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OBJECTIVE: The aim of this study was to assess pulmonary function and its predictors in very low birth weight (birth weight ≤1,500 g) children (VLBWc) with or without bronchopulmonary dysplasia (BPD), born at gestational age ≤32 weeks at a single tertiary center during 1996-1999, after the introduction of surfactant therapy. METHODS: Of the 120 surviving VLBW children, 48 (40%) VLBWc (22 with prior-BPD) at age 8.5 ± 1.0 years and 46 age-matched controls (8.8 ± 1.4 years) born at term, underwent lung function study. RESULTS: Adjusted values (z-score) of forced vital capacity (z-FVC), forced expiratory volume in 1 sec (z-FEV1), forced expiratory flow 25-75% (z-FEF25-75), carbon monoxide lung diffusion capacity (z-DLCO), and DLCO/alveolar volume (z-DLCO/VA) were significantly lower than controls (mean difference, 95% CI: -1.35, -1.81 to -0.90, P

Respiratory syncytial virus is a worldwide pathogen agent responsible for frequent respiratory tract infections that may become severe and potentially lethal in high risk infants and adults. Several studies have been performed to investigate the immune response that determines the clinical course of the infection. In the present paper, we review the literature on viral, environmental, and host factors influencing virus response; the mechanisms of the immune response; and the action of nonimmunological factors. These mechanisms have often been studied in animal models and in the present review we also summarize the main findings obtained from animal models as well as the limits of each of these models. Understanding the lung response involved in the pathogenesis of these respiratory infections could be useful in improving the preventive strategies against respiratory syncytial virus.

The aim of this study was to assess the diagnostic value of IgM Western blotting (WB), IgA enzyme immunoassay (EIA), and DNA amplification by real-time PCR on Guthrie cards to retrospectively establish the diagnosis of congenital toxoplasmosis (CT). To this purpose, Guthrie cards were collected from 18 infants born to mothers with primary Toxoplasma gondii infection during pregnancy. Moreover, the analytical sensitivity of T. gondii PCR was assessed by testing mock dried blood specimens set up with several known DNA dilutions. IgM WB was demonstrated to be the most sensitive method. When the results of T. gondii DNA detection and specific IgM recovery were combined, retrospective CT diagnosis by using Guthrie cards was established in 3 out of 6 infected infants (sensitivity, 50%; 95% confidence interval, 26.8% to 73.2%). No positive PCR or serologic results were found in the group of 12 uninfected infants, demonstrating the excellent specificity of the three methods (95% confidence interval, 78.1% to 99.5%). The findings of the present study suggest that, in cases of missed diagnosis of CT at birth, analysis of Guthrie cards for children with compatible clinical findings after the perinatal period, in particular the combination of recovery of specific IgM antibodies and T. gondii DNA amplification, could be helpful. Nevertheless, since suboptimal conditions of storage of dried blood specimens can seriously affect sensitivity, negative results cannot rule out CT diagnosis. In contrast, because of the excellent specificity shown by IgM serologic testing and T. gondii DNA amplification on Guthrie cards, positive results obtained by either of the two methods should be considered diagnostic.

Background/Aims: As evidence accumulates relating to mother-to-child (vertical) transmission of hepatitis C virus (HCV), it is timely to draw up guidelines for the clinical management of HCV infected pregnant women and their children. Methods: A review of evidence from the European Paediatric HCV Network (EPHN) prospective study of HCV infected women and their children and other published studies. Meeting of EPHN clinical experts to reach a consensus on recommendations for management. Each recommendation was graded according to the level of evidence. Results/conclusions: Although several risk factors for mother-to-child transmission have been identified, none are modifiable and there are currently no interventions available to prevent vertical transmission of HCV. Data on timing of loss of maternal antibodies and reliability of diagnostic tests inform the optimum follow-up schedule for confirmation or exclusion of infection in children born to HCV infected women. Based on the current evidence, routine antenatal screening for HCV should not be introduced and neither elective caesarean section nor avoidance of breastfeeding should be recommended to HCV infected women to prevent mother-to-child transmission of HCV. HCV/HIV co-infected women should follow existing HIV guidelines. © 2005 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Primary immunodeficiencies are rare inherited disorders that may lead to frequent and often severe acute respiratory infections. Respiratory syncytial virus (RSV) is one of the most frequent pathogens during early infancy and the infection is more severe in immunocompromised infants than in healthy infants, as a result of impaired T- and B-cell immune response unable to efficaciously neutralize viral replication, with subsequent increased viral shedding and potentially lethal lower respiratory tract infection. Several authors have reported a severe clinical course after RSV infections in infants and children with primary and acquired immunodeficiencies. Environmental prophylaxis is essential in order to reduce the infection during the epidemic season in hospitalized immunocompromised infants. Prophylaxis with palivizumab, a humanized monoclonal antibody against the RSV F protein, is currently recommended in high-risk infants born prematurely, with chronic lung disease or congenital heart disease. Currently however the prophylaxis is not routinely recommended in infants with primary immunodeficiency, although some authors propose the extension of prophylaxis to this high risk population.

