F. Mosca, M. Giannì, P. Roggero, Camilla Menis, L. Morlacchi, N. Liotto, B. Bracco
Infants born preterm represent a nutritional emergency that must be addressed immediately in order to avoid/limit the development of nutritional deficits that lead to postnatal growth retardation. When taking care of preterm infants from a nutritional point of view, it must be taken into consideration that promotion of growth is achieved by the accomplishment of their high nutritional needs, that become even more demanding with the occurrence of comorbidities. Identification of the factors that determine and/or affect nutrient requirements is therefore mandatory. A full understanding of the most appropriate biological setting that should be used for establishing preterm infants nutritional requirements is desirable. A deeper knowledge with regard to these points would allow for the provision of appropriate amount of specific essential nutrients, avoiding the under- or overexposure to certain nutrients, and for the individualization of nutritional care of preterm infants. The avoidance of early malnutrition is of major importance since adequate postnatal growth has been associated with improvement of later neurodevelopment outcome. Limitation of extrauterine growth restriction prevents the need for rapid catch-up growth after discharge which, in turns, has been linked to later adverse metabolic consequences. Increasing evidence has indicated that postnatal growth retardation is accompanied by a fat-free mass deficit, probably related to immature metabolic mechanisms, delayed amino acid administration and protein intakes lower than recommendations. The potential long-lasting effects of these body composition modifications on future health, both in terms of neurodevelopment outcome and metabolic risk, are still under investigation.
{"title":"Critical questions on nutrition of preterm infants","authors":"F. Mosca, M. Giannì, P. Roggero, Camilla Menis, L. Morlacchi, N. Liotto, B. Bracco","doi":"10.7363/060203","DOIUrl":"https://doi.org/10.7363/060203","url":null,"abstract":"Infants born preterm represent a nutritional emergency that must be addressed immediately in order to avoid/limit the development of nutritional deficits that lead to postnatal growth retardation. When taking care of preterm infants from a nutritional point of view, it must be taken into consideration that promotion of growth is achieved by the accomplishment of their high nutritional needs, that become even more demanding with the occurrence of comorbidities. Identification of the factors that determine and/or affect nutrient requirements is therefore mandatory. A full understanding of the most appropriate biological setting that should be used for establishing preterm infants nutritional requirements is desirable. A deeper knowledge with regard to these points would allow for the provision of appropriate amount of specific essential nutrients, avoiding the under- or overexposure to certain nutrients, and for the individualization of nutritional care of preterm infants. The avoidance of early malnutrition is of major importance since adequate postnatal growth has been associated with improvement of later neurodevelopment outcome. Limitation of extrauterine growth restriction prevents the need for rapid catch-up growth after discharge which, in turns, has been linked to later adverse metabolic consequences. Increasing evidence has indicated that postnatal growth retardation is accompanied by a fat-free mass deficit, probably related to immature metabolic mechanisms, delayed amino acid administration and protein intakes lower than recommendations. The potential long-lasting effects of these body composition modifications on future health, both in terms of neurodevelopment outcome and metabolic risk, are still under investigation.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49362933","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. Polizzi, G. Perricone, V. Duca, A. Carollo, M. Marceca, V. Fontana
Purpose: To investigate the possible effects of the fetal echocardiography experience on the prenatal attachment process. The predictive effect of specific women’s psychological variables will be explored as well. Design and methods: This between groups study involved 85 women with pregnancy at risk who underwent the fetal echocardiography, and 83 women who were about to undergo the morphological scan. The tools employed were: the Prenatal Attachment Inventory (P.A.I.) to explore the maternal-fetal attachment; the Maternity Social Support Scale to investigate the woman perception of being socially supported during pregnancy; both the Big Five Questionnaire and the FACES III to explore the personality traits of pregnant women and their perception of their couple relationship functioning. Findings: The outcomes of ANOVA do not show statistically significant differences between the two groups of the mothers-to-be with regard to the scores of the P.A.I. (F = .017; p = .897; η 2 = .000), while the regression analysis of the possible effect of the maternal psychological variables on the mother-fetus relationship shows a statistically significant result only with regard to the “social support” variable (r 2 = .061; df = 80; p = .025). Conclusions: It would seem that the process of the prenatal attachment develops independently whether the woman has to undergo a first level screening or a second level examination such as the fetal echocardiography.
