M. Puddu, M. A. Marcialis, A. D. Magistris, R. Irmesi, E. Coni, L. Mascia, V. Fanos
Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the neonatal intestine that strikes in 1 of 1,000 live births. Its etiology is unknown. This review describes in detail the new NECs especially those which affect preterm infants: contagion or lymphocytosis associated, transfusion associated and cow’s milk allergy associated. A wide repertory of images are presented, together with algorithms for differential diagnosis. Proceedings of the International Course on Perinatal Pathology (part of the 10 th International Workshop on Neonatology · October 22 nd -25 th , 2014) · Cagliari (Italy) · October 25 th , 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken
坏死性小肠结肠炎(NEC)是一种新生儿肠道的急性炎症性疾病，每1000个活产儿中就有1个发生。其病因尚不清楚。本文详细介绍了新的nec，特别是那些影响早产儿:传染或淋巴细胞增多相关，输血相关和牛奶过敏相关。广泛的剧目的图像提出，连同算法的鉴别诊断。围产期病理学国际课程论文集(第10届新生儿国际研讨会的一部分，2014年10月22日至25日)·卡利亚里(意大利)·2014年10月25日·临床病理对话在解决问题中的作用特邀编辑:Gavino Faa, Vassilios Fanos, Peter Van Eyken
{"title":"From the \"old NEC\" to the \"new NECs\"","authors":"M. Puddu, M. A. Marcialis, A. D. Magistris, R. Irmesi, E. Coni, L. Mascia, V. Fanos","doi":"10.7363/030245","DOIUrl":"https://doi.org/10.7363/030245","url":null,"abstract":"Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the neonatal intestine that strikes in 1 of 1,000 live births. Its etiology is unknown. This review describes in detail the new NECs especially those which affect preterm infants: contagion or lymphocytosis associated, transfusion associated and cow’s milk allergy associated. A wide repertory of images are presented, together with algorithms for differential diagnosis. Proceedings of the International Course on Perinatal Pathology (part of the 10 th International Workshop on Neonatology · October 22 nd -25 th , 2014) · Cagliari (Italy) · October 25 th , 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289974","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. A. Marcialis, A. Dessì, R. Irmesi, V. Marinelli, Maria Cristina Pintus
Periventricular leucomalacia (PVL) is traditionally considered a multifactorial lesion related to three main mechanisms: ischemia, inflammation and excitotoxicity. For years it was believed that hypoperfusion, associated with the peculiar vascular anatomy of the premature brain (border zones), was the conditio sine qua non in the pathogenesis of PVL. More recently this theory has been questioned. Many studies have stressed the importance of the association between inflammation/infection and white matter injury and have supported the multi hit hypothesis according to which several (genetic, hormonal, immune and nutritional) factors may team up in a multi-hit fashion. The emerging concept is that the fetal white cell activation together with the interaction between the innate and adaptive immune system play a main role in white matter damage. Currently there are increasing evidence that PVL is a disease of connectivity. In this article we review the news in the basics of pathogenesis, the incidence, the definition and the diagnosis of PVL. Furthermore, recent follow-up studies and neuroprotective therapies are mentioned. Proceedings of the International Course on Perinatal Pathology (part of the 10 th International Workshop on Neonatology · October 22 nd -25 th , 2014) · Cagliari (Italy) · October 25 th , 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken
脑室周围白质软化(PVL)传统上被认为是一种多因素病变，涉及三种主要机制:缺血、炎症和兴奋毒性。多年来，人们认为灌注不足与早产儿脑(边界区)的特殊血管解剖有关，是PVL发病的必要条件。最近，这一理论受到了质疑。许多研究强调了炎症/感染与白质损伤之间关联的重要性，并支持多重打击假说，根据多重打击假说，多种因素(遗传、激素、免疫和营养)可能以多重打击方式合作。胎儿白细胞的激活以及先天免疫系统和适应性免疫系统的相互作用在白质损伤中起主要作用。目前有越来越多的证据表明PVL是一种连通性疾病。本文就PVL的发病机制、发病率、定义及诊断等方面的研究进展作一综述。此外，还提到了最近的随访研究和神经保护治疗。围产期病理学国际课程论文集(第10届新生儿国际研讨会的一部分，2014年10月22日至25日)·卡利亚里(意大利)·2014年10月25日·临床病理对话在解决问题中的作用特邀编辑:Gavino Faa, Vassilios Fanos, Peter Van Eyken
{"title":"New light on white matter damage of the premature brain: a neonatologist's point of view","authors":"M. A. Marcialis, A. Dessì, R. Irmesi, V. Marinelli, Maria Cristina Pintus","doi":"10.7363/030237","DOIUrl":"https://doi.org/10.7363/030237","url":null,"abstract":"Periventricular leucomalacia (PVL) is traditionally considered a multifactorial lesion related to three main mechanisms: ischemia, inflammation and excitotoxicity. For years it was believed that hypoperfusion, associated with the peculiar vascular anatomy of the premature brain (border zones), was the conditio sine qua non in the pathogenesis of PVL. More recently this theory has been questioned. Many studies have stressed the importance of the association between inflammation/infection and white matter injury and have supported the multi hit hypothesis according to which several (genetic, hormonal, immune and nutritional) factors may team up in a multi-hit fashion. The emerging concept is that the fetal white cell activation together with the interaction between the innate and adaptive immune system play a main role in white matter damage. Currently there are increasing evidence that PVL is a disease