BACKGROUND: The effectiveness of Toxoplasma gondii (Tg) screening during pregnancy in areas with a low prevalence of the infection is debated. We investigate the Tg serological status, the rate of primary infection in a cohort of pregnant women and the rate of congenital toxoplasmosis among their infants during a 3-year period in an urban area with low Tg prevalence. METHODS: Demographic and Tg serological data for all pregnant women delivering from January 2009 to December 2011 were collected. All pregnant women with primary Tg infection during pregnancy and their infants were included in the study. RESULTS: In early pregnancy, 10,347 women underwent prenatal screening and 2308 (22.3%) had anti-Tg. The seroprevalence among non-native women was significantly higher than that among native women [32.8% vs. 19.1%, relative risk: 1.71, P < 0.001]. The incidence rate of primary Tg infection during pregnancy was 0.77%. Immigrant women were more likely to be infected during pregnancy than Italian women (relative risk: 4.88, P < 0.001). Tg infection was more frequent in women coming from Africa, Asia, Eastern Europe and South America. The CT incidence rate was 0.06%. All congenitally infected infants were born to immigrant mothers. CONCLUSIONS: Tg infection during pregnancy and congenital disease are more frequent in non-native mothers and their infants. Measures to prevent Tg exposition must be carefully explained to pregnant women, with a focus on specific habits in non-native women. Prenatal screening is still effective to select women for prenatal therapy aiming to decrease vertical transmission and to identify foetuses/newborns with congenital disease that could benefit from pre/postnatal antiparasitic therapy.

Introduction: The infant gut microbiota composition is established in a relatively short time during the first two years of life. In particular birth represents a sensitive checkpoint to the future microbiota development which will exert a strong influence on human health. Several factors are known to influence the early microbial colonization of the gut in newborns as the mode of delivery, maternal microbiota of intestine, vagina and epidermis, type of infant feeding, gestational age at birth, hospitalization after birth and the use of antibiotics during the first few months of life. Conversely, the use of antibiotics on the mother during labour, referred to as intrapartum antibiotic prophylaxis (IAP), has been scarcely investigated, although this practice is routinely used in the group B Streptococcus (GBS) positive women. GBS infection remains one of the major causes of neonatal morbidity and mortality although deaths have declined significantly in the last decade (2001-2011) due to the introduction of IAP. This work is therefore aimed at verifying whether IAP can influence the main microbial groups of the newborn gut microbiota at an early stage of microbiota formation. Methods: 26 infants whose mothers gave positive results to GBS and subjected to IAP with ampicillin (IAP group) were compared to 26 infants whose mothers gave negative results to GBS (control group) were enrolled. Faecal samples were obtained at the age of 1 week. Real-time PCR on DNA extracted from faeces was used to quantify selected microbial groups (Lactobacillus spp., Bidobacterium spp., Bacteroides fragilis group, C. difficile and E.coli). In order to investigate the potential perturbations within the Bidobacterium population that were observed with the real time PCR, PCR-DGGE analyses using genus-specific primers targeted to bifidobacteria were carried out both on the IAP samples and on the controls. Results: The real-time PCR analyses showed that the gut microbiota of the IAP group had a significantly lower counts of bifidobacteria (P= 0.001) with respect to the control group. The other microbial genera and species analysed were not significantly affected by the IAP. Furthermore PCR-DGGE analysis revealed that bifidobacteria were affected by IAP not only quantitatively but also qualitatively. In fact, IAP determined a decrement in the frequency of B. breve (P= 0.003, 25% reduction), B. bifidum (P= 0.003, 25% reduction) and B. dentium (P= 0.001, 25% reduction) with respect to the control group. On the other hand, B. pseudocatenulatum, B. pseudolongum and B. longum seemed to be less influenced by the treatment. Discussion: This study has shown for the first time that IAP has a significant influence on the early bifidobacterial pattern of newborns, both quantitatively and qualitatively. However, the obtained results on a larger number of IAP newborns and the possibility of microbial restoration over time should be considered in future studies.

Mother-to-child transmission of hepatitis C virus (HCV) has been reported in up to 10% of cases and is much more likely to occur when the mother is also infected by HIV. Although women with HCV viremia are especially likely to transmit infection, the precise time when transmission takes place is not known. Transmission of HCV was examined in a prospective cohort study using data from the European Pediatric Hepatitis C Network. Fifty-four HCV-infected children were tested by the HCV RNA polymerase chain reaction technique within 3 days of birth. Nearly one third (31%) of newborn infants tested in the first 3 days of life had positive results. Transmission was more likely if the mother was coinfected by HIV, but the difference was not statistically significant. Mode of delivery, gender, and gestational age failed to predict the polymerase chain reaction (PCR) findings. Mean birth weight was significantly lower in infected children, but there was no significant difference when low-birth-weight infants were compared with normal-weight neonates. Breast-fed infants were marginally less likely than formula-fed infants to be PCR-positive. Four of 10 infants born to mothers who tested positive 4 weeks before delivery were themselves PCR-positive, but this was not the case for any of 4 infants born to PCR-negative women. A positive association between PCR positivity in the first 3 days of life and infection by genotype 1 remained significant after adjusting for several possible confounding factors. In 36 infants who were PCR-negative when born, the mean age at the first positive test was 3.9 months. Late intrauterine or intrapartum transmission was considered to be most likely for 27 infants who were PCR-negative at birth but -positive by age 3 months. Peripartum transmission seemed likely for 9 infants who were PCR-negative at birth and PCR-positive for the first time after 3 months. It appears that at least one third of HCV-infected infants, and possibly as many as half of them, acquire infection before birth. Should effective treatment be developed that is safer for pregnant women than are interferon-a and ribavirin, treatment optimally would begin early in pregnancy.