{"title":"A study on maternal-fetal attachment in pregnant women undergoing fetal echocardiography","authors":"C. Polizzi, G. Perricone, V. Duca, A. Carollo, M. Marceca, V. Fontana","doi":"10.7363/060137","DOIUrl":"https://doi.org/10.7363/060137","url":null,"abstract":"Purpose: To investigate the possible effects of the fetal echocardiography experience on the prenatal attachment process. The predictive effect of specific women’s psychological variables will be explored as well. Design and methods: This between groups study involved 85 women with pregnancy at risk who underwent the fetal echocardiography, and 83 women who were about to undergo the morphological scan. The tools employed were: the Prenatal Attachment Inventory (P.A.I.) to explore the maternal-fetal attachment; the Maternity Social Support Scale to investigate the woman perception of being socially supported during pregnancy; both the Big Five Questionnaire and the FACES III to explore the personality traits of pregnant women and their perception of their couple relationship functioning. Findings: The outcomes of ANOVA do not show statistically significant differences between the two groups of the mothers-to-be with regard to the scores of the P.A.I. (F = .017; p = .897; η 2 = .000), while the regression analysis of the possible effect of the maternal psychological variables on the mother-fetus relationship shows a statistically significant result only with regard to the “social support” variable (r 2 = .061; df = 80; p = .025). Conclusions: It would seem that the process of the prenatal attachment develops independently whether the woman has to undergo a first level screening or a second level examination such as the fetal echocardiography.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44140546","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}
A. Caruso, A. Pane, A. Scanu, A. Muscas, R. Garau, F. Caddeo, L. Mascia
Introduction: Intussusception is the commonest cause of acute intestinal obstruction in children. Failure of timely diagnosis and treatment results in a surgical emergency leading to fatal outcome. The classic triad of symptoms is seen in less than one-third of the children affected. Aim of this study was to evaluate the comprehensive management of intussusception in children, evaluating the outcome of conservative treatment with hydrostatic ultrasound reduction and surgery. Material and methods: A retrospective analysis was conducted including pediatric patients (up to 14 years old) with diagnosis of bowel intussusception. The management and treatment depended on the patients’ situation: for children in good general conditions initial hydrostatic reduction under continuous ultrasonographic monitoring was attempted; if severe dehydration and/or septic shock was observed, the conservative treatment was contraindicated and direct surgical treatment was performed. Result: A total of 44 pediatric patients were included in the study. The most frequent symptoms observed were paroxysmal abdominal pain (100% of cases) and vomiting (72%); only 29% of patients presented with the classic triad of symptoms (abdominal pain, palpable mass and blood stained stools). 28 patients (64%) were managed conservatively with ultrasound hydrostatic reduction. 10 patients (23%) required primary surgical intervention because of clinical conditions; 6 patients (14%) were operated after failure of conservative approach. The total percentage of operated patients was 36%, with lead points identified in 12 cases. Conclusion: Our data confirm that hydrostatic reduction is a simple, real time procedure, free of radiations, non invasive and safe. Age had no impact on the reducibility whereas bloody stool, a prolonged duration of symptoms and the presence of lead point were risk factors of failure.