of connectivity. In this article we review the news in the basics of pathogenesis, the incidence, the definition and the diagnosis of PVL. Furthermore, recent follow-up studies and neuroprotective therapies are mentioned. Proceedings of the International Course on Perinatal Pathology (part of the 10 th International Workshop on Neonatology · October 22 nd -25 th , 2014) · Cagliari (Italy) · October 25 th , 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289870","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 term “hyaline membrane disease” refers to the histological aspect of the most frequent pulmonary pathology in preterm newborn patients. The lung of the preterm baby is morphologically and functionally immature. Surfactant deficiency in the immature lungs causes alveolar instability and collapse, capillary edema and the formation of hyaline membrane. Thus, the hyaline membranes are epiphenomena and are not the cause of respiratory failure in infants with immature lungs. This definition is presently used to indicate surfactant deficit alone and should not be used for other causes of respiratory distress. Clinicians prefer to talk of “respiratory distress syndrome” (RDS). Improvement in neonatal treatment has changed the natural course of the illness, its clinical and radiological features and has enabled extremely low birth weight newborns (ELBW) to survive. Alveoli paucity and pulmonary interstitial thickness in ELBW impair gas exchange and may necessitate prolonged ventilation treatment, increasing the risk of ventilator-induced lung injury (VILI) and bronchopulmonary dysplasia (BPD). RDS, therefore, is a complex illness where pulmonary immaturity and surfactant deficit play a role together with other pathological conditions that determine the course of the illness and both short and long-term results. Proceedings of the International Course on Perinatal Pathology (part of the 10 th International Workshop on Neonatology · October 22 nd -25 th , 2014) · Cagliari (Italy) · October 25 th , 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken
术语“透明膜病”是指组织学方面最常见的肺部病理早产儿患者。早产儿的肺在形态和功能上都不成熟。未成熟肺表面活性剂缺乏导致肺泡不稳定和塌陷，毛细血管水肿和透明膜的形成。因此，透明膜是副现象，并不是肺不成熟婴儿呼吸衰竭的原因。这一定义目前仅用于表面活性剂缺陷，不应用于其他原因的呼吸窘迫。临床医生更喜欢称之为“呼吸窘迫综合征”(RDS)。新生儿治疗的改善改变了该病的自然病程、临床和放射学特征，并使极低出生体重新生儿(ELBW)得以存活。ELBW的肺泡缺乏和肺间质厚度损害气体交换，可能需要延长通气治疗，增加呼吸机诱导的肺损伤(VILI)和支气管肺发育不良(BPD)的风险。因此，RDS是一种复杂的疾病，肺不成熟和表面活性物质缺乏与其他病理条件一起起作用，决定了疾病的病程和短期和长期结果。围产期病理学国际课程论文集(第10届新生儿国际研讨会的一部分，2014年10月22日至25日)·卡利亚里(意大利)·2014年10月25日·临床病理对话在解决问题中的作用特邀编辑:Gavino Faa, Vassilios Fanos, Peter Van Eyken
{"title":"Hyaline membrane disease or respiratory distress syndrome? A new approach for an old disease","authors":"L. Grappone, F. Messina","doi":"10.7363/030263","DOIUrl":"https://doi.org/10.7363/030263","url":null,"abstract":"The term “hyaline membrane disease” refers to the histological aspect of the most frequent pulmonary pathology in preterm newborn patients. The lung of the preterm baby is morphologically and functionally immature. Surfactant deficiency in the immature lungs causes alveolar instability and collapse, capillary edema and the formation of hyaline membrane. Thus, the hyaline membranes are epiphenomena and are not the cause of respiratory failure in infants with immature lungs. This definition is presently used to indicate surfactant deficit alone and should not be used for other causes of respiratory distress. Clinicians prefer to talk of “respiratory distress syndrome” (RDS). Improvement in neonatal treatment has changed the natural course of the illness, its clinical and radiological features and has enabled extremely low birth weight newborns (ELBW) to survive. Alveoli paucity and pulmonary interstitial thickness in ELBW impair gas exchange and may necessitate prolonged ventilation treatment, increasing the risk of ventilator-induced lung injury (VILI) and bronchopulmonary dysplasia (BPD). RDS, therefore, is a complex illness where pulmonary immaturity and surfactant deficit play a role together with other pathological conditions that determine the course of the illness and both short and long-term results. Proceedings of the International Course on Perinatal Pathology (part of the 10 th International Workshop on Neonatology · October 22 nd -25 th , 2014) · Cagliari (Italy) · October 25 th , 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken","PeriodicalId":51914,"journal":{"name":"Journal of Pediatric and Neonatal Individualized Medicine","volume":"47 26 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2014-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289781","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. Neroni, G. Ottonello, D. Manus, A. Atzei, Elisabetta Trudu, Susanna Floris, V. Fanos
