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Objective Aim of the study is to evaluate disorders related to positional plagiocephaly and introduce a new model of early intervention based on the osteopathic integrated approach. Methods We review clinical experience of the “Program for Neurodevelopmental Follow-up and Pediatric Osteopathy”, a service dedicated to newborns at risk for developmental disorders. Results We present clinical data of 310 newborns followed during first years of life. Data analysis examines perinatal history, general features and disorders that could be related to plagiocephaly. Conclusions The experience confirms that plagiocephaly is not only a problem regarding the shape of the head, it involves the functions. In our Service most babies (81%) with positional plagiocephaly showed isolated or associated disorders that had an impact on growth, behavior and development. The early intervention based on the osteopathic integrated approach is addressed not only to the cranial shape but consider the baby as a whole, and the environment where he lives.

Background: Vasomotor nephropathy is a common renal dysfunction in very preterm neonates. Objective: To determine whether theophylline could prevent vasomotor nephropathy in very preterm infants with respiratory distress syndrome. Methods: A randomised, double blind, placebo controlled trial of 50 preterm infants of gestational age ⩽32 weeks needing assisted ventilation. Infants received an intravenous dose of theophylline (1 mg/kg) or placebo for three days. The 24 hour urine volume was measured daily. On days 2, 5, and 11, blood samples and 12 hour urine collections were analysed for electrolytes, creatinine, and urea. Results: On day 1, urine output was significantly higher in the theophylline (2.4 (0.9) ml/kg/h) than the placebo (1.6 (1.0) ml/kg/h; p = 0.023) group (values are mean (SD)). The incidence of oligoanuria was significantly lower in the theophylline treated (5%) than the placebo (33%) group. Twenty four hours after the first administration of theophylline/placebo, serum creatinine concentration was significantly lower in the theophylline (0.76 (0.23) mg/dl) than the placebo (1.0 (0.41) mg/dl; p = 0.025) group. On day 5 an increase in serum creatinine was observed in both groups. On day 11 a significant reduction in serum creatinine was observed, compared with day 5, with no difference between the two groups. Conclusion: The results suggest that, in very preterm infants with respiratory distress syndrome, early theophylline administration improves renal function during the first two days of life.

UNLABELLED GM(1) gangliosidosis is a rare disorder characterized by deficiency of the ss-galactosidase enzyme, with the resulting accumulation of glycolipids, oligosaccharides and especially GM(1) ganglioside. It can be classified into three clinical types according to the time of onset: infantile, juvenile and adult form. We report a case of GM(1) gangliosidosis presenting with fetal hydrops at 24 wk of gestation. The parents were consanguineous; the baby, born at 35 wk of gestation, was dysmorphic and presented severe generalized oedema. The most common cause of fetal hydrops was excluded. A lysosomal storage disease was suspected, and GM(1) gangliosidosis was diagnosed. The child developed severe growth and mental retardation and died when she was 21 mo old. CONCLUSION We suggest that the possible association between inborn errors of metabolism and antenatal ascites should be considered, in order to offer genetic counselling due to the high recurrence risk and the availability of early antenatal diagnosis.

Inactivating mutations in the SLC12A3 gene that encodes the thiazide-sensitive co-transporter causes Gitelman syndrome. The main features of this syndrome include normal or low blood pressure, hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria, and hyperreninemia. These patients are at low risk for preterm birth and do not present with symptoms before school age. As a consequence, the condition is usually diagnosed in late childhood or in adult life. We report on four patients, two pairs of prematurely born twins, in whom hypokalemia was demonstrated early in life. In these children, a tendency towards hypokalemia was first noted during the third week of life. Overt hypokalemia subsequently appeared associated with normal blood pressure, hypochloremia, hyperreninemia, and an inappropriately high fractional excretion of potassium and chloride. Molecular biology studies failed to detect mutations in the SLC12A1, KCNJ1, and CLCNKB genes responsible for the Bartter syndromes type I, II and III, respectively. Compound heterozygous mutations in the SLC12A3 gene were detected in both pairs of twins: a frameshift mutation in exon 10 (c.1196_1202dup7bp), leading to the truncated protein p.Ser402X, and a missense mutation in exon 11, p.Ser475Cys (c.1424C>G) in the first pair; two missense mutations, p.Thr392Ile (c.1175C>T) in exon 9 and p.Ser615Leu in exon 15 (c.1844C>T), in the second pair. In conclusion, the diagnosis of Gitelman syndrome deserves consideration in infants with unexplained hypokalemia.

GM(1) gangliosidosis is a rare disorder characterized by deficiency of the ss-galactosidase enzyme, with the resulting accumulation of glycolipids, oligosaccharides and especially GM(1) ganglioside. It can be classified into three clinical types according to the time of onset: infantile, juvenile and adult form. We report a case of GM(1) gangliosidosis presenting with fetal hydrops at 24 wk of gestation. The parents were consanguineous; the baby, born at 35 wk of gestation, was dysmorphic and presented severe generalized oedema. The most common cause of fetal hydrops was excluded. A lysosomal storage disease was suspected, and GM(1) gangliosidosis was diagnosed. The child developed severe growth and mental retardation and died when she was 21 mo old.We suggest that the possible association between inborn errors of metabolism and antenatal ascites should be considered, in order to offer genetic counselling due to the high recurrence risk and the availability of early antenatal diagnosis.