{"title":"Intussusception in children: not only surgical treatment","authors":"A. Caruso, A. Pane, A. Scanu, A. Muscas, R. Garau, F. Caddeo, L. Mascia","doi":"10.7363/060135","DOIUrl":"https://doi.org/10.7363/060135","url":null,"abstract":"Introduction: Intussusception is the commonest cause of acute intestinal obstruction in children. Failure of timely diagnosis and treatment results in a surgical emergency leading to fatal outcome. The classic triad of symptoms is seen in less than one-third of the children affected. Aim of this study was to evaluate the comprehensive management of intussusception in children, evaluating the outcome of conservative treatment with hydrostatic ultrasound reduction and surgery. Material and methods: A retrospective analysis was conducted including pediatric patients (up to 14 years old) with diagnosis of bowel intussusception. The management and treatment depended on the patients’ situation: for children in good general conditions initial hydrostatic reduction under continuous ultrasonographic monitoring was attempted; if severe dehydration and/or septic shock was observed, the conservative treatment was contraindicated and direct surgical treatment was performed. Result: A total of 44 pediatric patients were included in the study. The most frequent symptoms observed were paroxysmal abdominal pain (100% of cases) and vomiting (72%); only 29% of patients presented with the classic triad of symptoms (abdominal pain, palpable mass and blood stained stools). 28 patients (64%) were managed conservatively with ultrasound hydrostatic reduction. 10 patients (23%) required primary surgical intervention because of clinical conditions; 6 patients (14%) were operated after failure of conservative approach. The total percentage of operated patients was 36%, with lead points identified in 12 cases. Conclusion: Our data confirm that hydrostatic reduction is a simple, real time procedure, free of radiations, non invasive and safe. Age had no impact on the reducibility whereas bloody stool, a prolonged duration of symptoms and the presence of lead point were risk factors of failure.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44638011","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}
Patient safety in the Neonatal Intensive Care Unit (NICU) environment is an under-researched area, but recently seems to get high priority on the healthcare quality agenda worldwide. NICU, as a highly sensitive and technological driven environment, signals the importance for awareness in causation of mistakes and accidents. Adverse events and near misses that comprise the majority of human errors, cause morbidity often with devastating results, even death. Likewise in other organizations, errors causes are multiple and complex. Other high reliability organizations, such as air force and nuclear industry, offer examples of how standardized/homogenized work and removal of systems weaknesses can minimize errors. It is widely accepted that medical errors can be explained based on personal and/or system approach. The impact/effect of medical errors can be reduced when thorough/causative identification approach is followed by detailed analysis of consequences and prevention measures. NICU’s medical and nursing staff should be familiar with patient safety language, implement best practices, and support safety culture, maximizing efforts for reducing errors. Furthermore, top management commitment and support in developing patient safety culture is essential in order to assure the achievement of the desirable organizational safety outcomes. The aim of the paper is to review patient safety issues in the NICU environment, focusing on development and implementation of strategies, enhancing high quality standards for health care.
{"title":"Focusing on patient safety in the Neonatal Intensive Care Unit environment","authors":"I. Chatziioannidis, G. Mitsiakos, F. Vouzas","doi":"10.7363/060132","DOIUrl":"https://doi.org/10.7363/060132","url":null,"abstract":"Patient safety in the Neonatal Intensive Care Unit (NICU) environment is an under-researched area, but recently seems to get high priority on the healthcare quality agenda worldwide. NICU, as a highly sensitive and technological driven environment, signals the importance for awareness in causation of mistakes and accidents. Adverse events and near misses that comprise the majority of human errors, cause morbidity often with devastating results, even death. Likewise in other organizations, errors causes are multiple and complex. Other high reliability organizations, such as air force and nuclear industry, offer examples of how standardized/homogenized work and removal of systems weaknesses can minimize errors. It is widely accepted that medical errors can be explained based on personal and/or system approach. The impact/effect of medical errors can be reduced when thorough/causative identification approach is followed by detailed analysis of consequences and prevention measures. NICU’s medical and nursing staff should be familiar with patient safety language, implement best practices, and support safety culture, maximizing efforts for reducing errors. Furthermore, top management commitment and support in developing patient safety culture is essential in order to assure the achievement of the desirable organizational safety outcomes. The aim of the paper is to review patient safety issues in the NICU environment, focusing on development and implementation of strategies, enhancing high quality standards for health care.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41801268","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}
M. Somaschini, S. Presi, M. Ferrari, B. Vergani, P. Carrera
Mutations in genes encoding surfactant protein B (SP-B), ATP-binding cassette transporter A3 (ABCA3) and surfactant protein C (SP-C) can result in neonatal and pediatric lung disease. We retrospectively reviewed 391 molecular analyses of genes encoding SP-B ( SFTPB ), SP-C ( SFTPC ) and ABCA3 ( ABCA3 ) performed in our laboratory from 2000 to 2015 in term and preterm newborn infants with severe respiratory distress syndrome (RDS), infants and children with interstitial lung disease (ILD), chorionic villi for prenatal diagnosis, parents and siblings of affected infants. Direct sequencing of SFTPB , SFTPC and ABCA3 was performed on genomic DNA extracted from peripheral blood. Histopathologic, immunohistochemical and ultrastructural analyses were performed when lung tissue was available. Genetic variants in SFTPB , SFTPC , ABCA3 were identified in 71 of 181 (39%) term and preterm newborn infants tested for severe and unexplained RDS and in 38 of 74 (51%) infants and children with ILD. A higher mortality rate was recorded among term newborn infants with homozygous or compound heterozygous mutations in SFTPB and ABCA3 . Light microscopy and immunohistochemical analysis of the lung tissue were performed in 11 infants and electron microscopy in 8. Prenatal diagnosis was performed in 8 women with a previous child who died because of ABCA3 deficiency; 2 fetuses affected, 5 carriers and 1 normal were identified. Surfactant dysfunction was identified in a significant number of newborn infants with severe unexplained respiratory failure and children with ILD, indicating the importance of genetic studies in infants and children with this phenotype. While actual treatment is primarily supportive, early identification is important to establish appropriate management and evaluation of treatment options and to offer genetic counselling and prenatal diagnosis.