Paroxysmal supraventricular tachycardia (PSVT) is the most frequent arrhythmia in newborns and infants. Most supraventricular tachycardias affect structurally healthy hearts. Apart from occasional detection by parents, most tachycardias in this age group are revealed by heart failure signs, such as poor feeding, sweating and shortness of breath. The main symptom reported by school-age children is palpitations. The chronic tachycardia causes a secondary form of dilative cardiomyopathy. Treatment of acute episode usually has an excellent outcome. Vagal manoeuvres are effective in patients with atrioventricular reentrant tachycardia. Adenosine is the drug of choice at all ages for tachycardias involving the atrioventricular node. Its key advantage is its short half life and minimum or no negative inotropic effects. Verapamil is not indicated in newborns and children as it poses a high risk of electromechanical dissociation. Antiarrhythmic prophylaxis of PSVT recurrence is usually recommended in the first year of life, because the diagnosis of tachycardia may be delayed up to the appearance of symptoms. Digoxin can be administered in all forms of PSVT involving the atrioventricular node, except for patients with Wolff-Parkinson-White syndrome below one year of age. Patients with atrioventricular reentrant PSVT can be treated effectively by class Ic drugs, such as propaphenone and flecainide. Amiodarone has the greatest antiarrhythmic effect, but should be used with caution owing to the high incidence of side 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":"Paroxysmal supraventricular tachycardia: physiopathology and management","authors":"P. Neroni, G. Ottonello, D. Manus, A. Atzei, Elisabetta Trudu, Susanna Floris, V. Fanos","doi":"10.7363/030243","DOIUrl":"https://doi.org/10.7363/030243","url":null,"abstract":"Paroxysmal supraventricular tachycardia (PSVT) is the most frequent arrhythmia in newborns and infants. Most supraventricular tachycardias affect structurally healthy hearts. Apart from occasional detection by parents, most tachycardias in this age group are revealed by heart failure signs, such as poor feeding, sweating and shortness of breath. The main symptom reported by school-age children is palpitations. The chronic tachycardia causes a secondary form of dilative cardiomyopathy. Treatment of acute episode usually has an excellent outcome. Vagal manoeuvres are effective in patients with atrioventricular reentrant tachycardia. Adenosine is the drug of choice at all ages for tachycardias involving the atrioventricular node. Its key advantage is its short half life and minimum or no negative inotropic effects. Verapamil is not indicated in newborns and children as it poses a high risk of electromechanical dissociation. Antiarrhythmic prophylaxis of PSVT recurrence is usually recommended in the first year of life, because the diagnosis of tachycardia may be delayed up to the appearance of symptoms. Digoxin can be administered in all forms of PSVT involving the atrioventricular node, except for patients with Wolff-Parkinson-White syndrome below one year of age. Patients with atrioventricular reentrant PSVT can be treated effectively by class Ic drugs, such as propaphenone and flecainide. Amiodarone has the greatest antiarrhythmic effect, but should be used with caution owing to the high incidence of side 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":"2014-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71290106","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}
Perinatal mortality in very low birth weight infants has dramatically decreased during the last decades. However, 15-25% of these infants will show neurodevelopmental impairment later on. The aim of implementing early developmental care (EDC), emerged as a new field in neonatology, is to create an intervention program designed to provide support for optimal neurobehavioral development during this highly vulnerable period of brain growth. The theoretical framework, which underlies the approach, is supported by research in different scientific fields, including neuroscience, psychology, medicine and nursing. EDC utilizes a range of medical and nursing interventions that aim to decrease the stress of preterm neonates in neonatal intensive care units (NICUs). The Neonatal Individualized Developmental Care Assessment Program (NIDCAP) is an integrated and holistic form of family-centered developmental care. Changing the traditional NICU towards an EDC-NICU includes training nursing and medical staff, investing in their quality and most importantly keeping parents in proximity to the infants. The new challenge of modern neonatology is to restore the mother-infant dyad applying “couplet care” starting at birth until discharge. Most of the European NICUs apply some elements of EDC, but it is more consistent in northern Europe. The development of NIDCAP training centers in Europe demonstrates the evolution of care. It is likely that future research and intervention programs will optimize our practices. Developmental care could prove to be an important recent step in improving outcome in extremely preterm neonates. 