8 results on '"Papoff, Paola"'
Search Results
2. Nasopharyngeal tubes in pediatric anesthesia: Is the flow‐dependent pressure drop across the tube suitable for calculating oropharyngeal pressure?
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Papoff, Paola, Rosini, Talitha, Oliva, Salvatore, Luciani, Stefano, Midulla, Fabio, Montecchia, Francesco, and Ungern‐Sternberg, Britta
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PRESSURE drop (Fluid dynamics) , *PEDIATRIC anesthesia , *CONTINUOUS positive airway pressure , *POSITIVE pressure ventilation , *DEGLUTITION , *TUBES , *ANESTHESIA in obstetrics - Abstract
Background: Nasopharyngeal tubes are useful in pediatric anesthesia for insufflating oxygen and anesthetics. During nasopharyngeal tube‐anesthesia, gas insufflation provides some positive oropharyngeal pressure that differs from the proximal airway pressure owing to the flow‐dependent pressure drop across the nasopharyngeal tube (ΔPNPT). Aims: This study aimed to investigate whether ΔPNPT could be used for calculating oropharyngeal pressure during nasopharyngeal tube‐assisted anesthesia. Methods: In a physical model of nasopharyngeal tube‐anesthesia, using Rohrer's equation, we calculated ΔPNPT for three nasopharyngeal tubes (3.5, 4.0, and 5.0 mm inner diameter) under oxygen and several sevoflurane in oxygen combinations in two ventilatory scenarios (continuous positive airway pressure and intermittent positive pressure ventilation). We then calculated oropharyngeal pressure as proximal airway pressure minus ΔPNPT. Calculated and measured oropharyngeal pressure couples of values were compared with the root mean square deviation to assess accuracy. We also investigated whether oropharyngeal pressure accuracy depends on the nasopharyngeal tube diameter, flow rate, gas composition, and leak size. Using ΔPNPT charts, we tested whether ΔPNPT calculation was feasible in clinical practice. Results: When we tested small‐diameter nasopharyngeal tubes at high‐flow or high‐peak inspiratory pressure, proximal airway pressure measurements markedly overestimated oropharyngeal pressure. Comparing measured and calculated maximum and minimum oropharyngeal pressure couples yielded root mean square deviations less than 0.5 cmH2O regardless of ventilatory modality, nasopharyngeal tube diameter, flow rate, gas composition, and leak size. Conclusion: During nasopharyngeal tube‐assisted anesthesia, proximal airway pressure readings on the anesthetic monitoring machine overestimate oropharyngeal pressure especially for smaller‐diameter nasopharyngeal tubes and higher flow, and to a lesser extent for large leaks. Given the importance of calculating oropharyngeal pressure in guiding nasopharyngeal tube ventilation in clinical practice, we propose an accurate calculation using Rohrer's equation method, or approximating oropharyngeal pressure from flow and pressure readings on the anesthetic machine using the ΔPNPT charts. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
3. Safety and efficacy of topiramate in neonates with hypoxic ischemic encephalopathy treated with hypothermia (NeoNATI)
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Filippi Luca, Fiorini Patrizio, Daniotti Marta, Catarzi Serena, Savelli Sara, Fonda Claudio, Bartalena Laura, Boldrini Antonio, Giampietri Matteo, Scaramuzzo Rosa, Papoff Paola, Del Balzo Francesca, Spalice Alberto, la Marca Giancarlo, Malvagia Sabrina, Della Bona Maria, Donzelli Gianpaolo, Tinelli Francesca, Cioni Giovanni, Pisano Tiziana, Falchi Melania, and Guerrini Renzo
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Neonatal hypoxic-ischemic encephalopathy ,Therapeutic hypothermia ,Topiramate ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Despite progresses in neonatal care, the mortality and the incidence of neuro-motor disability after perinatal asphyxia have failed to show substantial improvements. In countries with a high level of perinatal care, the incidence of asphyxia responsible for moderate or severe encephalopathy is still 2–3 per 1000 term newborns. Recent trials have demonstrated that moderate hypothermia, started within 6 hours after birth and protracted for 72 hours, can significantly improve survival and reduce neurologic impairment in neonates with hypoxic-ischemic encephalopathy. It is not currently known whether neuroprotective drugs can further improve the beneficial effects of hypothermia. Topiramate has been proven to reduce brain injury in animal models of neonatal hypoxic ischemic encephalopathy. However, the association of mild hypothermia and topiramate treatment has never been studied in human newborns. The objective of this research project is to evaluate, through a multicenter randomized controlled trial, whether the efficacy of moderate hypothermia can be increased by concomitant topiramate treatment. Methods/Design Term newborns (gestational age ≥ 36 weeks and birth weight ≥ 1800 g) with precocious metabolic, clinical and electroencephalographic (EEG) signs of hypoxic-ischemic encephalopathy will be randomized, according to their EEG pattern, to receive topiramate added to standard treatment with moderate hypothermia or standard treatment alone. Topiramate will be administered at 10 mg/kg once a day for the first 3 days of life. Topiramate concentrations will be measured on serial dried blood spots. 