{"title":"Genetic surfactant dysfunction in newborn infants and children with acute and chronic lung disease","authors":"M. Somaschini, S. Presi, M. Ferrari, B. Vergani, P. Carrera","doi":"10.7363/060134","DOIUrl":"https://doi.org/10.7363/060134","url":null,"abstract":"Mutations in genes encoding surfactant protein B (SP-B), ATP-binding cassette transporter A3 (ABCA3) and surfactant protein C (SP-C) can result in neonatal and pediatric lung disease. We retrospectively reviewed 391 molecular analyses of genes encoding SP-B ( SFTPB ), SP-C ( SFTPC ) and ABCA3 ( ABCA3 ) performed in our laboratory from 2000 to 2015 in term and preterm newborn infants with severe respiratory distress syndrome (RDS), infants and children with interstitial lung disease (ILD), chorionic villi for prenatal diagnosis, parents and siblings of affected infants. Direct sequencing of SFTPB , SFTPC and ABCA3 was performed on genomic DNA extracted from peripheral blood. Histopathologic, immunohistochemical and ultrastructural analyses were performed when lung tissue was available. Genetic variants in SFTPB , SFTPC , ABCA3 were identified in 71 of 181 (39%) term and preterm newborn infants tested for severe and unexplained RDS and in 38 of 74 (51%) infants and children with ILD. A higher mortality rate was recorded among term newborn infants with homozygous or compound heterozygous mutations in SFTPB and ABCA3 . Light microscopy and immunohistochemical analysis of the lung tissue were performed in 11 infants and electron microscopy in 8. Prenatal diagnosis was performed in 8 women with a previous child who died because of ABCA3 deficiency; 2 fetuses affected, 5 carriers and 1 normal were identified. Surfactant dysfunction was identified in a significant number of newborn infants with severe unexplained respiratory failure and children with ILD, indicating the importance of genetic studies in infants and children with this phenotype. While actual treatment is primarily supportive, early identification is important to establish appropriate management and evaluation of treatment options and to offer genetic counselling and prenatal diagnosis.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48909984","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}
E. Bertino, M. Giribaldi, E. Cester, A. Coscia, B. Trapani, C. Peila, S. Arslanoğlu, G. Moro, L. Cavallarin
Given its unique nutritional and functional advantages, human milk (HM) should be considered as the first choice for the nutrition of all infants, including preterm newborns. Since its protein, mineral and energy contents are not suitable to meet the high needs of very-low-birth-weight (VLBW) infants, HM should be fortified for these components. Fortification of HM is an important nutritional intervention in order to provide appropriate nutritional intake and appropriate growth. The standard fortification strategy has yielded inadequate protein intakes, resulting in slower growth as compared to preterm formulas. Improvement of outcomes depends on new fortification strategies, considering the large variability of HM composition. Individualized fortification, either targeted or adjustable, has been shown to be effective and practical in attaining adequate protein intakes and growth. Most commercially available multi-nutrient fortifiers and protein concentrates are derived from bovine milk (BM), which has a protein composition very different from that of HM. The use of BM proteins has been recently questioned for possible association with intestinal inflammation in VLBW infants. Recently, one HM-based fortifier was shown to be associated with lower necrotizing enterocolitis rates and lower mortality in extremely premature infants, compared to BM-based products. Other milk sources are currently under evaluation: a randomized, controlled, single-blind clinical trial, coordinated by the Neonatal Unit of the University of Turin in collaboration with the Italian National Research Council of Turin and the University of Cagliari, is being carried out to evaluate the adequacy of fortifiers derived from donkey milk for the nutrition of preterm infants.