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":"NIDCAP and developmental care","authors":"D. Haumont","doi":"10.7363/030240","DOIUrl":"https://doi.org/10.7363/030240","url":null,"abstract":"Perinatal mortality in very low birth weight infants has dramatically decreased during the last decades. However, 15-25% of these infants will show neurodevelopmental impairment later on. The aim of implementing early developmental care (EDC), emerged as a new field in neonatology, is to create an intervention program designed to provide support for optimal neurobehavioral development during this highly vulnerable period of brain growth. The theoretical framework, which underlies the approach, is supported by research in different scientific fields, including neuroscience, psychology, medicine and nursing. EDC utilizes a range of medical and nursing interventions that aim to decrease the stress of preterm neonates in neonatal intensive care units (NICUs). The Neonatal Individualized Developmental Care Assessment Program (NIDCAP) is an integrated and holistic form of family-centered developmental care. Changing the traditional NICU towards an EDC-NICU includes training nursing and medical staff, investing in their quality and most importantly keeping parents in proximity to the infants. The new challenge of modern neonatology is to restore the mother-infant dyad applying “couplet care” starting at birth until discharge. Most of the European NICUs apply some elements of EDC, but it is more consistent in northern Europe. The development of NIDCAP training centers in Europe demonstrates the evolution of care. It is likely that future research and intervention programs will optimize our practices. Developmental care could prove to be an important recent step in improving outcome in extremely preterm neonates. 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":"2014-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289923","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 early childhood years are a period of rapid change in the brain. During early childhood, the brain forms and refines a complex network of connections through synaptogenesis, pruning, and myelination. The development of the brain is regulated by genes, which interact profoundly with early experience. There are sensitive periods for development of certain capabilities. These refer to critical windows of time in the developmental process when certain parts of the brain may be most susceptible to particular experiences during its development. Most functions of the human brain result from a complex interplay between genetic potential and appropriately timed experiences. Early postnatal experiences play a major role in shaping the functional capacity of the neural systems responsible for mediating our cognitive, emotional, social and physiological functions. When the necessary experiences are not provided at the optimal times, these neural systems do not develop in optimal ways. Adverse environments and experiences during the neonatal period can dramatically affect the development of the hypothalamic-pituitary-adrenal axis (HPA axis) that underlies adaptive behavioral responses. Early life stress programs HPA axis development and exerts profound effects on neural plasticity, with resultant long-term influences on neurobehavior. Animal studies show that not only are these neurobiological changes long lasting, but that they too can be passed on to future generations via non-genetic transmission. Olfactory, auditory, visual and tactile stimulation may serve as an important cue for brain development exerting specific effects on neuroendocrine systems regulating social and emotional behavior which may have consequences for subsequent generations of offspring. 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 maltreatment and brain development","authors":"K. Yurdakök","doi":"10.7363/030228","DOIUrl":"https://doi.org/10.7363/030228","url":null,"abstract":"The early childhood years are a period of rapid change in the brain. During early childhood, the brain forms and refines a complex network of connections through synaptogenesis, pruning, and myelination. The development of the brain is regulated by genes, which interact profoundly with early experience. There are sensitive periods for development of certain capabilities. These refer to critical windows of time in the developmental process when certain parts of the brain may be most susceptible to particular experiences during its development. Most functions of the human brain result from a complex interplay between genetic potential and appropriately timed experiences. Early postnatal experiences play a major role in shaping the functional capacity of the neural systems responsible for mediating our cognitive, emotional, social and physiological functions. When the necessary experiences are not provided at the optimal times, these neural systems do not develop in optimal ways. Adverse environments and experiences during the neonatal period can dramatically affect the development of the hypothalamic-pituitary-adrenal axis (HPA axis) that underlies adaptive behavioral responses. Early life stress programs HPA axis development and exerts profound effects on neural plasticity, with resultant long-term influences on neurobehavior. Animal studies show that not only are these neurobiological changes long lasting, but that they too can be passed on to future generations via non-genetic transmission. Olfactory, auditory, visual and tactile stimulation may serve as an important cue for brain development exerting specific effects on neuroendocrine systems regulating social and emotional behavior which may have consequences for subsequent generations of offspring. 