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Objective: To investigate the features of cardiorespiratory events in infants born preterm during the transitional period, and to evaluate whether different neonatal characteristics may correlate with event type, duration, and severity. Study design: Infants with gestational age (GA)

Survival rate of extremely low gestational age (ELGA) newborns has increased over 80% in the last 15 years, but its consequences on the short- and longer-term developmental competencies may be severe. The aim of this study was to describe growth trajectories of linguistic, motor and cognitive skills among ELGA children, compared to full-term (FT) peers, from the first to the third year of life, a crucial period for development. Growth curve analysis was used to examine individual and group differences in terms of initial status at 12 months and rate of growth through the second and the third year of life with five points of assessment. Twenty-eight monolingual Italian children, of whom 17 were ELGA (mean GA 25.7 weeks) and 11 were FT children, were assessed through the BSID-III at 12, 18, 24, 30 and 36 months for language skills and at 12, 24 and 30 months for motor and cognitive skills. ELGA children presented significantly lower scores than FT peers in language, motor and cognitive skills and they did not overcome their disadvantage by 3 years, even if their corrected age was taken into account. Concerning growth curves, in motor development a significant increasing divergence was found showing a Matthew effect with the preterm sample falling further behind the FT sample. In linguistic and cognitive development, instead, a stable gap between the two samples was found. In addition, great inter-individual differences in rate of change were observed for language development in both samples. Our findings highlight the theoretical and clinical relevance of analyzing, through growth curve analyses, the developmental trajectories of ELGA children in language skills taking into account their inter-individual variability also across motor and cognitive domains. Learning outcomes: After reading this article, the reader will interpret: (a) characteristics and growth trajectories of ELGA children from the first to the third year of life with respect to FT children in language, motor and cognitive development; (b) the method of growth curve analyses to describe group as well as inter-individual trajectories; (c) the rate of inter-individual variability in language as well as motor and cognitive skills, which gives useful indications for early interventions.

Background: Brain Cooling (BC) represents the elective treatment in asphyxiated newborns. Amplitude Integrated Electroencephalography (aEEG) and Near Infrared Spectroscopy (NIRS) monitoring may help to evaluate changes in cerebral electrical activity and cerebral hemodynamics during hypothermia. Objectives: To evaluate the prognostic value of aEEG time course and NIRS data in asphyxiated cooled infants. Methods: Twelve term neonates admitted to our NICU with moderate-severe Hypoxic-Ischemic Encephalopathy (HIE) underwent selective BC. aEEG and NIRS monitoring were started as soon as possible and maintained during the whole hypothermic treatment. Follow-up was scheduled at regular intervals; adverse outcome was defined as death, cerebral palsy (CP) or global quotient

Background Apnoea of prematurity (AOP) frequently recurs in preterm infants. We have previously shown that a significant but variable proportion of AOP is induced by gastro-oesophageal reflux (GOR). Aim The aim of this study is to evaluate the efficacy of sodium alginate in reducing the frequency of GOR-related AOP. Subjects Twenty-eight preterm infants with AOP were studied by a six-hour recording of combined multichannel intraluminal impedance and pH monitoring and polysomnography, including two three-hour postprandial periods: sodium alginate was given after one single meal named as drug-given (DG) meal, while the other as drug-free (DF). Results During 165 h of registration, 715 apnoeas were recorded, 368 after-DG and 347 after-DF (p = .99); furthermore, 851 GOR episodes were detected, 315 after-DG and 536 after-DF (p = .001). No differences in the number of AOP were found between DG and DF. A significant reduction in the number of acid GORs and in acid exposure was found during DG, while the administration of sodium alginate didn't influence non-acid GOR indexes. The frequency of GOR-related apnoeas didn't differ between DG and DF. Discussion Sodium alginate doesn't reduce the total number of AOP nor GOR-related apnoeas. On the other hand, it reduces acid GOR features, while it had no effect on non-acid GOR indexes.

The present study involved a systematic longitudinal analysis, with three points of assessment in the second year of life, of gestures/actions, word comprehension, and word production in a sample of very preterm infants compared to a sample of full-term infants. The relationships among these competencies as well as their predictive value on language development at 24 months and the contribution of biological, medical and social risk factors on language delay at 24 months were also analysed. One hundred and four monolingual Italian very preterms (mean gestational age 29.5 weeks) without major cerebral damages, and a comparison group of 20 monolingual healthy Italian full-terms were followed at 12, 18 and 24 months by administering to their parents the Italian short forms of the MacArthur-Bates CDI. Preterms showed a slower acquisition in gesture/action production, word comprehension, and word production with an increasing divergence with respect to full-terms from 12 to 24 months, when 20% of preterms were delayed in word production (

The hypothesis that nutrition during critical windows in fetal and early life can program long-term health is intriguing and has a potentially strong implication for public health and pediatric nutritional practice. Specifically, it has been hypothesized that there are critical periods in the differentiation and maturation of the central nervous system during which environmental and nutritional factors can produce long-term structural and/or functional changes. Many studies have focused on the relationship between nutrition during early life and long-term neurodevelopmental outcome, leading to contrasting results: in fact, although experimental data in animals and short-term follow-up studies indicate a possible relationship between nutrition during early life and neurodevelopment, the results of long-term follow-up studies are more controversial and less convincing.

