini P, Contiero R, Ellero S, Furlan R, Abbiati L, Borroni C, Prandi G, Fabris C, Vielmi F, Agosti M, Tandoi F, Guidali, De Curtis M, Tozzi C, Lucchini R, Battaglioli M, Lista GL, Introvini P, Ferrari F, Gallo C, Cervello P, Bellante E, Bottura C, Pasquali F, Boccacci S, Latini G, Giannuzzi R, Martinelli S, Brunelli A, Motta G, Di Nunzio ML, Vendemiati A, Zorzi C, Carli G, Alfiero, Romeo N, Mammoliti P, Mastretta E, Barberis L, Farina D, Gancia G, Dalmazzo C, Napolitano M, Messina F, Rinaldi G, Magaldi R, Rinaldi M, Litta R, Lago P, Zanardo V, Chiandetti L, Visentin S, Presta G, Cella D, Poggiani C, Ferrari D, Parati S, Lombardo F, Grigorio R, Barera G, Franco M, Poloniato A, Colombo A, Burgio G, Sala E, Barberi I, Tiralongo V, Arco A, Careggi F, Dani C, Pratesi S, Mignatti V, Ancora G, Faldella G, Grandi S, Stronati M, Perotti G, Chirico G, Migliori C, De Marini S, Forleo V, Mansi G, Bona G, Stucchi I, Savastio, Ferrero F, Parola A, Padovani EM, Viviani E, Pecoraro L, Tiberina FI, Agostino R, Gizzi C, Massenzi L, Messner H, Staffier A, Salvia G, Esposito L, Forziati V, Latorre G, Sandri F, Alati S, Demaria F, Lombardi O, Costabile CD, Scarpelli G, Cavalli C, Volante E, Proietti D, Ganguzza O, Spinella B, Pietro RS, Haass C, Scapillati E, Consigli C, Gatta A, Quitadamo P, Boldrini A, Vuerich M, Sigali E, Ghirri P, Fiorini P, Petrucci L, Moroni M, Braghetti P, Casucci P, Minelli L, Mezzetti D, Orfeo L, De Luca MG, Laforgia N, Grassi A, Gesu RB, Dotta A, Savignoni F, Bagnoli F, De Felice C, Badii S, Biasini A, Belluzzi A, Stella M, Romagnoli C, Zecca E, Barone G, Colleselli P, Vecchiato L, Nicolussi D, Monaldi N, Giliberti P, Chello G, Rojo S, Giovanettoni C, Colnaghi CA, Verucci E, Placidi G, Belloni C, Carrera G, Zambetti C, Biban P, Serra A, Carnielli V, Pedini A, Vetrano G, Furcolo G, Pasquariello B, Falco L, Ausanio G, Bernardo I, Marchesano G, Nosari N, Sarnelli P, Maccabruni M, Merazzi D, Gazzolo D, Sabatini FT, Colivicchi M, Del Vecchio A, Tarantino M, Gargano G, Pedori S, Bellettato M, Pesavento R, Cesaro A, Nicolò A, Mondello I, Pugliese A, Iervolino C, Corsello G, Giuffré M, Betta M, Romeo MG, Saporito A, D'Incecco C, Perrone B, Rodonò MG, Serra G, Franceschi A, Risso FM, Carpentieri M, Cigliano MP, Casilino R, Paolillo P, Picone S, Marra A, Rossetti D, Testa T, Del Cuore F., PALUDETTO, ROBERTO, CAPASSO, LETIZIA, RAIMONDI, FRANCESCO, Bellù, R, Gagliardi, L, Tagliabue, P, Corchia, C, Vendettuoli, V, Mosca, F, Zanini, R, Corsello, G, Giuffrè, M, Italian Neonatal Network., Condò, M, Turoli, D, Weissmann, G, Vanzati, M, De Nisi, G, Villa, E, Moro, G, Guerrini, P, Contiero, R, Ellero, S, Furlan, R, Abbiati, L, Borroni, C, Prandi, G, Fabris, C, Vielmi, F, Agosti, M, Tandoi, F, Guidali, De Curtis, M, Tozzi, C, Lucchini, R, Battaglioli, M, Lista, Gl, Introvini, P, Ferrari, F, Gallo, C, Cervello, P, Bellante, E, Bottura, C, Pasquali, F, Boccacci, S, Latini, G, Giannuzzi, R, Martinelli, S, Brunelli, A, Motta, G, Di Nunzio, Ml, Vendemiati, A, Zorzi, C, Carli, G, Alfiero, Romeo, N, Mammoliti, P, Mastretta, E, Barberis, L, Farina, D, Gancia, G, Dalmazzo, C, Napolitano, M, Messina, F, Rinaldi, G, Magaldi, R, Rinaldi, M, Litta, R, Lago, P, Zanardo, V, Chiandetti, L, Visentin, S, Presta, G, Cella, D, Poggiani, C, Ferrari, D, Parati, S, Lombardo, F, Grigorio, R, Barera, G, Franco, M, Poloniato, A, Colombo, A, Burgio, G, Sala, E, Barberi, I, Tiralongo, V, Arco, A, Careggi, F, Dani, C, Pratesi, S, Mignatti, V, Ancora, G, Faldella, G, Grandi, S, Stronati, M, Perotti, G, Chirico, G, Migliori, C, De Marini, S, Forleo, V, Paludetto, Roberto, Capasso, Letizia, Mansi, G, Raimondi, Francesco, Bona, G, Stucchi, I, Savastio, Ferrero, F, Parola, A, Padovani, Em, Viviani, E, Pecoraro, L, Tiberina, Fi, Agostino, R, Gizzi, C, Massenzi, L, Messner, H, Staffier, A, Salvia, G, Esposito, L, Forziati, V, Latorre, G, Sandri, F, Alati, S, Demaria, F, Lombardi, O, Costabile, Cd, Scarpelli, G, Cavalli, C, Volante, E, Proietti, D, Ganguzza, O, Spinella, B, Pietro, R, Haass, C, Scapillati, E, Consigli, C, Gatta, A, Quitadamo, P, Boldrini, A, Vuerich, M, Sigali, E, Ghirri, P, Fiorini, P, Petrucci, L, Moroni, M, Braghetti, P, Casucci, P, Minelli, L, Mezzetti, D, Orfeo, L, De Luca, Mg, Laforgia, N, Grassi, A, Gesu, Rb, Dotta, A, Savignoni, F, Bagnoli, F, De Felice, C, Badii, S, Biasini, A, Belluzzi, A, Stella, M, Romagnoli, C, Zecca, E, Barone, G, Colleselli, P, Vecchiato, L, Nicolussi, D, Monaldi, N, Giliberti, P, Chello, G, Rojo, S, Giovanettoni, C, Colnaghi, Ca, Verucci, E, Placidi, G, Belloni, C, Carrera, G, Zambetti, C, Biban, P, Serra, A, Carnielli, V, Pedini, A, Vetrano, G, Furcolo, G, Pasquariello, B, Falco, L, Ausanio, G, Bernardo, I, Marchesano, G, Nosari, N, Sarnelli, P, Maccabruni, M, Merazzi, D, Gazzolo, D, Sabatini, Ft, Colivicchi, M, Del Vecchio, A, Tarantino, M, Gargano, G, Pedori, S, Bellettato, M, Pesavento, R, Cesaro, A, Nicolò, A, Mondello, I, Pugliese, A, Iervolino, C, Giuffré, M, Betta, M, Romeo, Mg, Saporito, A, D'Incecco, C, Perrone, B, Rodonò, Mg, Serra, G, Franceschi, A, Risso, Fm, Carpentieri, M, Cigliano, Mp, Casilino, R, Paolillo, P, Picone, S, Marra, A, Rossetti, D, Testa, T, and Del Cuore, F.