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":"2014-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289680","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. Giannattasio, C. Veropalumbo, L. Mari, Valentina Marra, Maria Vittoria Andreucci, L. Capasso, F. Raimondi
Fungal infections represent a serious problem in neonatal intensive care units (NICUs) worldwide. Preterm infants are a vulnerable population for major events and adverse sequelae from fungal sepsis. The primary fungus of concern in neonates is C. albicans , whose colonization is associated with devastating complication and high rate of mortality. Among the risk factors responsible for development of invasive fungal infections, previous mucosal and skin colonization are of primary importance. Fungal colonization in neonates may be secondary to either maternal transmission or nosocomial acquisition in the nursery. Antifungal prophylaxis is currently applied in different NICUs and in various patients groups with successful results. Prophylactic drugs can include oral nystatin and oral or intravenous fluconazole. To date, antifungal prophylaxis with fluconazole is the recommended approach for neonates lower than 1,000 g and/or 27 weeks’ gestation or less, manly in NICUs with relatively high frequency of invasive candidiasis. First-line treatment of invasive fungal infections includes amphotericin B deoxycholate, lipid preparations of amphotericin B, fluconazole, or micafungin. However, data on pharmacokinetic, schedule treatment and appropriate dosage of antifungal agents in neonates, mainly in premature, are still limited. Future strategies to reduce neonatal morbidity and mortality derived from invasive fungal infections include new echinocandins not yet approved for neonatal use (caspofungin or anidulafungin) and other adjuvant treatments as intravenous immunoglobulin, lactoferrin or probiotics. Since current therapies for systemic fungal diseases are not universally successful and morbidity remains high, future efforts will be also focused on better prevention of fungal diseases and understanding of appropriate dosing schedule of the available antifungal agents. 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":"Treatment of fungal infections: an update","authors":"A. Giannattasio, C. Veropalumbo, L. Mari, Valentina Marra, Maria Vittoria Andreucci, L. Capasso, F. Raimondi","doi":"10.7363/030242","DOIUrl":"https://doi.org/10.7363/030242","url":null,"abstract":"Fungal infections represent a serious problem in neonatal intensive care units (NICUs) worldwide. Preterm infants are a vulnerable population for major events and adverse sequelae from fungal sepsis. The primary fungus of concern in neonates is C. albicans , whose colonization is associated with devastating complication and high rate of mortality. Among the risk factors responsible for development of invasive fungal infections, previous mucosal and skin colonization are of primary importance. Fungal colonization in neonates may be secondary to either maternal transmission or nosocomial acquisition in the nursery. Antifungal prophylaxis is currently applied in different NICUs and in various patients groups with successful results. Prophylactic drugs can include oral nystatin and oral or intravenous fluconazole. To date, antifungal prophylaxis with fluconazole is the recommended approach for neonates lower than 1,000 g and/or 27 weeks’ gestation or less, manly in NICUs with relatively high frequency of invasive candidiasis. First-line treatment of invasive fungal infections includes amphotericin B deoxycholate, lipid preparations of amphotericin B, fluconazole, or micafungin. However, data on pharmacokinetic, schedule treatment and appropriate dosage of antifungal agents in neonates, mainly in premature, are still limited. Future strategies to reduce neonatal morbidity and mortality derived from invasive fungal infections include new echinocandins not yet approved for neonatal use (caspofungin or anidulafungin) and other adjuvant treatments as intravenous immunoglobulin, lactoferrin or probiotics. Since current therapies for systemic fungal diseases are not universally successful and morbidity remains high, future efforts will be also focused on better prevention of fungal diseases and understanding of appropriate dosing schedule of the available antifungal agents. 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":"2014-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289940","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. Pisoni, F. Garofoli, I. Baiardini, C. Tzialla, M. Stronati