Gastroesophageal reflux (GOR) is very common among preterm infants, due to several physiological mechanisms. Although GOR should not be usually considered a pathological condition, its therapeutic management still represents a controversial issue among neonatologists; pharmacological overtreatment, often unuseful and potentially harmful, is increasingly widespread. Hence, a stepwise approach, firstly promoting conservative strategies such as body positioning, milk thickening, or changes of feeding modalities, should be considered the most advisable choice in preterm infants with GOR. This review focuses on the conservative management of GOR in the preterm population, aiming to provide a complete overview, based on currently available evidence, on potential benefits and adverse effects of nonpharmacological measures. Nonpharmacological management of GOR might represent a useful tool for neonatologists to reduce the use of antireflux medications, which should be limited to selected cases of symptomatic babies.

Il capitolo presenta le ricerche in ambito internazionale, nazionale e del gruppo di ricerca interdisciplinare degli autori dello stesso capitolo relativamente allo sviluppo psicomotorio nei primi anni di vita dei bambini nati pretermine, tenendo conto dei diversi fattori di rischio neonatali, tra cui l’età gestazionale, e dei fattori di rischio e di protezione ambientali. Il capitolo esamina poi specificamente gli studi longitudinali condotti sui bambini nati pretermine mediante le scale di sviluppo Griffiths e presenta uno studio molto recente del gruppo di ricerca sullo sviluppo psicomotorio a 2 anni di bambini nati pretermine figli di italiani e figli di migranti. Infine, discute i risultati ottenuti in questa ricerca alla luce del modello neurocostruttivista, evidenziando come gli esiti neuropsicologici dei bambini nati pretermine dipendano da una stretta interazione tra fattori biologici e ambientali e sottolineando la necessità di nuovi strumenti di valutazione dello sviluppo nella prima infanzia che tengano conto del contesto linguistico e culturale a cui i bambini appartengono.

La nascita pretermine è un evento frequente, in Italia riguarda il 7% dei neonati. Dagli anni ’90, l’introduzione di nuovi farmaci e tecnologie mediche ha infatti determinato un incremento della sopravvivenza dei neonati con estrema immaturità. Alle cure mediche si sono progressivamente affiancate modalità di cura e assistenza psicologica sia nei reparti di Terapia Intensiva Neonatale sia dopo le dimissioni, al fine di monitorare lo sviluppo di questi bambini e migliorare la loro qualità di vita. I nati pretermine, infatti, anche quando non hanno danni neurologici, possono presentare problematiche mediche e sequele minori, motorie, relazionali, cognitive, linguistiche, di apprendimento e di comportamento. Il volume raccoglie i contributi di studiosi italiani che si occupano dello sviluppo neurologico, fisico e psicologico dei bambini nati pretermine, degli strumenti di valutazione e screening da utilizzare nel follow-up di questi bambini, e degli interventi di cura e supporto finalizzati a migliorarne il percorso evolutivo. L’approccio interdisciplinare, l’aggiornamento nell’ambito della ricerca e clinico, la prospettiva evolutiva forniscono a chi lavora con questi bambini un modello di riferimento fondamentale per progettare percorsi di cura e supporto allo sviluppo del bambino e alla sua famiglia mediante un’assistenza multidisciplinare che prosegue per diversi anni dopo le dimissioni e coinvolge, oltre ai neonatologi e agli psicologi, diverse figure professionali: tra questi, il pediatra di famiglia, il neuropsichiatra infantile, il fisiatra, il fisioterapista, il logopedista, l’educatore e l’insegnante.

Monoclonal antibodies are widely used both in infants and in adults for several indications. Humanized monoclonal antibodies (palivizumab) have been used for many years for the prevention of respiratory syncytial virus infection in pediatric populations (preterm infants, infants with chronic lung disease or congenital heart disease) at high risk of severe and potentially lethal course of the infection. This drug was reported to be safe, well tolerated and effective to decrease the hospitalization rate and mortality in these groups of infants by several clinical trials. In the present paper we report the development and the current use of monoclonal antibodies for prophylaxis against respiratory syncytial virus.