Subjects
Preterm infants, Ventilation, Ventilatory support, Medicine (all), Drug Utilization, Humans, Infant Mortality, Infant, Newborn, Infant, Very Low Birth Weight, Intubation, Intratracheal, Italy, Oxygen Inhalation Therapy, Pulmonary Surfactants, Respiration, Artificial, Infant, Premature, Settore MED/38 - Pediatria Generale E Specialistica, Premature, Very Low Birth Weight, Respiration, Infant, Newborn, national survay, Intratracheal, Very preterm infant, national survay, neonatal respiratory care, Very preterm infant, Artificial, Preterm infant, neonatal respiratory care, Intubation
Abstract

INTRODUCTION: Variation of respiratory care is described between centers around the world. The Italian Neonatal Network (INN), as a national group of the Vermont-Oxford Network (VON) allows to perform a wide analysis of respiratory care in very low birth weight infants. METHODS: We analyzed the dataset of infants enrolled in the INN in 2009 and 2010 and, for surfactant administration only, from 2006 to 2010 from 83 participating centers. All definitions are those of the (VON). A questionnaire analysis was also performed with a questionnaire on centers practices. RESULTS: We report data for 8297 infants. Data on ventilator practices and outcomes are outlined. Variation for both practices and outcome is found. Trend in surfactant administration is also analyzed. CONCLUSIONS. The great variation across hospitals in all the surveyed techniques points to the possibility of implementing potentially better practices with the aim of reducing unwanted variation. These data also show the power of large neonatal networks in identifying areas for potential improvement.

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