The theory of human attachment, developed in 1951 by John Bowlby, has been widely applied across psychological, medical and social disciplines, especially in the context of developmental psychology; more recently it has been studied in the obstetric and neonatal fields. Numerous studies suggest that attachment patterns have an impact on the social, cognitive and emotional development of the off-spring, and are also believed to influence the individual’s psychosocial trajectories across the lifespan. Starting from empirical study of attachment, the psychological analysis of the experience of pregnancy allowed to introduce the concept of prenatal attachment, considered as the earlier internalized representation of the fetus that both parents acquire and elaborate during pregnancy. Recent studies have attempted to investigate how prenatal attachment develops in conditions of hazard, as for example in women hospitalized for a high-risk pregnancy or preterm birth. Literature showed that these clinical conditions may represent risk factors that, along with psychological distress and lack of familiar and social support, may adversely affect the mother-child relationship, with consequences on the psycosocial development of the off-spring. During pregnancy, medical team should assess mothers’ distress and attachment, perform procedures to positively develop attachment, and direct parents with low attachment scores to receive a professional, specific counseling. In the premature birth context, it is important to closely support mother-infant contact and to decrease maternal stress in every possible way during hospitalization and after discharge. Promotion of psychological wellbeing and attachment during pregnancy and after birth may serve as a crucial opportunity of improving maternal health practices, perinatal health and neonatal outcomes. 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":"The development of parents-infant relationship in high-risk pregnancies and preterm birth","authors":"C. Pisoni, F. Garofoli, I. Baiardini, C. Tzialla, M. Stronati","doi":"10.7363/030233","DOIUrl":"https://doi.org/10.7363/030233","url":null,"abstract":"The theory of human attachment, developed in 1951 by John Bowlby, has been widely applied across psychological, medical and social disciplines, especially in the context of developmental psychology; more recently it has been studied in the obstetric and neonatal fields. Numerous studies suggest that attachment patterns have an impact on the social, cognitive and emotional development of the off-spring, and are also believed to influence the individual’s psychosocial trajectories across the lifespan. Starting from empirical study of attachment, the psychological analysis of the experience of pregnancy allowed to introduce the concept of prenatal attachment, considered as the earlier internalized representation of the fetus that both parents acquire and elaborate during pregnancy. Recent studies have attempted to investigate how prenatal attachment develops in conditions of hazard, as for example in women hospitalized for a high-risk pregnancy or preterm birth. Literature showed that these clinical conditions may represent risk factors that, along with psychological distress and lack of familiar and social support, may adversely affect the mother-child relationship, with consequences on the psycosocial development of the off-spring. During pregnancy, medical team should assess mothers’ distress and attachment, perform procedures to positively develop attachment, and direct parents with low attachment scores to receive a professional, specific counseling. In the premature birth context, it is important to closely support mother-infant contact and to decrease maternal stress in every possible way during hospitalization and after discharge. Promotion of psychological wellbeing and attachment during pregnancy and after birth may serve as a crucial opportunity of improving maternal health practices, perinatal health and neonatal outcomes. 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":"2014-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71289757","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 lack of specific drugs and labelling recommendations for the neonatal population is a long-standing problem throughout the world. With the introduction of the Paediatric Regulation in 2007, in Europe tangible steps have been made to increase clinical research in children, but only a limited number of clinical trials included neonates that remain therapeutic orphans. This leads to a widespread use of medicines outside the terms indicated in the product license (off-label as regards dose, route of administration, indication, age group) or in an unlicensed manner (formulations modified, extemporaneous preparations, imported medicines, chemicals used as drugs). This use, often made on the basis of a consolidated clinical experience in absence of other authorized options, does not imply that a drug is contraindicated or disapproved, but simply means that insufficient data are available to grant approval status and the risks and benefits of using a drug in a particular situation have not been examined. Given the importance that neonatal population not be denied of drugs that are clearly beneficial, an updated overview of the worldwide situation of off-label and unlicensed drug use in the newborn will be presented, by analyzing also the impact of recent legislative initiatives and the well recognized problems (increased risk of ineffective or toxic treatments, adverse drug reactions and medication errors). 