Premessa Secondo la letteratura internazionale, per l’assistenza a pazienti con patologie croniche complesse sono particolarmente importanti coordinamento e continuità delle cure. Le evidenze sono ancora limitate per neonati e bambini con problematiche complesse, una categoria di pazienti a bassa prevalenza e ad alto costo assistenziale. L’integrazione e il coordinamento tra servizi e professionisti coinvolti influiscono sulla qualità dell’assistenza e sulla soddisfazione delle famiglie. Tra i Programmi finanziati dalla Regione Emilia‐Romagna, il Progetto SpeNK (Special Needs Kids) indaga i percorsi integrati ospedale-territorio nella provincia di Bologna, il grado di coordinamento fra servizi e professionisti, il ruolo del Pediatra di Libera Scelta e il punto di vista delle famiglie. Scopo dello studio Obiettivo della presente analisi è esplorare la percezione rispetto alla continuità delle cure dei genitori di bambini con problemi complessi. Materiali e metodi Sono state condotte interviste semi-strutturate con 10 famiglie per indagare l’esperienza vissuta nel contatto con i servizi ospedalieri e territoriali a 1 mese dopo la dimissione dai reparti di neonatologia del Policlinico S.Orsola e dell’Ospedale Maggiore di Bologna e pediatria dell’Ospedale di Imola. Con l’analisi qualitativa del contenuto sono stati identificati i temi trasversali e specifici delle esperienze raccontate. Risultati I risultati preliminari rilevano il carico emotivo vissuto dalle famiglie soprattutto durante il ricovero ospedaliero. Aspetti legati a continuità e coordinamento sono presenti nell’esperienza di contatto delle famiglie con i servizi sia ospedalieri che territoriali. Informazione e addestramento risultano importanti per i genitori nella gestione del bambino sia in ospedale che a casa. Il punto di riferimento dopo la dimissione continua a essere l’ospedale. Il confronto e la condivisione con altri genitori rappresentano una risorsa importante. Conclusioni I risultati qualitativi preliminari confermano che informazione e coinvolgimento dei genitori influiscono sulla percezione della famiglia e che il coordinamento fra professionisti è ritenuto fondamentale ma spesso carente. È necessario sviluppare e validare strumenti per monitorare la percezione delle famiglie in maniera sistematica.

AIMS Congenital Toxoplasmosis (CT) in newborns results from primary maternal infection with T. gondii (TG). Most infected children show no symptoms at birth but are at great risk of sequelae during the first year of life or in early childhood [1]. Polymerase chain reaction (PCR) analysis of dried blood samples on the Guthrie card has been proposed as a sensitive method to screen for congenital CMV infection, but there are no data about the use for TG screening. The aim of present study was to assess the utility of PCR analysis of dried blood samples for the retrospective diagnosis of CT. METHODS A retrospective study was performed with 18 infants born between January 2010 and June 2012. Transmitters mothers seroconverted in the second trimester of pregnancy (mean 23.5 ± 7.9 weeks). At birth, serological tests (Enzygnost Toxoplasmosis IgG, IgM, IgA-Siemens Healthcare Diagnostics; Vidas Toxo IgMbioMerieux) as well as IgM-IgG WB (LDBio Toxoplasma WB IgG/IgM-LDBio Diagnostics) were performed in all mother-child pairs.Nucleic acids were extracted from Guthrie cards with VERSANT kPCR Sample Preparation system (Siemens) and Toxoplasma Q-PCR Alert Kit (Nanogen) was used for the amplification of TG target region AF 146527. RESULTS In 7/18 (38.9%) infants, CT was diagnosed by IgM-WB positivity at birth. The remaining 11 were considered non-infected (61.1%) and became IgG negative within 12 months of life. Infected infants received one-year therapy (pyrimethamine/sulfadiazine) and were followed according to our protocol. Four of these had a pathological neuroimaging (4/4 calcifications, 2/4 ventriculomegaly). None had hearing loss. TG DNA was detected in only one of the Guthrie cards of the infected newborns, while all the others were negative. CONCLUSIONS Although serological methods remain basic in the diagnosis of CT, TG DNA detection in Guthrie cards could be considered a retrospective method to evaluate infants (> 1 year of age) with clinical signs suggestive of CT. More studies with a larger number of infected cases are needed to assess the sensitivity of this method.

AIMS Chlamydia trachomatis is one of the most common sexually transmitted agents. Infants born vaginally to infected mothers may present with conjunctivitis (20-50%) and/or pneumonia (5-20%) [1]. Chlamydia spp. is a frequent identifiable cause of neonatal conjunctivitis, in association with S. aureus, E. coli, N. gonorrhoeae. Topical eye drops such as silver nitrate 1% effectively prevent gonococcal neonatal conjunctivitis; however, antibiotic topical agents are commonly used in the clinical practice in the attempt to prevent also chlamydial infections. METHODS Topical ocular prophylaxis with fusidic acid was instituted early after birth. Data about new cases of chlamydial conjunctivitis from September 2011 to August 2012 were recorded. Data included length and course of pregnancy, maternal diseases, delivery method, newborn weight, postnatal course. RESULTS Two cases of isolated chlamydial conjunctivitis were recorded. Both infants (one male, one female) were born by vaginal delivery. They were full term, healthy infants,without ocular malformations, whose mothers were treated with neither systemic nor local antibiotics near delivery. Birth weight: 3,400 and 2,380 g respectively. Pregnancy courses are unknown. Both infants received antibiotic prophylaxis in each eye 20 minutes after delivery. The age of presentation for conjunctivitis was between day 10 and 12 of life. Infants presented with hyperemic conjunctiva, mucopurulent discharge and swollen eyelids. The male infant also had blood-stained eye discharge. Ophthalmological examinations showed follicular conjunctivitis. Definite diagnosis was made by detection of Chlamydia DNA by PCR on specimens obtained by swabbing the conjunctiva. Both infants were treated with systemic Clarithromycin at 10 mg/kg/day in 2 doses for 14 days, after an electrocardiogram was performed. No long-term ocular sequelae were found. CONCLUSIONS In addition to the typical features of chlamydial conjunctivitis, a follicular conjunctivitis was demonstrated at ophthalmological examination in both our neonates. Prophylaxis with fusidic acid did not prevent all cases of chlamydial neonatal conjunctivitis. In the absence of information about pregnancy, screening for Chlamydia spp. may be an effective practice to prevent neonatal infection and related complications.

