Childhood obesity is the metabolic disorder with the highest prevalence in both children and adults. Urgency to treat and prevent childhood obesity is based on the clear evidence that obesity tends to track from childhood to adulthood, is associated to morbidity also in childhood and to long-term mortality. Early life, i.e., intrauterine life and the first two years, is a sensitive window for prevention. Anatomical and functional maturation of the hypothalamic structures devoted to regulating energy intake and expenditure and body size mainly occurs in the first 1,000 days of life. Therefore, factors affecting the foetal exposition to maternal metabolic environment and early postnatal nutrition are crucial in modulating the definition of the metabolic programming processes in the brain. Maternal diseases, mainly malnutrition for defect or excess, obesity and diabetes, placental disorders and dysfunctions, maternal use of alcohol and drugs, smoking, affect long term metabolic programming of the foetus with lifelong consequences. Similarly, early nutrition contributes to complete the long-term metabolic regulating framework initiated in the uterus. Breastfeeding, adequate weaning, attention to portion size and diet composition are potential tools for reducing the obesity risk later in childhood. Longitudinal randomized controlled studies are needed for exploring the efficacy of obesity prevention strategies initiated after conception. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou
{"title":"Early prevention of obesity","authors":"C. Maffeis","doi":"10.7363/030250","DOIUrl":"https://doi.org/10.7363/030250","url":null,"abstract":"Childhood obesity is the metabolic disorder with the highest prevalence in both children and adults. Urgency to treat and prevent childhood obesity is based on the clear evidence that obesity tends to track from childhood to adulthood, is associated to morbidity also in childhood and to long-term mortality. Early life, i.e., intrauterine life and the first two years, is a sensitive window for prevention. Anatomical and functional maturation of the hypothalamic structures devoted to regulating energy intake and expenditure and body size mainly occurs in the first 1,000 days of life. Therefore, factors affecting the foetal exposition to maternal metabolic environment and early postnatal nutrition are crucial in modulating the definition of the metabolic programming processes in the brain. Maternal diseases, mainly malnutrition for defect or excess, obesity and diabetes, placental disorders and dysfunctions, maternal use of alcohol and drugs, smoking, affect long term metabolic programming of the foetus with lifelong consequences. Similarly, early nutrition contributes to complete the long-term metabolic regulating framework initiated in the uterus. Breastfeeding, adequate weaning, attention to portion size and diet composition are potential tools for reducing the obesity risk later in childhood. Longitudinal randomized controlled studies are needed for exploring the efficacy of obesity prevention strategies initiated after conception. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Marseglia, S. Manti, G. D'angelo, E. Gitto, I. Barberi
Reactive oxygen species play an important role in the pathogenesis of several diseases during the perinatal and neonatal period. Melatonin, an effective direct free-radical scavenger and indirect antioxidant agent, diffuses through biological membranes easily and exerts pleiotropic actions on every cell. Several studies have tested the efficacy of melatonin to counteract oxidative damage in diseases of newborn such as chronic lung disease, perinatal brain injury, necrotizing enterocolitis and sepsis, giving promising results. The peculiar perinatal susceptibility to oxidative stress indicates that prophylactic use of antioxidants as melatonin could help to prevent or at least reduce oxidative stress related diseases in newborns. However, more studies are needed to confirm these beneficial effects. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou
{"title":"Melatonin for the newborn","authors":"L. Marseglia, S. Manti, G. D'angelo, E. Gitto, I. Barberi","doi":"10.7363/030232","DOIUrl":"https://doi.org/10.7363/030232","url":null,"abstract":"Reactive oxygen species play an important role in the pathogenesis of several diseases during the perinatal and neonatal period. Melatonin, an effective direct free-radical scavenger and indirect antioxidant agent, diffuses through biological membranes easily and exerts pleiotropic actions on every cell. Several studies have tested the efficacy of melatonin to counteract oxidative damage in diseases of newborn such as chronic lung disease, perinatal brain injury, necrotizing enterocolitis and sepsis, giving promising results. The peculiar perinatal susceptibility to oxidative stress indicates that prophylactic use of antioxidants as melatonin could help to prevent or at least reduce oxidative stress related diseases in newborns. However, more studies are needed to confirm these beneficial effects. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The delivery of extremely low gestational age newborns and extremely low birth weight infants presents challenging ethical issues for caregivers and parents. Major concerns regard the high mortality and morbidity resulting in long term sequelae, the limit of viability as well as the conflict and difficulty in judgement involving “quality of life” and “sanctity of life” issues. Other paramount ethical concepts include the newborn’s best interest, the decision to initiate or withhold treatment at birth and the decision to withdraw treatment with the consequence that the infant will die. On the basis of the ethical principles of beneficence, autonomy, justice and nonmaleficence we will discuss the best interest standards, the standard for the decision making process and treatment decisions, which should always be governed by the prospect for the individual infant. In this paper we propose that ethical questions should not be regulated by law and the legal system should not interfere in the patient-physician relationship. Continuous improvement in medicine over the last decades led to increased treatment possibilities, which on the other hand also resulted in more ethical dilemmas. Therefore, today more than ever, it is essential that the neonatologist becomes familiar with basic ethical concepts and their application to clinical reality. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou
{"title":"Neonatal ethics in ELBW","authors":"H. Messner, A. Staffler","doi":"10.7363/030216","DOIUrl":"https://doi.org/10.7363/030216","url":null,"abstract":"The delivery of extremely low gestational age newborns and extremely low birth weight infants presents challenging ethical issues for caregivers and parents. Major concerns regard the high mortality and morbidity resulting in long term sequelae, the limit of viability as well as the conflict and difficulty in judgement involving “quality of life” and “sanctity of life” issues. Other paramount ethical concepts include the newborn’s best interest, the decision to initiate or withhold treatment at birth and the decision to withdraw treatment with the consequence that the infant will die. On the basis of the ethical principles of beneficence, autonomy, justice and nonmaleficence we will discuss the best interest standards, the standard for the decision making process and treatment decisions, which should always be governed by the prospect for the individual infant. In this paper we propose that ethical questions should not be regulated by law and the legal system should not interfere in the patient-physician relationship. Continuous improvement in medicine over the last decades led to increased treatment possibilities, which on the other hand also resulted in more ethical dilemmas. Therefore, today more than ever, it is essential that the neonatologist becomes familiar with basic ethical concepts and their application to clinical reality. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"9 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The development of guidelines for palliative care in the paediatric settings is judged to be still incomplete and characterized by many controversial issues; in order to explore the life-experience of individual health care professionals, we proposed a semi-structured questionnaire with open questions on end-of-life procedures to the staff members of the Paediatric Onco-hematology Ward of the University of Padua, of the Oncology Ward and in the Home Assistance Module of the Giannetta Gaslini Hospital, Genoa, both in Italy. This paper will focus on the responses provided to the third question: “ In your opinion, can inducing the suspension of the state of consciousness be counted among end-of-life procedures? If so, how and when? ”. Staff members were found to face challenging interactions at at least three levels: within the professional team, with respect to the parents and with respect to the adolescent patients. Among the most complex issues raised by the participants we found the moral distress sometimes experienced by nurses with respect to the decisions assumed by doctors, as stated by a nurse: “ Everything is subjective in those 24 hours (…) and