{"title":"New human milk fortifiers for the preterm infant","authors":"E. Bertino, M. Giribaldi, E. Cester, A. Coscia, B. Trapani, C. Peila, S. Arslanoğlu, G. Moro, L. Cavallarin","doi":"10.7363/060124","DOIUrl":"https://doi.org/10.7363/060124","url":null,"abstract":"Given its unique nutritional and functional advantages, human milk (HM) should be considered as the first choice for the nutrition of all infants, including preterm newborns. Since its protein, mineral and energy contents are not suitable to meet the high needs of very-low-birth-weight (VLBW) infants, HM should be fortified for these components. Fortification of HM is an important nutritional intervention in order to provide appropriate nutritional intake and appropriate growth. The standard fortification strategy has yielded inadequate protein intakes, resulting in slower growth as compared to preterm formulas. Improvement of outcomes depends on new fortification strategies, considering the large variability of HM composition. Individualized fortification, either targeted or adjustable, has been shown to be effective and practical in attaining adequate protein intakes and growth. Most commercially available multi-nutrient fortifiers and protein concentrates are derived from bovine milk (BM), which has a protein composition very different from that of HM. The use of BM proteins has been recently questioned for possible association with intestinal inflammation in VLBW infants. Recently, one HM-based fortifier was shown to be associated with lower necrotizing enterocolitis rates and lower mortality in extremely premature infants, compared to BM-based products. Other milk sources are currently under evaluation: a randomized, controlled, single-blind clinical trial, coordinated by the Neonatal Unit of the University of Turin in collaboration with the Italian National Research Council of Turin and the University of Cagliari, is being carried out to evaluate the adequacy of fortifiers derived from donkey milk for the nutrition of preterm infants.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47815627","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}
Zika virus has been known for more than half a century. Its clinical significance was just recently discovered, after the epidemic of Zika virus emerged in South and Central America. A task force established in 2015 by the Brazil Ministry of Health investigated the possible association between congenital Zika infection and microcephaly in fetuses and newborns. Since then more and more evidence emerged, supporting this hypothesis. The objective of this article is to review and summarize the currently available literature regarding Zika virus from a neonatologist’s standpoint and provide some guidance to medical providers who may have to care for potentially exposed pregnant patients and their newborns.
{"title":"Zika virus from a neonatologist’s perspective","authors":"Anna Zylak, S. Golombek","doi":"10.7363/060128","DOIUrl":"https://doi.org/10.7363/060128","url":null,"abstract":"Zika virus has been known for more than half a century. Its clinical significance was just recently discovered, after the epidemic of Zika virus emerged in South and Central America. A task force established in 2015 by the Brazil Ministry of Health investigated the possible association between congenital Zika infection and microcephaly in fetuses and newborns. Since then more and more evidence emerged, supporting this hypothesis. The objective of this article is to review and summarize the currently available literature regarding Zika virus from a neonatologist’s standpoint and provide some guidance to medical providers who may have to care for potentially exposed pregnant patients and their newborns.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44418223","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}
P. Kaingade, I. Somasundaram, A. Nikam, Padmanava Behera, Sachin Kulkarni, J. Patel
Universal breastfeeding has been a stated policy of the American Academy of Pediatrics, the World Health Organization as well as UNICEF. Human milk is considered as the gold standard for infants owing to its colossal nutritional values. However, the presence of various cellular components of breast milk have been gaining more attention in recent years since the first discovery of mammary stem cells in 2007, thereby providing a ray of hope not only for growth and immunity of the neonate but also an insight into its regenerative applicability. In this relation, this article summarizes the cell components of breast milk that have been identified to date. It highlights the beneficial effects of these cells for term and preterm delivered infants along with the need for breast milk and its cell banking.