Background and Aims: Gastro-oesophageal reflux (GER) is a common condition in preterm infants. The management usually begins with nonpharmacologic approaches (body positioning/milk thickening). However, the thickened formulas role is still debated and at present, commerciallyavailable thickened formula are not adequate to satisfy preterm nutritional needs. The aim of this study was to evaluate the efficacy of an amylopectin-thickened formula on GER by combined pH-impedance monitoring (pH-MII). The tested formula is specifically thought to satisfy the nutritional needs of preterm infants. Methods: Twenty-five symptomatic preterm infants (GA

Background and Aims: RHD is characterised by haemolysis and hyperbilirubinaemia. New AAP guidelines recommended high-dose IVIg as an alternative of exchange transfusion (EXT). The aim of this study was to compare clinical outcomes of RHD patients before and after the introduction of IVIg. Methods: A chart-review of 88 Coombs-positive RHD patients (1999– 2009) was performed. Patients were divided into two groups, treated before (Group A [GA], n = 35) and after (Group B [GB], n = 53) the introduction of IVIg, respectively. Number of EXT and RBC transfusions, days of permanence of umbilical catheter (UC), duration of hospitalisation and phototherapy, maximum bilirubinaemia, changes in bilirubinaemia over time, and morbidity were compared in the two groups. Results: GB-patients had lower EXT need (13% vs 82% in GA, p = 0.000), UC need (58% vs 97%, p = 0.001) and UC days (mean 2.8/patient vs 4.6, p = 0.001), higher need of RBC transfusions (mean 0.9/patient vs 0.2, p = 0.000), longer hospitalisation (mean 12.1 days/patient vs 6.9, p = 0.000) and longer phototherapy (mean 7.6 days/patient vs 4.5, p = 0.000). No significant difference in maximum bilirubinaemia was found; in GB-patients bilirubinaemia overcame neurological-risk value for shorter period (mean 55.4 hours/patients vs 74.6, p = 0.047). 43.9% GA-patients had thrombocytopenia, 21.9% hypocalcaemia, 4.9% hypomagnesaemia, 19.5% UC-related complications, and 9.8% adverse reactions during EXT. Two infants in GB developed NEC. Conclusions: High-dose IVIg in RHD patients reduced EXT need, UC need and permanence time, and risk of hyperbilirubinaemia-related neurological damage. Instead, IVIg-treated patients needed longer hospitalisation, longer phototherapy, and had increased need of RBC transfusions.

Introduzione. La letteratura evidenzia che i bambini nati di età gestazionale estremamente bassa (ELGA ≤ 28 settimane), presentano maggiori probabilità di incorrere in ritardi evolutivi e disturbi relazionali. Nell’ambito del Progetto Strategico sui rischi associati alla nascita gravemente pretermine, la presente indagine fornisce i dati preliminari inerenti lo stress genitoriale e i vissuti materni rispetto allo sviluppo del proprio bambino. Metodo. Il campione include 19 madri, di cui 8 di nati pretermine ELGA, senza danni motori/neurologici permanenti. A 12 e 18 mesi del bambino (corretti per i nati ELGA) le madri hanno compilato il Parenting Stress Index, inerente il livello di distress percepito rispetto al proprio ruolo genitoriale e alla relazione con il figlio, e le CBCL - Child Behavior Checklist 1/2-5, inerenti la percezione materna del funzionamento comportamentale, affettivo e sociale del bambino. Risultati. L’intero campione mostra punteggi nella norma nei due strumenti. Nei prematuri emerge una percezione materna dell’interazione genitore-bambino più disfunzionale rispetto ai controlli, sia a 12 (p=0,045) che a 18 mesi (p=0,027). Tra i due assessment, le madri dei controlli mostrano un calo nel distress genitoriale, mentre nei prematuri le madri mostrano un aumento a 18 mesi (p=0,048). Nella CBCL/1/2-5, i prematuri ottengono valori minori dei controlli nelle scale Externalizing (p=0,045) e Somatic Complaints (p=0,025). La scala Somatic Complaints della CBCL/1/2-5 mostra correlazioni positive con la percezione materna di: una disfunzionale interazione genitore-bambino, nei controlli (r=0,798; p=0,003); il proprio bambino come difficile, nei prematuri (r=0,570; p=0,042). Conclusioni. Sebbene in un range di normalità, i risultati mostrano come nei nati ELGA vi sia un ritardo nello sviluppo della motivazione a fare da solo e nell’esternalizzazione dei comportamenti di ostinazione e protesta psicosomatica, fisiologici a 18 mesi, come da noi già evidenziato in precedenti lavori. Ciò si accompagna a una percezione materna del nato pretermine come maggiormente problematico.