you are to do or not do certain things and it makes you feel distressed ”. Second, it emerged that the relationship with the parents becomes very challenging when the two are not in agreement: “ The father wants to give the morphine, but the mother secretly closes the drip ”. Finally, the relationship of trust with the adolescent patients is under threat when they ‘want to know’ while parents seem to be unable to tolerate this degree of painful but essential self-consciousness in their ‘child’: “ He locked me in the room and asked, ‘Am I dying?’, and I wanted to die at that point… ”. Our study shows that health care professionals require not just guidelines but a tailor-made training and support which integrate much deeply the therapeutic as well as the moral and philosophical approaches to the issues raised by palliative care in paediatric settings. Articoli Selezionati del Congresso “Medicina Narrativa e Comunicazione nella Pratica Clinica” · Cagliari · 14 Aprile 2014 Guest Editors: Massimiliano Zonza, Vassilios Fanos, Gian Paolo Donzelli
在儿科环境中制定姑息治疗指南被认为仍然不完整，并以许多有争议的问题为特征;为了探索个人医疗保健专业人员的生活经验，我们向意大利帕多瓦大学儿科肿瘤血液学病房、肿瘤科病房和热那亚Giannetta Gaslini医院家庭援助模块的工作人员提出了一份关于临终程序的半结构化问卷，其中包含开放式问题。本文将重点关注对第三个问题的回答:“在你看来，诱导意识状态的暂停可以算在临终程序中吗?”如果是，如何以及何时?”。研究发现，工作人员至少在三个层面上面临着具有挑战性的互动:专业团队内部、与父母的关系以及与青少年患者的关系。在参与者提出的最复杂的问题中，我们发现护士有时会因为医生的决定而感到道德上的痛苦，正如一位护士所说:“在这24小时内，一切都是主观的(……)，你要做或不做某些事情，这让你感到痛苦。”其次，当双方意见不一致时，与父母的关系变得非常具有挑战性:“父亲想给吗啡，但母亲偷偷地关上了点滴。”最后，当青少年患者“想知道”时，父母与他们的信任关系受到威胁，而父母似乎无法容忍他们的“孩子”有这种痛苦但重要的自我意识:“他把我锁在房间里，问:‘我要死了吗?’我想在那一刻死去……”我们的研究表明，卫生保健专业人员不仅需要指导方针，而且需要量身定制的培训和支持，这些培训和支持将治疗以及道德和哲学方法深入地整合到儿科环境中由姑息治疗提出的问题中。2014年4月14日，卡利亚里，特约编辑:Massimiliano Zonza, Vassilios Fanos, Gian Paolo Donzelli
{"title":"[Exploring life-experience of the staff and volunteers assisting pediatric patients in end-of-life situations] [Article in Italian] • I vissuti dello staff e dei volontari che assistono pazienti pediatrici terminali","authors":"R. L. Grotto, Debora Tringali, M. Papini","doi":"10.7363/030220","DOIUrl":"https://doi.org/10.7363/030220","url":null,"abstract":"The development of guidelines for palliative care in the paediatric settings is judged to be still incomplete and characterized by many controversial issues; in order to explore the life-experience of individual health care professionals, we proposed a semi-structured questionnaire with open questions on end-of-life procedures to the staff members of the Paediatric Onco-hematology Ward of the University of Padua, of the Oncology Ward and in the Home Assistance Module of the Giannetta Gaslini Hospital, Genoa, both in Italy. This paper will focus on the responses provided to the third question: “ In your opinion, can inducing the suspension of the state of consciousness be counted among end-of-life procedures? If so, how and when? ”. Staff members were found to face challenging interactions at at least three levels: within the professional team, with respect to the parents and with respect to the adolescent patients. Among the most complex issues raised by the participants we found the moral distress sometimes experienced by nurses with respect to the decisions assumed by doctors, as stated by a nurse: “ Everything is subjective in those 24 hours (…) and you are to do or not do certain things and it makes you feel distressed ”. Second, it emerged that the relationship with the parents becomes very challenging when the two are not in agreement: “ The father wants to give the morphine, but the mother secretly closes the drip ”. Finally, the relationship of trust with the adolescent patients is under threat when they ‘want to know’ while parents seem to be unable to tolerate this degree of painful but essential self-consciousness in their ‘child’: “ He locked me in the room and asked, ‘Am I dying?’, and I wanted to die at that point… ”. Our study shows that health care professionals require not just guidelines but a tailor-made training and support which integrate much deeply the therapeutic as well as the moral and philosophical approaches to the issues raised by palliative care in paediatric settings. Articoli Selezionati del Congresso “Medicina Narrativa e Comunicazione nella Pratica Clinica” · Cagliari · 14 Aprile 2014 Guest Editors: Massimiliano Zonza, Vassilios Fanos, Gian Paolo Donzelli","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":"1-6"},"PeriodicalIF":0.4,"publicationDate":"2014-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although breastfeeding is the normative standards for infant nutrition, exclusive breastfeeding rates at hospital discharge in the general population of newborns are still suboptimal. Besides many other