Two infants on high-frequency oscillatory ventilation for chronic lung disease and severe respiratory failure, received a bolus of warmed and oxygenated perfluorodecalin up to residual functional capacity, followed by a continuous infusion of 6 ml/kg/hour. Our aim was to improve gas exchange without increasing ventilatory-induced lung injury. Heart rate, oxygen saturation, blood pressure, and TcPO(2)/TcPCO(2) were continuously monitored during treatment. Arterial blood gas was evaluated every 3 hours. Both patients showed improvement of gas exchange with a 13.6 and 12.5% reduction of oxygenation index, respectively. High-frequency partial liquid ventilation is an experimental ventilation technique that could be considered as rescue treatment, to improve oxygenation in subjects with critical respiratory failure. This method could probably produce less damage, than other ventilation modes, to severely injured lungs.

Every year approximately 3.7 million neonatal deaths occur worldwide plus an additional 3.3 million stillbirths. Thirty-eight percent of all under 5-year-old deaths are concentrated in the first 28 days of life, 75 % of them in the first 7 days, making the first week the most dangerous period of a lifetime. Sub-Saharan Africa remains the most dangerous region to be born, here 1.16 million babies do not survive more than 28 days and every year, half a million babies die within the first 24 h of life [1]. Just three causes account for 86 % of those deaths: asphyxia, prematurity, and severe infections like tetanus, pneumonia, and diarrhea. In fact, it is estimated that serious infections represent 36 % of all neonatal deaths [2], making hygiene a priority. We here report our experience of 7 years of collaboration with the Neonatal Care Unit of the CMSC of Ouagadougou, Burkina Faso, one of the world’s poorest countries. Over 70 % of the 15.4 million inhabitants of Burkina Faso live below the poverty line. Schooling is sparse and health facilities are scarce [3]. Many people, especially children, are severely malnourished and do not have access to clean water, secure food supply, or medical care [4]. Many of these children die from treatable or even preventable infectious diseases such as diarrhea, pneumonia, malaria, HIV, TB, measles, and tetanus [5]. In 2004, the Center St. Camille comprised a maternity ward where more than 5,000 babies were delivered every year and a Neonatal Care Unit equipped with 12 incubators sent from Italy during the early 1980s. 1,200 babies were admitted each year to these incubators and to an additional 50 neonatal cots (all in one room). Oxygen was available from two 20 L pressure tanks. A small room for invasive procedures was available, and the center had a day-time laboratory and a small X-ray facility. Cardiologists equipped with sonography and fetal sonography were available twice weekly (Figs. 1, 2, 3, 4). Country-wide, the CMSC is the only unit specializing in the care of premature newborns and is known beyond the borders of Burkina Faso. In fact, patients come also from neighboring countries such as Mali, Mauritania, and Sierra Leone. Since 2005, Medicus Mundi Italy, a section of Medicus Mundi International, a Non-Governmental Organization (NGO), officially recognized by the WHO, as a specialized health organization, has an ongoing collaboration with the P. E. Villani (&) A. Beatrice G. Mescoli Dipartimento Materno-Infantile, UO TIN, Neonatologia e Nido, AO ‘‘C.Poma’’, Mantua, Italy e-mail: paoloernesto.villani@aopoma.it

Patient hospitalization was compared in 207 pediatric patients (age ≤15 years at the start of dialysis) on chronic peritoneal dialysis (CPD) (127 patients) or center hemodialysis (HD) (80 patients), treated in 17 dialysis centers during the period 1989 to 1994, and followed up for at least three months. The hospitalization rate was expressed as hospital days per patient-month, and was calculated on the overall period of treatment and separately for the first and second year. Since the age at start of dialysis markedly differed between CPD (8.2±4.7 years) and HD (11.2±2.9 years) patients (with no HD patient younger than five years), results are separately presented in three patient groups: CPD patients aged A statistically significant difference in total days hospitalized was found between each of the two groups of CPD patients and the HD patients; the results for hospitalization for dialysis-related complications were higher in the group of younger children on CPD, while the difference between the two age-matched groups of patients on CPD and HD was not significant.

Anemia, through a hyperkinetic state, is an Important contributor to myocardial function impairment. To determine the cardiovascular effects of recombinant human erythropoietin (rHuEPO) therapy, 10 chronic peritoneal dialysis (CPD)-treated anemic children were studied be fore and during 18 months of treatment. The following parameters were recorded: hemoglobin (Hb) [percent of target level (TL) = x 2 standard deviations of normal Hb values for age and sex], heart rate (HR, beats/minute), mean arterial pressure (MAP, mmHg), end-diastolic left ventricular diameter (EDLVD, mm/sm BSA), shortening fraction (SF, percent), and Interventricular septal thickness (IVS, mm/sm BSA). Student's t-test for paired data showed (vs time before treatment, TO) a progressive Increase In Hb, a progressive decrease In HR, and a progressive Increase In MAP. EDLVD progressively decreased, while SF and IVS remalned unchanged throughout the study. Regression analysis showed a close correlation between anemIa cor rection and decrease of HR (p Our data indicate that anemia correction In these patients Is mainly associated with a decrease in hyperkinetic state (HR reduction with SF unvaried), while left ventricular function and dimensions remain normal, despite an Increase in MAP.