Background Protein content of preterm human milk (HM) is relatively low and extremely variable among mothers: thus, recommended protein intake is rarely met. Objectives To evaluate in a NICU setting if HM protein content after standard fortification meets the recommended intake, and also to check the effect of fortification on the osmolality of HM, as an index of feeding intolerance. Methods Protein content of 34 preterm HM samples was evaluated by a bedside technique (Near-Infrared-Reflectance-Analysis — NIRA); osmolality was also checked. Seventeen samples were fortified with Aptamil BMF, Milupa (Group A) and 17 with FM85, Nestle (Group B). Fortification was performed as recommended by the manufacturer (“full fortification [FF]”) and also with a lower amount of fortifier (“low-dose fortification [LF]”). After fortification, actual protein content was calculated and compared to that needed to meet recommended intake (2.33–3 g/dl), and osmolality was measured. Results After FF, protein content was above 3 g/dl in none of the samples, and below 2.33 g/dl in 16/34 samples (11 in Group A, 5 in Group B). After LF, protein content was above 3 g/dl in none of the samples and below 2.33 g/dl in 32/34 samples (15 in Group A, 17 in Group B). Osmolality exceeded 400 mOsm/kg in 19 samples after FF (10 in Group A, 9 in Group B) and in 2/34 samples after LF (1 in each group). Conclusion HM protein content after standard fortification fails to meet the recommended intake for preterm infants in approximately half of the cases.

This article summarizes the Italian Pediatric Society guideline on the management of the signs and symptoms of fever in children, prepared as part of the National Guideline Program (NGLP).Relevant publications in English and Italian were identified through searches of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through December 31, 2007. Based on the consensus of a multidisciplinary expert panel, the strength of the recommendations was categorized into 5 grades (A-E) according to NGLP methodology.In the health care setting, axillary measurement of body temperature using a digital thermometer is recommended in children aged4 weeks; for children agedor =4 weeks, axillary measurement using a digital thermometer or tympanic measurement using an infrared thermometer is recommended. When body temperature is measured at home by parents or care-givers, axillary measurement using a digital thermometer is recommended for all children. Children who are afebrile when seen by the clinician but are reported to have had fever by their caregivers should be considered febrile. In special circumstances, high fever may be a predictive factor for severe bacterial infection. Use of physical methods of reducing fever is discouraged, except in the case of hyperthermia. Use of antipyretics-paracetamol (acetaminophen) or ibuprofen-is recommended only when fever is associated with discomfort. Combined or alternating use of antipyretics is discouraged. The dose of antipyretic should be based on the child's weight rather than age. Whenever possible, oral administration of paracetamol is preferable to rectal administration. Use of ibuprofen is not recommended in febrile children with chickenpox or dehydration. Use of ibuprofen or paracetamol is not contraindicated in febrile children with asthma. There is insufficient evidence to form any recommendations concerning fever in children with other chronic conditions, but caution is advised in cases of severe hepatic/renal failure or severe malnutrition. Newborns with fever should always be hospitalized because of the elevated risk of severe disease; paracetamol may be used, with the dose adjusted to gestational age. Use of paracetamol or ibuprofen is not effective in preventing febrile convulsion or the adverse effects of vaccines.

Positive syphilis serology was noted in 119 (0.49%) of the 24 053 pregnant women delivering at St Orsola Hospital in Bologna, Italy, from November 2000 through July 2007. Six presumptive cases of congenital syphilis with IgM western blot positive results were found. Two infants had a positive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory test result (one also had a positive CSF PCR result), another presented long-bone lesions, and the remaining three were preterm. These observations confirmed that antenatal syphilis screening facilitates treatment during pregnancy and offsets vertical transmission; moreover, the use of IgM western blot and careful CSF examination allowed the identification and treatment of high-risk newborns.

There have been few investigations of the effects of very immature preterm birth on specific linguistic competencies and phonological working memory at preschool age. Study 1 aimed to investigate early grammatical abilities in very immature healthy preterms, taking into account their cognitive development and biological and social factors. The linguistic and cognitive differences found between preterms and fullterms led to investigate in Study 2 the role of phonological working memory on preterms’ grammatical development. Very immature preterm birth resulted to affect grammatical, cognitive and phonological working memory abilities until 3.5 years leading to persisting difficulties in comparison with fullterms, albeit not severe deficits. Tight relations between phonological working memory and grammar were found both in preterms and fullterms, that highlights the reciprocal support of these abilities in development. A partial compensatory effect by the maternal level of education on preterms’ grammatical and cognitive abilities was also found. Learning outcomes The reader will become familiar with the relations between grammatical and phonological working memory abilities in typical and preterm 3.5-year-old children.