psychological, social, economical, cultural factors, breastfeeding success is also significantly influenced by maternity practices that have the potential to foster or otherwise to hinder breastfeeding physiology during postpartum hospital stay. On their part, health professionals need to improve their knowledge on lactation, to acquire better skills to manage breastfeeding problems and to commit themselves to prepare evidence based clinical protocols that support breastfeeding and the use of human milk. At the Institute for Maternal and Child Health in Trieste (Italy), we have developed two surveillance protocols related to situations that commonly challenge health professionals to give their qualified advice to the breastfeeding dyad. Particularly, we have documented the feasibility of a protocol on the management of skin to skin contact between mother and his/her newborn infant. This protocol is applied in the delivery room in the context of the prevention of sudden unexpected postnatal collapse. The second protocol refers to the management of early neonatal weight loss. Finally, we believe that combining an effective promotion of breastfeeding with good clinical practice is appropriated and safe and we recognize that both the competence and the attitude of staff have an essential role in the success of the initiation of breastfeeding. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou
{"title":"Integrating health care practices with the promotion of breastfeeding","authors":"R. Davanzo, P. Brovedani, L. Travan","doi":"10.7363/030217","DOIUrl":"https://doi.org/10.7363/030217","url":null,"abstract":"Although breastfeeding is the normative standards for infant nutrition, exclusive breastfeeding rates at hospital discharge in the general population of newborns are still suboptimal. Besides many other psychological, social, economical, cultural factors, breastfeeding success is also significantly influenced by maternity practices that have the potential to foster or otherwise to hinder breastfeeding physiology during postpartum hospital stay. On their part, health professionals need to improve their knowledge on lactation, to acquire better skills to manage breastfeeding problems and to commit themselves to prepare evidence based clinical protocols that support breastfeeding and the use of human milk. At the Institute for Maternal and Child Health in Trieste (Italy), we have developed two surveillance protocols related to situations that commonly challenge health professionals to give their qualified advice to the breastfeeding dyad. Particularly, we have documented the feasibility of a protocol on the management of skin to skin contact between mother and his/her newborn infant. This protocol is applied in the delivery room in the context of the prevention of sudden unexpected postnatal collapse. The second protocol refers to the management of early neonatal weight loss. Finally, we believe that combining an effective promotion of breastfeeding with good clinical practice is appropriated and safe and we recognize that both the competence and the attitude of staff have an essential role in the success of the initiation of breastfeeding. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Survival of extremely low birth weight (ELBW) and extremely premature (EP) infants has shown consistent improvement thanks to advances and innovations in perinatal and neonatal care. Regionalization, with high-risk deliveries in a tertiary perinatal center, offers the coordinated, collaborative, expert and specialized care needed by these mothers and their infants. Despite decreasing rates of the major neonatal morbidities observed in recent years, these continue still to be significant for ELBW/EP infants, impacting their overall prognosis. After NICU discharge and in the first years of life, issues with health, growth and development are common. In school age and adolescence, problems with behavior, socialization and cognition are prevalent. Adult outcomes of ELBW/EP need further clarity, emphasizing the importance for consistent long-term follow-up for this special cohort. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou
{"title":"Management and outcome of extremely low birth weight infants","authors":"A. Papageorgiou, E. Pelausa","doi":"10.7363/030209","DOIUrl":"https://doi.org/10.7363/030209","url":null,"abstract":"Survival of extremely low birth weight (ELBW) and extremely premature (EP) infants has shown consistent improvement thanks to advances and innovations in perinatal and neonatal care. Regionalization, with high-risk deliveries in a tertiary perinatal center, offers the coordinated, collaborative, expert and specialized care needed by these mothers and their infants. Despite decreasing rates of the major neonatal morbidities observed in recent years, these continue still to be significant for ELBW/EP infants, impacting their overall prognosis. After NICU discharge and in the first years of life, issues with health, growth and development are common. In school age and adolescence, problems with behavior, socialization and cognition are prevalent. Adult outcomes of ELBW/EP need further clarity, emphasizing the importance for consistent long-term follow-up for this special cohort. Proceedings of the 10 th International Workshop on Neonatology · Cagliari (Italy) · October 22 nd -25 th , 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Non-immune hydrops fetalis (NIHF) refers to hydrops in the absence of maternal circulating red-cell antibodies, and constitutes up to 90% of all described hydrops fetalis cases. One-third of hydropic fetuses are discovered incidentally during prenatal sonography in the first or second trimester of gestation. Although hydrops is a fetal condition, in many cases there are associated maternal findings, such as preeclampsia, polyhydramnios, and mirror syndrome (generalized maternal edema, that ‘mirrors’ the edema of the hydropic fetus and placenta). NIHF should be seen as a symptom or clinical phenotype rather than as a disorder, and considered as a non-specific, end-stage status of a wide variety of disorders. Numerous disorders including fetal disorders, maternal diseases (e.g., severe maternal anemia, diabetes and maternal indomethacin use) and placental/cord abnormalities have been associated with NIHF. Despite extensive investigations, the etiology on NIHF may remain unknown in 15% to 25% of patients, even after an autopsy has been performed. Chromosomal abnormalities are the cause of NIHF in 25-70% of the cases. Therefore, fetal or neonatal chromosome analysis is indicated in all cases of NIHF. Abnormalities of the cardiovascular system are responsible for as many as 40% of cases of NIHF. Thoracic abnormalities increase intrathoracic pressure and can obstruct venous return to the heart, leading to peripheral venous congestion, or they may obstruct the lymphatic duct, resulting in lymphedema. Fetal anemia accounts for 10-27% of hydrops. To evaluate the risk of fetal anemia, Doppler measurement of the middle cerebral artery peak systolic velocity should be performed in all hydropic fetuses after 16 weeks of gestation. Parvovirus B19 is the most common infectious agent associated with hydrops. Even in persistent severe anemia, the prognosis is generally good if the fetus is supported by intrauterine fetal transfusions. The development of hydrops in fetuses with a TORCH infection is a poor prognostic indicator. Although hypoproteinemia is frequently proposed as one of the causes of hydrops fetalis, recent studies show that hypoalbuminemia is unlikely to cause the initial development of hydrops. However, it seems to occur as a secondary effect in the cascade of hydrops, and might be the trigger for mild hydrops to evolve into severe hydrops. In addition, not all infants with hypoproteinemia become hydropic, and hydrops fetalis is uncommon in congenital nephrotic syndrome and congenital analbuminemia. In the pathogenesis, inherited metabolic disorders, especially lysosomal storage diseases, are more common than previously thought. Inherited metabolic disorders must be always thought when investigating cases of recurrent NIHF in the same family. It is very important to examine the placenta carefully in cases where hydrops or ascites are present at birth or detected by ultrasound, especially in the transient form. Even if a family does not agree to aut
{"title":"Non-immune hydrops fetalis","authors":"M. Yurdakök","doi":"10.7363/030214","DOIUrl":"https://doi.org/10.7363/030214","url":null,"abstract":"Non-immune hydrops fetalis (NIHF) refers to hydrops in the absence of maternal circulating red-cell antibodies, and constitutes up to 90% of all described hydrops fetalis cases. One-third of hydropic fetuses are discovered incidentally during prenatal sonography in the first or second trimester of gestation. Although hydrops is a fetal condition, in many cases there are associated maternal findings, such as preeclampsia, polyhydramnios, and mirror syndrome (generalized maternal edema, that ‘mirrors’ the edema of the hydropic fetus and placenta). NIHF should be seen as a symptom or clinical phenotype rather than as a disorder, and considered as a non-specific, end-stage status of a wide variety of disorders. Numerous disorders including fetal