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The authors report their experience in the Division of Neonatology of the Catholic University of Rome about the choice of milk alimentation and mineral and vitamin supplementation before discharge and during the subsequent follow-up, with particular reference to very low-birthweight preterm infants (< 1500 g). Basing on empirical experiences, the authors emphasize the importance in current practice of post-conceptional age, with special regard to the kind of milk to choose after discharge and the time and terms of the weaning. Furthermore they stress nutritional, immuno-allergic and psychological advantages of human milk before and after hospital discharge, particularly related to the presence of long-chain polyunsaturated fatty acid (LCP), recently known to be essential on retina and brain development in the preterm infant. When breast milk is not available, the authors confirm the efficacy, before discharge, of preterm infant formulas and subsequently of infant formulas and after of follow-up formulas. The authors hope that the directions proposed by the American Academy of Pediatrics in 1983 will be modified in order to recommend cow-milk only after the first year of life of the infant. They finally suggest specific mineral and vitamin supplementations (iron, calcium, phosphorus, fluoride; vitamins K, D, E and folic acid), to be started after hospital discharge.

AIM: Primary gastrointestinal perforations have an incidence of between 1% and 3% in NICU patients. The 3 Centers participating in this study cover nearly 40% of the NICU population of the Lazio Region--Italy. The aim of this study is to discuss factors affecting survival in patients affected by a primary intestinal perforation. METHODS: From 1991 to 2001, 67 cases of 85 with a neonatal gastrointestinal perforation, were related to primary bowel lesions. Necrotizing enterocolitis (NEC) was not always the cause of perforation and in many patients an isolated bowel lesion without signs of NEC was found. The aim of this study was to examine clinical and intraoperative findings of NEC and non NEC perforations and their impact on survival. A relevant number of these patients were extremely low-birth weight (ELBW). Controversies about treatment of this category of neonates are discussed. RESULTS: Patients were 37 males and 30 females (mean birth weight 1 274.8 g, mean gestational age 28.9 weeks, mean age at perforation 10 days). Overall survival was 56.8%. Patients were divided by intraoperative findings in 2 groups: NEC (n=48), or isolated intestinal perforation (IIP) without signs of NEC (n=19). Differences between these 2 groups with regard to birth weight, maturity, associated cardiac anomalies (patent ductus arteriosus, PDA) were significant. NEC and IIP behaved as 2 distinct entities, each with peculiar clinical (age at perforation, oral feeding, need of ventilatory support) and radiological aspects. At surgery, multiple lesion on necrotic bowel were typical of NEC versus single, isolated perforations on healthy bowel typical of IIP. Overall survival was almost identical in the 2 groups (59% vs 58%). ELBW patients (55% of the total neonatal intestinal perforations) were also studied. There were 21 patients with NEC and 16 with IIP. The 2 groups were different in age at perforation, previous oral feeding and associated cardiac anomalies (PDA). Overall survival was 62

To investigate the importance of transfusion practice with packed red cells (PRCs) in premature infants and to identify risk factors significant influencing transfusion practice, we analyzed 75 preterm infants (gestational age: 31 +/- 2 weeks; birth weight: 1459 +/- 402 g) admitted to the neonatal intensive care unit of Catholic University of Rome. Fifty-three (70.7%) of the infants received one or more PRCs transfusions (in total 246 transfusions). The variables associated with an increase in number and frequency of PRCs transfusions were: a) gestational age < or = 30 weeks; b) birth weight < or = 1000 g; c) severe neonatal pathology (ie a respiratory disease requiring ventilatory support and/or a clearly documented or suspected sepsis). Repeated PRCs transfusions during the first week of life significantly (p < 0.01) influenced the need for late transfusions, after 4 weeks of age, for the treatment of the anemia of prematurity. These data indicate that preterm infants with a gestational age < or = 30 weeks, a birth weight < 1000 g and a severe respiratory or infectious disease represent natural candidates for administration of recombinant human erythropoietin to reduce the need for late PRCs transfusions.

To verify in the preterm newborn the hypothesis, recently proposed by some authors, of an hepatosynthetic deficiency, blood fibrinogen (FIB), prothrombin time (PT) and albumin (ALB) levels at birth were studied in 44 neonates, selected to obtain 4 groups of the same number and gestational age, different only for the presence of intrauterine growth retard and preeclampsia during pregnancy. In the newborns born of preeclamptic pregnancies, FIB, PT and ALB blood levels at birth resulted lower, but not significantly, than in those born of normal pregnancies; in SGA newborns the values (except for albumin) resulted significantly lower than in AGA newborns (FIB = 168 +/- 63 mg/dl vs 223 +/- 55 mg/dl; p < 0.01; PT = 51 +/- 15% vs 71 +/- 19%; p < 0.001). Besides, PT values resulted significantly lower (p < 0.01), in presence of normal pregnancy, in SGA than in AGA newborns, while FIB values resulted significantly lower (p < 0.01), in presence of preeclampsia, in SGA than in AGA newborns. It seems that, in preterm newborn, the intrauterine growth retard, rather than preeclampsia, would condition lower blood levels of the examined seric proteins. These results could be explained by hypothesizing, in the SGA preterm newborn, 3 possible etiopathogenetic mechanisms: 1) increased turnover of hepatosynthetized seric proteins, such as albumin; 2) deficiency of liver enzymes involved in proteic synthesis, already demonstrated for some coagulation factors; 3) diminished amino acidic substratum, necessary for proteic hepatosynthesis, caused by poor amino acidic passage through placenta, possible in presence of intrauterine growth retard. This would probably be the most important mechanism in causing low levels of the examined seric proteins.