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":"Off-label drug in the newborn","authors":"L. Cuzzolin","doi":"10.7363/030224","DOIUrl":"https://doi.org/10.7363/030224","url":null,"abstract":"The lack of specific drugs and labelling recommendations for the neonatal population is a long-standing problem throughout the world. With the introduction of the Paediatric Regulation in 2007, in Europe tangible steps have been made to increase clinical research in children, but only a limited number of clinical trials included neonates that remain therapeutic orphans. This leads to a widespread use of medicines outside the terms indicated in the product license (off-label as regards dose, route of administration, indication, age group) or in an unlicensed manner (formulations modified, extemporaneous preparations, imported medicines, chemicals used as drugs). This use, often made on the basis of a consolidated clinical experience in absence of other authorized options, does not imply that a drug is contraindicated or disapproved, but simply means that insufficient data are available to grant approval status and the risks and benefits of using a drug in a particular situation have not been examined. Given the importance that neonatal population not be denied of drugs that are clearly beneficial, an updated overview of the worldwide situation of off-label and unlicensed drug use in the newborn will be presented, by analyzing also the impact of recent legislative initiatives and the well recognized problems (increased risk of ineffective or toxic treatments, adverse drug reactions and medication errors). 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":"71289197","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}
In a global society as the present, the nomenclature and terminology of diseases must be universally accepted among the specialists. This sentence is particularly true in some fields of medicine, as genetics, in which the progress of knowledge has been particularly rapid in last years. Many genetic disorders were termed using the names of the doctor (or the doctors) who discovered and described them. The name of doctors and specialist were also frequently used to term sign and symptoms of diseases, including genetic syndromes. More rarely, a new disease received the name of the first patients described. In some cases the authors clearly proposed acronyms, that rapidly diffused as a good method to term genetic diseases and syndromes. Acronyms can be originated from the initial of main signs and symptoms; in some instances the acronym reproduces a word with other kind of semantic suggestions; some acronyms in their list of initials show also numbers, while others show also the initial of the words related to the physiopathology of disease. In more recent years acronyms were proposed to mark multicentric studies. 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":"Genetics and acronyms","authors":"G. Corsello","doi":"10.7363/030251","DOIUrl":"https://doi.org/10.7363/030251","url":null,"abstract":"In a global society as the present, the nomenclature and terminology of diseases must be universally accepted among the specialists. This sentence is particularly true in some fields of medicine, as genetics, in which the progress of knowledge has been particularly rapid in last years. Many genetic disorders were termed using the names of the doctor (or the doctors) who discovered and described them. The name of doctors and specialist were also frequently used to term sign and symptoms of diseases, including genetic syndromes. More rarely, a new disease received the name of the first patients described. In some cases the authors clearly proposed acronyms, that rapidly diffused as a good method to term genetic diseases and syndromes. Acronyms can be originated from the initial of main signs and symptoms; in some instances the acronym reproduces a word with other kind of semantic suggestions; some acronyms in their list of initials show also numbers, while others show also the initial of the words related to the physiopathology of disease. In more recent years acronyms were proposed to mark multicentric studies. 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":"71290055","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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