disorders, maternal diseases (e.g., severe maternal anemia, diabetes and maternal indomethacin use) and placental/cord abnormalities have been associated with NIHF. Despite extensive investigations, the etiology on NIHF may remain unknown in 15% to 25% of patients, even after an autopsy has been performed. Chromosomal abnormalities are the cause of NIHF in 25-70% of the cases. Therefore, fetal or neonatal chromosome analysis is indicated in all cases of NIHF. Abnormalities of the cardiovascular system are responsible for as many as 40% of cases of NIHF. Thoracic abnormalities increase intrathoracic pressure and can obstruct venous return to the heart, leading to peripheral venous congestion, or they may obstruct the lymphatic duct, resulting in lymphedema. Fetal anemia accounts for 10-27% of hydrops. To evaluate the risk of fetal anemia, Doppler measurement of the middle cerebral artery peak systolic velocity should be performed in all hydropic fetuses after 16 weeks of gestation. Parvovirus B19 is the most common infectious agent associated with hydrops. Even in persistent severe anemia, the prognosis is generally good if the fetus is supported by intrauterine fetal transfusions. The development of hydrops in fetuses with a TORCH infection is a poor prognostic indicator. Although hypoproteinemia is frequently proposed as one of the causes of hydrops fetalis, recent studies show that hypoalbuminemia is unlikely to cause the initial development of hydrops. However, it seems to occur as a secondary effect in the cascade of hydrops, and might be the trigger for mild hydrops to evolve into severe hydrops. In addition, not all infants with hypoproteinemia become hydropic, and hydrops fetalis is uncommon in congenital nephrotic syndrome and congenital analbuminemia. In the pathogenesis, inherited metabolic disorders, especially lysosomal storage diseases, are more common than previously thought. Inherited metabolic disorders must be always thought when investigating cases of recurrent NIHF in the same family. It is very important to examine the placenta carefully in cases where hydrops or ascites are present at birth or detected by ultrasound, especially in the transient form. Even if a family does not agree to aut","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Mocci, T. Congiu, D. Fanni, C. Gerosa, M. Komuta, P. Eyken, G. Faa, A. Riva
We have extensively studied the ultrastructural picture of the liver by scanning electron microscopy ( SEM) but these studies were not used, up to now, in clinical practice because they were considered to be mainly a means of research in the 3D structure of liver specimens. Our new technique allows us to introduce ourselves to the 3D structure of intracellular organelles, making it possible to study them in normal and pathologic conditions. We used a very small part of the liver biopsies from 5 children aged 3 to 8 years old, who underwent a liver biopsy for diagnostic purposes. The specimens were fixed and processed according to our modification of the OsO 4 maceration method of Tanaka and Mitsushima. Liver biopsies fixed for 20’ in a mixture of glutaraldehyde and paraformaldehyde, postfixed in 1% OsO 4 for 2 h, cut with a tissue sectioner and then macerated in 0.1% OsO 4 for 60 h at room temperature. Specimens were dehydrated in graded acetone, critical point dried and coated with gold palladium. To selectively remove cell components, some specimens were subjected to ultrasound treatment (25 Hz for 1’) prior to dehydration. To demonstrate the hepatic stroma, some aldehyde-fixed specimens were submitted to maceration with NaOH 1N according to Ohtani method. With this method, all cells were removed, allowing the visualization of collagen fibers. Observation was carried out by an Hitachi S4000 Field Emission SEM (Hitachi High-Technologies Co., Tokyo, Japan) operated at 20 kV. We are showing the results of our new technique applied to the liver tissue. These data open, in our opinion, a new field in the research of nuclear pathology, with possible intriguing data on pathological nuclear pore changes in the setting of different liver diseases.
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{"title":"JPNIM Vol. 3 N. 1 April 2014 - Contents","authors":"Jpnim","doi":"10.7363/030125","DOIUrl":"https://doi.org/10.7363/030125","url":null,"abstract":"","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"JPNIM Vol. 3 N. 1 April 2014 - FULL ISSUE","authors":"Jpnim","doi":"10.7363/FULL-ISSUE","DOIUrl":"https://doi.org/10.7363/FULL-ISSUE","url":null,"abstract":"","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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