This case concerns a premature infant with typical signs of congenital syphilis born to an untreated foreign mother. Syphilis prevalence in pregnant women has been rising in Italy since the beginning of the 21st century, mainly due to immigration. A correct antenatal syphilis screening and consequent adequate therapy of pregnant woman are fundamental to prevent the neonatal infection.

BACKGROUND: Gastro-oesophageal reflux is common in preterm newborns; at present, no studies have evaluated the efficacy of sodium alginate in this population. AIM: To evaluate the effect of sodium alginate on gastro-oesophageal reflux features in preterm newborns by combined pH and impedance monitoring (pH-MII). METHODS: Thirty-two symptomatic preterm newborns underwent a 24 h pH-MII, during which each baby was fed eight times. Sodium alginate was given four times at alternate meals [drug-given (DG) vs. drug-free (DF) meals]. Gastro-oesophageal reflux features (i.e. number, acidity, duration and height of gastro-oesophageal reflux) after DG and DF meals were compared by Wilcoxon signed ranks test. RESULTS: Sodium alginate significantly decreased the number of acid gastro-oesophageal reflux detected either by pH monitoring (DG vs. DF: median 17.00 vs. 29.00, P = 0.002) and MII (DG vs. DF: 4.0 vs. 6.00, P = 0.050), and also acid oesophageal exposure (DG vs. DF: 4.0% vs. 7.6%, P = 0.030), without any influence on non-acid gastro-oesophageal reflux. Furthermore, it decreased the number of gastro-oesophageal reflux reaching proximal oesophagus (DG vs. DF: 5.50 vs. 7.50, P = 0.030). CONCLUSIONS: The use of sodium alginate in preterm infants seems to be promising, because this drug decreases gastro-oesophageal reflux acidity and height with the advantage of a nonsystemic way of action and a more favourable safety profile over H2 blockers and PPIs.

BACKGROUND: To evaluate whether physical and/or chemical features of gastro-esophageal reflux (GER) influence its relationship with apnea of prematurity (AOP). METHODS: Fifty-eight preterm newborns (GA ≤ 33 weeks) with recurrent apneas were studied by simultaneous polysomnography and combined impedance and pH monitoring, to analyze whether the correlation between GER and AOP varies according to the acidity, duration and height of GERs. KEY RESULTS: The frequency of apnea (number apnea/min) occurring after-GER [median (range) 0.07 (0-0.25)] was higher than the one detected in GER-free period [0.06 (0.04-0.13), P = 0.015], and also than the one detected before-GER [0 (0-0.8), P = 0.000]. The frequency of apneas detected in the 30'' after pH-GER [median (range), 0 min(-1) (0-1.09)] was higher than the frequency detected in the 30'' before [0 (0-0.91), P = 0.04]; even more, the frequency of apneas detected after non-acid MII-GER episodes [0 (0-2)] was significantly higher than the one detected before [0 (0-1), P = 0.000], whereas the frequency of apneas detected before acid MII-GER episodes [0 (0-0.67)] did not differ from the one detected after [0 (0-2), P = 0.137]. The frequency of pathological apneas detected in the 30'' after-GER (0 min(-1), range 0-0.55) was higher than the frequency detected before (0, range 0-0.09; P = 0.001). No difference in mean height or in mean duration was found between GERs correlated and those non-correlated to apnea. CONCLUSIONS & INFERENCES: Non-acid GER is responsible for a variable amount of AOP detected after-GER: this novel finding must be taken into consideration when a therapeutic strategy for this common problem is planned.

Diversi studi hanno mostrato che i nati pretermine presentano difficoltà nelle competenze linguistiche orali in età prescolare e anche scritte in età scolare (per una rassegna si veda Guarini e Sansavini, 2010). Difficoltà nello sviluppo della produzione lessicale e grammaticale sono state evidenziate dai due anni, soprattutto nei nati pretermine a più elevato rischio biologico a causa di una elevata immaturità in termini di età gestazionale e peso alla nascita E’ quindi rilevante comprendere come e quando emergano tali difficoltà indagandone lo sviluppo prima dei due anni e focalizzandosi su competenze verbali, quali la comprensione, e non verbali, quali i gesti, che nello sviluppo tipico sono associate all’emergere della produzione lessicale (Capirci et al., 1996). Obiettivi. Il primo obiettivo del lavoro è esaminare longitudinalmente lo sviluppo delle competenze gestuali e lessicali, in comprensione e produzione, di nati pretermine con elevata immaturità neonatale nel secondo anno di vita confrontandole con quelle di un campione longitudinale di bambini nati a termine. Il secondo obiettivo è indagare se le prime competenze gestuali e lessicali siano predittive della produzione lessicale a due anni di età nei campioni di bambini esaminati. Metodo. 104 bambini pretermine di madre lingua italiana, nati presso l’Unità di Neonatologia dell’Università di Bologna, con un’età gestazionale