{"title":"Breast milk cell components and its beneficial effects on neonates: need for breast milk cell banking","authors":"P. Kaingade, I. Somasundaram, A. Nikam, Padmanava Behera, Sachin Kulkarni, J. Patel","doi":"10.7363/060115","DOIUrl":"https://doi.org/10.7363/060115","url":null,"abstract":"Universal breastfeeding has been a stated policy of the American Academy of Pediatrics, the World Health Organization as well as UNICEF. Human milk is considered as the gold standard for infants owing to its colossal nutritional values. However, the presence of various cellular components of breast milk have been gaining more attention in recent years since the first discovery of mammary stem cells in 2007, thereby providing a ray of hope not only for growth and immunity of the neonate but also an insight into its regenerative applicability. In this relation, this article summarizes the cell components of breast milk that have been identified to date. It highlights the beneficial effects of these cells for term and preterm delivered infants along with the need for breast milk and its cell banking.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49597912","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. Morais, G. Rocha, F. Flôr-de-Lima, P. Éden, A. Fragoso, H. Guimarães
Introduction: Congenital diaphragmatic hernia (CDH) is a severe malformation, displaying relevant mortality and morbidity rates in newborns. Aim: To characterize clinically and demographically all neonatal cases of CDH admitted to a level III Neonatal Intensive Care Unit during a 12-year period and to evaluate the predictive value of baseline characteristics on mortality and morbidity at discharge. Methods: Maternal/infant clinical and electronic records were ret- rospectively reviewed. All neonates with posterolateral CDH admitted between January 2003 and December 2014 were included. Results: Fifty-three newborns were included. Overall mortality during hospitalization was 22/53 (41.5%). Clinical characteristics associated with mortality were the presence of intrathoracic liver (p = 0.005), intrathoracic stomach (p = 0.015), elevated arterial pCO 2 or lower pH values at admission (respectively, p = 0.001 and p < 0.001), pre-ductal oxygen saturation < 85% at admission (p = 0.012) and surgical repair with prosthetic patch (p = 0.041). Morbidity at discharge was reported in 7 (22.6%) survivors. Stomach herniation and sepsis were associated with higher morbidity (respectively, p = 0.012 and p = 0.029). In a logistic regression, patch repair was the only variable with predictive value for death during hospitalization, with an odds ratio (OR) of 15 (95% CI 0.98-228.9), and intrathoracic stomach was a predictor of morbidity at discharge (OR = 15.7, 95% CI 1.4-174.2). Conclusion: Structural characteristics, namely defect size and presence of intrathoracic stomach, remain the primary determinants of neonatal prognosis in CDH. Although post-natal approaches have progressively proven their value in increasing survival and improving management of high-risk cases, future researches should continue focusing on the definition of foetal anatomical markers of severity and prenatal treatment of CDH.
{"title":"Predictors of prognosis in neonates with congenital diaphragmatic hernia: experience of 12 years","authors":"C. Morais, G. Rocha, F. Flôr-de-Lima, P. Éden, A. Fragoso, H. Guimarães","doi":"10.7363/060126","DOIUrl":"https://doi.org/10.7363/060126","url":null,"abstract":"Introduction: Congenital diaphragmatic hernia (CDH) is a severe malformation, displaying relevant mortality and morbidity rates in newborns. Aim: To characterize clinically and demographically all neonatal cases of CDH admitted to a level III Neonatal Intensive Care Unit during a 12-year period and to evaluate the predictive value of baseline characteristics on mortality and morbidity at discharge. Methods: Maternal/infant clinical and electronic records were ret- rospectively reviewed. All neonates with posterolateral CDH admitted between January 2003 and December 2014 were included. Results: Fifty-three newborns were included. Overall mortality during hospitalization was 22/53 (41.5%). Clinical characteristics associated with mortality were the presence of intrathoracic liver (p = 0.005), intrathoracic stomach (p = 0.015), elevated arterial pCO 2 or lower pH values at admission (respectively, p = 0.001 and p < 0.001), pre-ductal oxygen saturation < 85% at admission (p = 0.012) and surgical repair with prosthetic patch (p = 0.041). Morbidity at discharge was reported in 7 (22.6%) survivors. Stomach herniation and sepsis were associated with higher morbidity (respectively, p = 0.012 and p = 0.029). In a logistic regression, patch repair was the only variable with predictive value for death during hospitalization, with an odds ratio (OR) of 15 (95% CI 0.98-228.9), and intrathoracic stomach was a predictor of morbidity at discharge (OR = 15.7, 95% CI 1.4-174.2). Conclusion: Structural characteristics, namely defect size and presence of intrathoracic stomach, remain the primary determinants of neonatal prognosis in CDH. Although post-natal approaches have progressively proven their value in increasing survival and improving management of high-risk cases, future researches should continue focusing on the definition of foetal anatomical markers of severity and prenatal treatment of CDH.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44765820","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}
