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1. A regional audit system for stillbirth: a way to better understand the phenomenon

Author

Po G., Monari F., Zanni F., Grandi G., Lupi C., Facchinetti F., Mancini L., Lugli L., Lanzoni C., Sgarbi L., Chiossi C., Ricchieri F., Roberta C., Contiero R., Garani G., Pedriali M., Rossi S., Fini S., Di Bartolo M., Radi D., Vancini A., Donati A., Guadalupi E., Righetti F., Salerno A., Cocchi G., Morandi R., Gabrielli L., Graziano C., Seri M., Caprara G., Mario S. N. C., Fantuz F., Ferlini F., Righi E., Silvestrini D., Foschi F., Fieni S., Frusca T., Ferretti A., Galli L., Magnani C., Silini E., Balduzzi L., Bellini M., Rodolfi A. M., Sgarabotto M. P., Fragni G., Comitini G., Bonasoni M. P., Fioroni L., Rozzi C., Tuzio A., Vito I., Mammoliti P., De Ambrosi E., Ricci M., Bandini A., Belosi C., Muratori C., Zago S., Turci A., Vitarelli M., Po G., Monari F., Zanni F., Grandi G., Lupi C., Facchinetti F., Mancini L., Lugli L., Lanzoni C., Sgarbi L., Chiossi C., Ricchieri F., Roberta C., Contiero R., Garani G., Pedriali M., Rossi S., Fini S., Di Bartolo M., Radi D., Vancini A., Donati A., Guadalupi E., Righetti F., Salerno A., Cocchi G., Morandi R., Gabrielli L., Graziano C., Seri M., Caprara G., Mario S.N.C., Fantuz F., Ferlini F., Righi E., Silvestrini D., Foschi F., Fieni S., Frusca T., Ferretti A., Galli L., Magnani C., Silini E., Balduzzi L., Bellini M., Rodolfi A.M., Sgarabotto M.P., Fragni G., Comitini G., Bonasoni M.P., Fioroni L., Rozzi C., Tuzio A., Vito I., Mammoliti P., De Ambrosi E., Ricci M., Bandini A., Belosi C., Muratori C., Zago S., Turci A., and Vitarelli M.

Subjects
Clinical audit, Multivariate analysis, Placenta Diseases, Perinatal Death, Eastern, Umbilical Cord, Africa, Northern, Pregnancy, Risk Factors, Cause of Death, Northern, Europe, Eastern, Pregnancy Complications, Infectious, Multivariate Analysi, Causes of death, Cause of death, Fetal Growth Retardation, Obstetrics, Placenta Disease, Infectious, Obstetrics and Gynecology, Stillbirth, Perinatal audit, Quality of care, Adult, Africa South of the Sahara, Clinical Audit, Female, Fetal Death, Fetal Diseases, Humans, India, Italy, Multivariate Analysis, Pregnancy Complications, Quality of Health Care, Pregnancy Complication, Europe, Gestation, Human, Research Article, medicine.medical_specialty, Reproductive medicine, Fetal Disease, Audit, lcsh:Gynecology and obstetrics, medicine, lcsh:RG1-991, Late Stillbirth, business.industry, Risk Factor, medicine.disease, Africa, Pregnancy Complications, Infectiou, business
Abstract

Background Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy. Methods For each stillbirth (≥ 22 weeks of gestation, ≥ 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case. Results Total stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62–7.03) and intrapartum cases (OR 6.64, CI95% 2.61–17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06–3.36) and were more frequent before term (OR 1.86, CI95% 1.11–3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61–17.02). Conclusions Regional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures.