Background and aims: The relationship between apnoea of prematurity (AOP) and gastro-oesophageal reflux (GOR) has been frequently hypothesized. Both GOR and AOP occur frequently in preterm infants: actually, in clinical practice it is common to observe an increased frequency of AOP during postprandial periods, when the majority of GOR episodes also occurs. The widespread clinical perception that postprandial apnoeas in preterm infants can be related to GOR probably contributes to the well-known GOR over-treatment in this population. In a previous study, we found a significant increase of the frequency of AOP in the period following the onset of GOR, suggesting a possible causal relationship between GOR and AOP in a limited and variable proportion of AOP. We aim to evaluate whether physical and/or chemical features of gastro-oesophageal reflux (GOR) influence the relationship between GOR and apnoea of prematurity (AOP). Materials and methods: Fifty-eight preterm newborns (20 male) with gestational age ≤ 33 weeks were studied as they had recurrent apnoeas. None of them had malformation or major gastrointestinal problems, nor was taking drugs influencing gastrointestinal motility or gastric acidity. Each infant underwent a simultaneous recording of polysomnography (PSG) and combined impedance and pH monitoring (pH-MII). The investigator who analyzed pH-MII layouts was blind to the results of PSG, and vice versa. All the data, recorded during each postprandial period, were then separately analyzed. We analyze whether the correlation between GOR and AOP varies according to the acidity, duration and height of GOR episodes. All the episodes detected by MII with a concomitant decrease in pH to less than 4 are defined as acid MII-GOR (a-MII-GOR), while the episodes with a pH >4 are defined as non-acid MII-GOR (Na-MII-GOR). Acid GOR episodes recorded only by pH probe are defined a pH-GOR. PSG detects apneas by recording of breathing movement, nasal airflow, electrocardiogram and oxygen saturation. We considered as apnoeas each oral/nasal flow cessation lasting at least 5 seconds. Apnoeas were then classified as central (CA), obstructive (OA) and mixed (MA) depending on absence or presence of obstructed respiratory efforts. Apnoeas detected in the 1-minute time around the onset of each kind of GOR were further divided into apnoeas detected 30” before and 30” after the onset of GOR. Apnoeas detected within 30 seconds after the onset of a GOR episode were defined GOR-induced Results: One-hundred-eighty-seven apnoeas out of 1523 were detected within 30” before and/or after the onset of a GOR episode. The frequency of apnoeas detected in the 30” after pH-GOR (0.148/min) was higher than the frequency detected in the 30”before (0.085/min; p=.04); even more, the frequency of apnoeas detected in the 30” after non-acid MII-GOR episodes (0.223/min) was significantly higher than the one detected in the 30” before (0.057/min; p=.000), whereas the frequency of apnoeas detected 30” before acid MII-GOR episodes (0.029/min) did not differ from the one detected after (0.109/min, p=.137). Furthermore we calculated -apnoea-frequency (defined as the difference between the frequency of apnoea after and before GOR for each type of GOR and for each patient) and we found that -apnoea-frequency of Na-MII-GOR (0.166/min) was significantly higher than those of pH-GOR (0.055/min; p=.025) and aMII-GOR (0.065/min; p=.007). No difference in the mean height nor in the mean duration was found between GOR episodes inducing and those non-inducing an apnoea. Conclusion: The analysis of physical and chemical features of GOR highlights that the most dramatic increase (approximately four-fold) in the frequency of apnoeas after GOR is due to non-acid GOR episodes. Non–acid GOR is prevalent soon after feeding, when the stomach is full of milk: thus, we can hypothesize that, in that period, the majority of GORs, beyond being non-acid, is huge enough to distend mechanically the mid-oesophagus, thus evoking an apnoea. This data could explain the clinical observation of an increase of AOP in the post-prandial period. Non-acid GOR is the main responsible for the variable amount of AOP induced by GOR: this novel finding must be taken into consideration when a therapeutic strategy for this common problem is planned.

OBJECTIVE: Palivizumab reduces respiratory syncytial virus (RSV) hospitalization in children at high risk by ∼50% compared with placebo. We compared the efficacy and safety of motavizumab, an investigational monoclonal antibody with enhanced anti-RSV activity in preclinical studies, with palivizumab. METHODS: This randomized, double-blind, multinational, phase 3, noninferiority trial assessed safety and RSV hospitalization in 6635 preterm infants aged ≤6 months at enrollment or children aged ≤24 months with chronic lung disease of prematurity who received 15 mg/kg palivizumab or motavizumab monthly. Secondary end points included outpatient medically attended lower respiratory tract infections (MALRIs), RSV-specific LRIs, otitis media, antibiotic use, development of antimotavizumab antibodies, and motavizumab serum concentrations. RESULTS: Motavizumab recipients had a 26% relative reduction in RSV hospitalization compared with palivizumab recipients, achieving noninferiority. Motavizumab was superior to palivizumab for reduction of RSV-specific outpatient MALRIs (50% relative reduction). Overall, adverse events (AEs) were not significantly different between groups. Cutaneous events were reported in 2 percentage points more motavizumab recipients (7.2% vs 5.1%); most were mild, but 0.3% resulted in dosing discontinuation. Antidrug antibodies (ADA) were detected in 1.8% of motavizumab recipients. Patients with anti-drug antibody reported 6 RSV events and 17 cutaneous events. CONCLUSIONS: Children receiving prophylaxis with motavizumab or palivizumab had low rates of RSV hospitalization; motavizumab recipients experienced 50% fewer RSV MALRIs than palivizumab recipients. AEs were similar in both groups, although cutaneous AEs were higher for motavizumab recipients. Motavizumab may offer an improved alternative in prophylaxis for serious RSV disease in infants and children at high risk.