Background: The American Academy of Pediatrics recommends the consideration of the ability and confidence of a caregiver to take care of a preterm infant before discharge (D/C). Objective: To identify how parental self-efficacy as measured by the Infant Care Survey (ICS) evolves during their preterm child’s Neonatal Intensive Care Unit (NICU) admission, and to identify conditions associated with caregiver confidence. Methods: Prospective cohort study involving parents of infants ≤ 32 weeks gestation who were enrolled between 10-20 days of their infant’s life. Parent/infant demographic, pregnancy, NICU, and D/C data was collected. Parents responded to the ICS at enrollment and D/C. Enrollment and D/C ICS scores were compared to one another using a Paired Samples t-test to assess the change in scores over time. Further, conditions which are thought to affect self-efficacy were compared to enrollment, D/C, and the change in total ICS scores to assess for correlations. Results: Total ICS scores showed significant improvement from enrollment to D/C: (188.3 ± 60.5 vs. 235.9 ± 20.9). When comparing caregivers who did not have other children in the home to parents who did, caregivers without previous children had significantly lower ICS scores at enrollment (149.8 ± 64.0 vs. 221.7 ± 31.2); however, D/C ICS scores were similar (228.7 ± 23.1 vs. 242.1 ± 17.2). This was the result of a more profound improvement in self-efficacy amongst first time parents during their child’s NICU admission (79.0 ± 68.1 vs. 20.3 ± 35.2). Conclusion: Despite the stress and anxiety of having a child in the NICU, parental self-efficacy is likely to significantly improve during their child’s hospitalization. This was most evident amongst first time parents. We suspect that parental participation in their infant’s care and formal educational opportunities contribute to improvement in confidence over time.
{"title":"The evolution of parental self-efficacy in knowledge and skill in the home care of preterm infants","authors":"Nicolette Anne Ribeiro, J. Kase","doi":"10.7363/060118","DOIUrl":"https://doi.org/10.7363/060118","url":null,"abstract":"Background: The American Academy of Pediatrics recommends the consideration of the ability and confidence of a caregiver to take care of a preterm infant before discharge (D/C). Objective: To identify how parental self-efficacy as measured by the Infant Care Survey (ICS) evolves during their preterm child’s Neonatal Intensive Care Unit (NICU) admission, and to identify conditions associated with caregiver confidence. Methods: Prospective cohort study involving parents of infants ≤ 32 weeks gestation who were enrolled between 10-20 days of their infant’s life. Parent/infant demographic, pregnancy, NICU, and D/C data was collected. Parents responded to the ICS at enrollment and D/C. Enrollment and D/C ICS scores were compared to one another using a Paired Samples t-test to assess the change in scores over time. Further, conditions which are thought to affect self-efficacy were compared to enrollment, D/C, and the change in total ICS scores to assess for correlations. Results: Total ICS scores showed significant improvement from enrollment to D/C: (188.3 ± 60.5 vs. 235.9 ± 20.9). When comparing caregivers who did not have other children in the home to parents who did, caregivers without previous children had significantly lower ICS scores at enrollment (149.8 ± 64.0 vs. 221.7 ± 31.2); however, D/C ICS scores were similar (228.7 ± 23.1 vs. 242.1 ± 17.2). This was the result of a more profound improvement in self-efficacy amongst first time parents during their child’s NICU admission (79.0 ± 68.1 vs. 20.3 ± 35.2). Conclusion: Despite the stress and anxiety of having a child in the NICU, parental self-efficacy is likely to significantly improve during their child’s hospitalization. This was most evident amongst first time parents. We suspect that parental participation in their infant’s care and formal educational opportunities contribute to improvement in confidence over time.","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2017-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47506424","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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