Published
2019
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2. Stewardship antimicrobica nel neonato e nel piccolo lattante: Perché e come praticarla

Author

Berardi, Alberto, Ficara, Monica, Pietrella, Elisa, Boncompagni, Alessandra, Toffoli, Carlotta, Bianchini, Anastasia, Della Casa, Elisa, Spada, Caterina, Spaggiari, Eugenio, Ciccia, Matilde, Gargano, Giancarlo, Rizzo, Vittoria, Azzalli, Milena, Biasucci, Giacomo, Gambini, Lucia, Bolognesi, Serenella, Ferrari, Fabrizio, Memo, L., Nicolini, G., Ciccia, M., Sandri, F., Capretti, M. G., Dondi, A., Pasini, L., Ragni, L., Albarelli, A., Fiorini, V., Giugno, C., Lanzoni, P., Di Grande, E., Polese, A., China, M. C., Rizzo, V., Stella, M., Zucchini, A., Malaguti, L., Azzalli, M., Garani, G., Nasi, S., Bacchini, P., Fragni, G., Baldassarri, P., Pulvirenti, R. M., Valletta, E., Bidetti, M. L., Incerti, S. Storchi, Di Carlo, C., Lanzoni, A., Serra, L., Silvestrini, D., Berardi, A., Ferrari, F., Lugli, L., Venturelli, C., Sarti, M., Volta, A., Dodi, I., Magnani, C., Guidi, B., Biasucci, G., Chiarabini, R., De Paulis, N., Padrini, D., Riboni, S., Pedna, M. F., Casadio, L., Marchetti, F., Muratori, C., Piccinini, G., Renzelli, C., Amarri, S., Baroni, L., Carretto, E., Gargano, G., Pedori, S., Riva, M., Zuelli, C., Ancona, G., Bolognesi, S., Vergine, G., Viola, L., Chiossi, C., Pagano, R., Zanacca, C., Palmieri, R., PICCININI, GIANCARLO, BASTELLI, ANNALISA, AMBRETTI, SIMONE, CORVAGLIA, LUIGI TOMMASO, LANARI, MARCELLO, LAMA, CARLA, VENTUROLI, VINCENZO, ALESSANDRINI, CATERINA, FACCHINETTI, FABRIZIO, GAMBINI, LUIGI, BERTELLI, MICHELE, SAMBRI, VITTORIO, FORNACIARI, SILVIA, PAPA, IRENE, RIVI, CLAUDIA, BONVICINI, CARLOTTA, Berardi, Alberto, Ficara, Monica, Pietrella, Elisa, Boncompagni, Alessandra, Toffoli, Carlotta, Bianchini, Anastasia, Della Casa, Elisa, Spada, Caterina, Spaggiari, Eugenio, Ciccia, Matilde, Gargano, Giancarlo, Rizzo, Vittoria, Azzalli, Milena, Biasucci, Giacomo, Gambini, Lucia, Bolognesi, Serenella, Piccinini, Giancarlo, Ferrari, Fabrizio, Memo, L., Nicolini, G., Ciccia, M., Bastelli, A., Sandri, F., Ambretti, S., Capretti, M. G., Corvaglia, L., Dondi, A., Lanari, M., Pasini, L., Ragni, L., Albarelli, A., Fiorini, V., Giugno, C., Lanzoni, P., Di Grande, E., Polese, A., China, M. C., Rizzo, V., Stella, M., Zucchini, A., Malaguti, L., Azzalli, M., Garani, G., Lama, C., Nasi, S., Bacchini, P., Fragni, G., Baldassarri, P., Pulvirenti, R. M., Valletta, E., Venturoli, V., Alessandrini, C., Bidetti, M. L., Incerti, S. Storchi, Di Carlo, C., Lanzoni, A., Serra, L., Silvestrini, D., Berardi, A., Facchinetti, F., Ferrari, F., Lugli, L., Venturelli, C., Sarti, M., Volta, A., Dodi, I., Gambini, L., Magnani, C., Guidi, B., Bertelli, M., Biasucci, G., Chiarabini, R., De Paulis, N., Padrini, D., Riboni, S., Pedna, M. F., Sambri, V., Casadio, L., Marchetti, F., Muratori, C., Piccinini, G., Renzelli, C., Amarri, S., Baroni, L., Carretto, E., Fornaciari, S., Gargano, G., Pedori, S., Riva, M., Zuelli, C., Ancona, G., Bolognesi, S., Papa, I., Vergine, G., Viola, L., Chiossi, C., Pagano, R., Rivi, C., Zanacca, C., Bonvicini, C., and Palmieri, R.