Background and aims: Apnoea of prematurity (AOP) is one of the most common and frequently recurring problem in preterm infants and its relationship with gastro-oesophageal reflux (GOR) is widely debated in literature. Our previous study highlights an increase of AOP in periods after GOR. The aim of this study is to evaluate the efficacy of sodium alginate (Gaviscon®) in reducing frequency of AOP related to GOR in preterm infants by a simultaneous and synchronized pH-Intraluminal Impedance Monitoring (pH-MII) and polysomnography in preterm infants. Materials and methods: Twenty-eight preterm infants (gestational age < 33 weeks; mean birth weight 1100 gr) were studied as they had recurrent apneas. Patients who were taking drugs influencing gastrointestinal motility or gastric acidity and infants with malformations, major gastrointestinal problems or sepsis were ruled out. They underwent a six-hour simultaneous and synchronized recording of polysomnography and pH-impedance monitoring (pH-MII). Polysomnography detects apneas by recording of breathing movement, nasal airflow, electrocardiogram and pulse oximeter saturation. To avoid possible artefacts a portable camera video registered the infants during all the recording. We considered as apnoeas each oral/nasal flow cessation lasting at least 5 seconds. Apnoeas were then classified as central (CA), obstructive (OA) and mixed (MA) depending on absence or presence of obstructed respiratory efforts. pH-MII is the state-of-the-art methodology for GOR detection in preterm newborns. By pH-MII monitoring we registered both acid and non acid GORs. A standard period of 30 seconds after the onset of GOR episodes was chosen in order to test the temporal relation between GOR and apnoea. Apnoeas detected within 30 seconds after the onset of a GOR episode were defined GOR-induced. Layouts involved 2 post-prandial periods lasting 3 hours each one, characterized by presence or absence of treatment with Gaviscon® (2cc/kg) after meal. The period after Gaviscon administration was called GAV, the other No-GAV. The meal after which Gaviscon® was administered was randomly assigned in order to avoid any possible carry-over effects. During the analysis of layouts the investigator was blind to the administration of Gaviscon. pH-MII and polysomnography data were independently analyzed by two different investigators and then compared. Data obtained during these two periods were finally compared. Results: Seven-hundred-fifteen apnoeas were recorded during 165 hours of registration and then divided according to the administration of Gaviscon®. Comparing data found after the treatment with those registered during freetreatment periods, we found no differences in number of total apnoeas (AOP during GAV vs NO-GAV was 12.4±9.5 vs 13.1±12.0 apnoeas/period, p=0.99) and related events. However a significant reduction in the number of GOR episodes after using Gaviscon® was observed (GOR during GAV vs NO-GAV was 11.3±8.6 vs 19.1±10.5 events/period, p=0.001), but this data is not the same for each type of GOR. Actually the analysis of GOR highlighted as the acid episodes resulted less after Gaviscon®, whereas the administration of Gaviscon do not modify the number of non acid GORs. Conclusion: Our data demonstrate as the administration of Gaviscon® has not effects on the AOP. Nevertheless there is a significant reduction of acid GORs after administration of Gaviscon®.We hypothesized that the lack effect on AOP could be explained by the poor efficacy in reducing non acid GORs, particularly relevant in preterm infants

In letteratura diverse ricerche hanno dimostrato che la nascita pretermine ha effetti sullo sviluppo cognitivo nell’infanzia e in età scolare. Meno indagati sono stati gli effetti su specifiche competenze cognitive e linguistiche e il cambiamento di tali effetti nel tempo. Si intendono quindi presentare i risultati di ricerche condotte da noi e da altri ricercatori in ambito nazionale e internazionale, che hanno analizzato, accanto alle competenze cognitive, specifiche competenze linguistiche in nati pretermine, tenendo conto sia dei fattori di rischio biologici (peso, età gestazionale, complicazioni neonatali), sia dei fattori sociali, con particolare attenzione all’interazione tra tali fattori. Si intende inoltre evidenziare quali sono i sottogruppi di nati pretermine con maggiori difficoltà e quali indici di rischio precoci sono predittivi dello sviluppo cognitivo e linguistico successivo di questi bambini. I risultati di questi studi sono rilevanti ai fini della comprensione dello sviluppo cognitivo e linguistico di questa popolazione e dell’individuazione precoce dei bambini che necessitano interventi mirati di supporto e riabilitazione.