A combined DTPa-IPV booster vaccine was administered as a 4th or 5th dose after DTPa or DTPw priming. Over 99% vaccines developed antibody levels considered to be protective to diphtheria, tetanus and poliovirus, and >95% mounted a response to acellular pertussis antigens. Rectal temperature >39.5 degrees C was observed in at most 3.2% of vaccinees. Swelling >50 mm occurred in 24% of DTPa-primed compared to 5.5% of DTPw-primed children. Large swelling involving the entire upper arm (extending to involve the elbow joint) was reported for up to 1.2% of DTPa-primed subjects, which is consistent with literature reports for other DTPa vaccines.

Aim. Apnoea of prematurity (AOP) is a perplexing disorder of respiratory control that is very common in preterm infants and requires therapeutic intervention to avoid potential morbidity. The existence of a relationship between gastroesophageal reflux (GER) and AOP in preterm infants is still controversial. We aimed to evaluate the relationship between GER and apnoeas in preterm newborns, by the simultaneous and synchronized use of combined Multichannel Intraluminal Impedance and pH-monitoring (pH-MII), and polysomnography (PSG). Methods. Twenty-six preterm infants were studied as they had recurrent apnoeas. They underwent a 6-h simultaneous and synchronized recording of polysomnography and pH-MII. Each registration involved 2 post-prandial periods lasting 3 h each. Polysomnography detects and characterizes apnoeas, desaturations and bradycardia, by recording of breathing movement, nasal airflow, electrocardiogram, pulse oximeter saturation. All apnoeas lasting more than 5 s were considered, and classified as central (CA), obstructive (OA) and mixed apnoeas (MA). By pH-MII we registered acid/non acid GER. The temporal association between GER and apnoea was analysed by the frequency of apnoea in the 30 s preceding and following the onset of GER episodes. Apnoeas detected within thirty seconds after GER were defined GER-triggered. Results. One-hundred-fifty-four apnoeas out of 1136 were detected within 30 second before and/or after the onset of a GER episode. The frequency of apnoea during the 1-min time around the onset of a GER episode (mean 0.17/min; range [0–0.84/min]) was significantly different (p = 0.03) from the one detected during the GER-free period (0.12/min [0–0.43/min]), which is defined as the time difference between the total recording time and the time around all GER episodes. The frequency of apnoea before the onset of GER (0.10/min [0–0.69/min]) did not differ from the one detected during GER-free period (p = 0.17). The frequency of apnoea occurring after the onset of GER (0.25/min [0–1/min]) was higher than the one detected in the GER-free period (p = 0.02), and also than the one detected before the onset of GER (p = 0.01). A great inter-individual variability was documented in the ratio of GER-triggered apnoeas to the total number of apnoeas (median 10.34%, range: 0–20%), as well as in the ratio of GER-triggered apnoeas to the total number of GERs (median 5.77%, range: 0–50%). The increase of apnoeas after GER, defined as the difference between the number of apnoeas detected in the 30 s after GER and the one detected 30 s before GER, was calculated (median 2; range: −2/+8). A significant correlation was found between this difference and the total number of apnoeas (ρ = 0.425, p = 0.034); on the other hand, no correlation was documented between total number of GERs and GER-triggered apnoeas (ρ = 0.019; p = 0.930). Conclusion.We found that, in preterm infants with recurrent apnoeas, these events occur more frequently soon after GER than in the period immediately before GER or GERfree. This suggests that the relationship between GER and AOP is not simply by chance. The ratio of GER-triggered apnoeas to the total number of apnoeas is widely variable. Furthermore, the wide variability in the ratio of GERtriggered apnoeas to the total number of GERs documents that in some newborns a GER episode more likely evokes an apnoea. Patients who had the most significant increase of apnoeas after GER also had the highest number of total apnoeas: in other words, in the most unstable infants also GER episodes can easily act as a trigger event for apnoeas.Onthe other hand, the lack of correlation between GER-triggered apnoeas and total number of GERs highlights that the severity of GER is not predictive by itself of the risk of reflex apnoeas.

Objective To evaluate the pattern of acid and nonacid gastroesophageal reflux (GER) in different body positions in preterm infants with reflux symptoms by a combined multichannel intraluminal impedance (MII)‐pH monitoring, which identifies both acid and nonacid GER. Study design Premature infants with frequent regurgitation and postprandial desaturation (n 22) underwent a 24-hour recording of MII-pH. In a within-subjects design, reflux indexes were analyzed with the infants in 4 different positions: supine (S), prone (P), on the right side (RS), and on the left side (LS). Results All infants were analyzed for 20 hours. The mean number of recorded GER episodes was 109.7. The mean esophageal exposure to acid and nonacid GER was lower in positions P (4.4% and 0.3%, respectively) and LS (7.5% and 0.7%, respectively) than in positions RS (21.4% and 1.2%, respectively) and S (17.6% and 1.3%, respectively). The number of postprandial nonacid GER episodes decreased but the number of acid GER episodes increased over time. The LS position showed the lowest esophageal acid exposure (0.8%) in the early postprandial period, and the P position showed the lowest esophageal acid exposure (5.1%) in the late postprandial period. Conclusion Placing premature infants in the prone or left lateral position in the postprandial period is a simple intervention to limit GER. (J Pediatr 2007;151:591-6)