Subjects
Sepsi, Pediatrics, Perinatology and Child Health, Antibiotic, Antimicrobial stewardship, Prophylaxi, Infection, Newborn
Abstract

Antimicrobial resistances are increasing worldwide, due to the misuse of antibiotic therapies in humans as well as in animals. It is expected that within a few decades multi-resistant pathogens will become the leading cause of death worldwide. The misuse of antibiotics in the neonatal period depends on the lack of predictive diagnostic tests and the peculiarity of symptoms of sepsis, which frequently are vague and unspecific at the time of presentation. Policies to prevent the emergence of antimicrobial resistances rely on a judicious use of antibiotics, on protocols and additional measures shared by health care providers. This document summarizes recent indications issued in the Emilia-Romagna subsequent to a review of the literature.

Published
2017

3. Antimicrobial stewardship in newborns and young infants: Why and how to do it,Stewardship antimicrobica nel neonato e nel piccolo lattante: Perché e come praticarla

Author

Berardi, A., Ficara, M., Pietrella, E., Boncompagni, A., Toffoli, C., Bianchini, A., Della Casa, E., Spada, C., Spaggiari, E., Ciccia, M., Gargano, G., Rizzo, V., Azzalli, M., Biasucci, G., Gambini, L., Bolognesi, S., Piccinini, G., Ferrari, F., Memo, L., Nicolini, G., Bastelli, A., Sandri, F., Ambretti, S., Capretti, M. G., Corvaglia, L., Dondi, A., Lanari, M., Pasini, L., Ragni, L., Albarelli, A., Fiorini, V., Giugno, C., Lanzoni, P., Di Grande, E., Polese, A., China, M. C., Stella, M., Zucchini, A., Malaguti, L., Garani, G., Lama, C., Nasi, S., Bacchini, P., Fragni, G., Baldassarri, P., Pulvirenti, R. M., Valletta, E., Venturoli, V., Alessandrini, C., Bidetti, M. L., Incerti, S. S., Di Carlo, C., Lanzoni, A., Serra, L., Silvestrini, D., Facchinetti, F., licia lugli, Venturelli, C., Sarti, M., Volta, A., Dodi, I., Magnani, C., Guidi, B., Bertelli, M., Chiarabini, R., Paulis, N., Padrini, D., Riboni, S., Pedna, M. F., Sambri, V., Casadio, L., Marchetti, F., Muratori, C., Renzelli, C., Amarri, S., Baroni, L., Carretto, E., Fornaciari, S., Pedori, S., Riva, M., Zuelli, C., Ancona, G., Papa, I., Vergine, G., Viola, L., Chiossi, C., Pagano, R., Rivi, C., Zanacca, C., Bonvicini, C., and Palmieri, R.

4. Antimicrobial stewardship in newborns and young infants: Why and how to do it,Stewardship antimicrobica nel neonato e nel piccolo lattante: Perché e come praticarla

Author

Berardi, A., Ficara, M., Pietrella, E., Boncompagni, A., Toffoli, C., Bianchini, A., Della Casa, E., Spada, C., Spaggiari, E., Ciccia, M., Gargano, G., Rizzo, V., Azzalli, M., Biasucci, G., Gambini, L., Bolognesi, S., Piccinini, G., Ferrari, F., Memo, L., Nicolini, G., Bastelli, A., Sandri, F., Ambretti, S., Capretti, M. G., Corvaglia, L., Dondi, A., Lanari, M., Pasini, L., Ragni, L., Albarelli, A., Fiorini, V., Giugno, C., Lanzoni, P., Di Grande, E., Polese, A., China, M. C., Stella, M., Zucchini, A., Malaguti, L., Garani, G., Lama, C., Nasi, S., Bacchini, P., Fragni, G., Baldassarri, P., Pulvirenti, R. M., Valletta, E., Venturoli, V., Alessandrini, C., Bidetti, M. L., Incerti, S. S., Di Carlo, C., Lanzoni, A., Serra, L., Silvestrini, D., Facchinetti, F., Lugli, L., Venturelli, C., Sarti, M., Volta, A., Dodi, I., Magnani, C., Guidi, B., Bertelli, M., Chiarabini, R., Paulis, N., Padrini, D., Riboni, S., Pedna, M. F., Sambri, V., Casadio, L., Marchetti, F., Muratori, C., Renzelli, C., Amarri, S., Baroni, L., Edoardo Carretto, Fornaciari, S., Pedori, S., Riva, M., Zuelli, C., Ancona, G., Papa, I., Vergine, G., Viola, L., Chiossi, C., Pagano, R., Rivi, C., Zanacca, C., Bonvicini, C., and Palmieri, R.

5. [Perinatal risk factors for infection in the newborn. Multicenter clinico-epidemiologic investigation].

Author

Bevilacqua G, Braibanti S, Solari E, Anfuso S, Fragni G, and Soncini E

Subjects
Adult, Bacterial Infections prevention & control, Bacterial Infections transmission, Case-Control Studies, Female, Fetal Membranes, Premature Rupture, Humans, Infant, Newborn, Infant, Newborn, Diseases prevention & control, Infectious Disease Transmission, Vertical, Italy epidemiology, Mass Screening, Pregnancy, Pregnancy Complications, Infectious prevention & control, Retrospective Studies, Risk Factors, Vaginal Smears methods, Bacterial Infections epidemiology, Bacterial Infections microbiology, Infant, Newborn, Diseases epidemiology, Infant, Newborn, Diseases microbiology, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious microbiology
Abstract

Unlabelled: The neonate, in particular if preterm, has a specific immunological system that makes him/her more susceptible to infections which are still a major cause of mortality and morbidity. The early onset infective patterns are often vertically transmitted from the mother to the fetus in the perinatal period. Some mother conditions like genitourinary infections, pre-delivery fever, PROM, pPROM, preterm delivery, abortions, fetal demise are important neonatal risk factors. The role of these factors as causes of early onset neonatal infections was evaluated by an Italian multicentric epidemiologic investigation supported by the MIUR. Mothers admitted to obstetrician hospitals for parturition were studied in a case control retrospective analysis. Mothers presenting with the selected risk factors were the cohort of cases while the admissions without risk factors next to each case represented the controls. The following risk factors were considered for analysis: 2nd trimester abortion, PROM, pPROM, preterm delivery and fetal demise. Eight hospitals entered the multicentric research and 29610 patients have been analyzed: 2466 PROM, 478 pPROM, 946 preterm delivery, 244 abortions, 133 fetal demise. Every woman received a microbiological screening by cervico-vaginal and rectal swab and/or urine culture. As much as 3892 cases from the University Hospitals of Parma and Torino concern, the cervicovaginal swab was positive in 76.5% pPROM, in 50.6% PROM and 50.5% preterm deliveries. The positivity of the swabs showed statistical relevance in cases compared to controls. In cases presenting with abortion the frequency of positive cultures (44.1%) was higher than the controls, but it did not reach statistical relevance. Conversely, positivity of cultures was lower in cases with fetal demise than control group but without statistical difference. In the cohort of 675 women selected from our Institute (University of Parma) the overall rate of positivity of cervico-vaginal swabs was about 44% and only one germ was isolated in 94.6% cases: 49,8% Gram positive and negative, 14.1% Streptococcus hemolyticus B group, 34.7% Candida. The rate of cultural tests performed before delivery was statistically higher in cases than controls (74.3% vs 23.2%, p < 0.001). Furthermore 14.3% newborns from mothers in the case group and 2.3% newborns from mothers in the control group were admitted to the neonatal care unit. Among them 8.4% and 1.2% respectively needed antibiotics while 0.4% and 0.2% respectively presented with early onset infection. Ear swabs were performed in 48,8% of infants born to mothers from the case group and in 26.9% of infants born to mothers from the control group, in 6.5% and in 2.9% respectively were the skin swabs performed as well. No statistical difference was met. The choice to perform cultural examinations was statistically higher in cases than controls, but the positivity rate was similar in both groups, perhaps because of a more specific choice in the control group., Conclusion: our data confirm the relationship between infections and preterm delivery, PROM, pPROM and support the hypothesis that infections might be the cause of these conditions and not simply an association. A prompt maternal microbiological control during pregnancy and delivery, especially in women presenting with known risk factors, gives the possibility to do early diagnostic-therapeutic interventions and to minimize the frequency and severity of early sepsis in newborns.

Published
2005

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