64 participants will be recruited in the study. To evaluate the safety of topiramate administration, cardiac and respiratory parameters will be continuously monitored. Blood samplings will be performed to check renal, liver and metabolic balance. To evaluate the efficacy of topiramate, the neurologic outcome of enrolled newborns will be evaluated by serial neurologic and neuroradiologic examinations. Visual function will be evaluated by means of behavioural standardized tests. Discussion This pilot study will explore the possible therapeutic role of topiramate in combination with moderate hypothermia. Any favourable results of this research might open new perspectives about the reduction of cerebral damage in asphyxiated newborns. Trial registration Current Controlled Trials ISRCTN62175998; ClinicalTrials.gov Identifier NCT01241019; EudraCT Number 2010-018627-25
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- 2012
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4. Variability in a three-generation family with pierre robin sequence, acampomelic campomelic dysplasia, and intellectual disability due to a novel ∼1 Mb deletion upstream of SOX9, and including KCNJ2 and KCNJ16
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Castori, Marco, Bottillo, Irene, Morlino, Silvia, Barone, Chiara, Cascone, Piero, Grammatico, Paola, Laino, Luigi, Polimeni, Antonella, Pizzuti, Antonio, Silvestri, Alessandro, Roggini, Mario, Tarani, Luigi, Papoff, Paola, Giancotti, Antonella, Manganaro, Lucia, Lenzi, Jacopo, and Sforzolini, Giovanna Scassellati
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genotype-phenotype correlations ,SOX9 transcription factor ,pediatrics ,genetic association studies ,molecular sequence data ,developmental biology ,male ,middle aged ,embryology ,deletion ,Potassium Channels, Inwardly Rectifying ,genes ,dominant ,humans ,Genes, Dominant ,variability ,adult ,inwardly rectifying ,Robin sequence ,pedigree ,potassium channels ,base sequence ,infant ,Pierre Robin syndrome ,female ,intellectual disability ,genetic variation ,gene expression ,perinatology and child health ,acampomelic ,SOX9 ,campomelic dysplasia ,genes, dominant ,potassium channels, inwardly rectifying ,sequence deletion ,pediatrics, perinatology and child health - Abstract
Campomelic dysplasia and acampomelic campomelic dysplasia (ACD) are allelic disorders due to heterozygous mutations in or around SOX9. Translocations and deletions involving the SOX9 5' regulatory region are rare causes of these disorders, as well as Pierre Robin sequence (PRS) and 46,XY gonadal dysgenesis. Genotype-phenotype correlations are not straightforward due to the complex epigenetic regulation of SOX9 expression during development.We report a three-generation pedigree with a novel ∼1 Mb deletion upstream of SOX9 and including KCNJ2 and KCNJ16, and ascertained for dominant transmission of PRS.Further characterization of the family identified subtle appendicular anomalies and a variable constellation of axial skeletal features evocative of ACD in several members. Affected males showed learning disability.The identified deletion was smaller than all other chromosome rearrangements associated with ACD. Comparison with other reported translocations and deletions involving this region allowed further refining of genotype-phenotype correlations and an update of the smallest regions of overlap associated with the different phenotypes. Intrafamilial variability in this pedigree suggests a phenotypic continuity between ACD and PRS in patients carrying mutations in the SOX9 5' regulatory region.
- Published
- 2016
5. Comparison of ultrasound and magnetic resonance imaging in the prenatal diagnosis of Apert syndrome: report of a case
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Giancotti, Antonella, D'Ambrosio, Valentina, DE FILIPPIS, Angela, Aliberti, Camilla, Pasquali, Gaia, Bernardo, Silvia, Manganaro, Lucia, Polimeni, Antonella, Pizzuti, Antonio, Cascone, Piero, Silvestri, Alessandro, Roggini, Mario, Tarani, Luigi, Papoff, Paola, Castori, Marco, and Lenzi, Jacopo
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Adult ,congenital, hereditary, and neonatal diseases and abnormalities ,Pathology ,medicine.medical_specialty ,Acrocephalosyndactylia ,Prenatal diagnosis ,Apert syndrome ,Pediatrics ,Fetal ultrasound ,Magnetic resonance ,Female ,Follow-Up Studies ,Humans ,Magnetic Resonance Imaging ,Prenatal Diagnosis ,Ultrasonography, Doppler ,Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,Medicine (all) ,Craniosynostosis ,medicine ,Hypertelorism ,Ultrasonography ,medicine.diagnostic_test ,business.industry ,Doppler ,General Medicine ,Perinatology and Child Health ,medicine.disease ,Hypoplasia ,Agenesis ,Amniocentesis ,medicine.symptom ,business - Abstract
The birth prevalence of Apert syndrome is estimated at 1:64,500 and accounts for about 4.5 % of all craniosynostosis with a male/female ratio equal to 1:1. It is associated to allelic mutations in the fibroblast growth factor receptor 2 (FGFR2) gene. Majority cases are sporadic. Prenatal ultrasound diagnosis is based on the detection of abnormal cranial shape, midfacial hypoplasia and bilateral syndactyly of hands and feet, hypertelorism, and exorbitism. Other abnormalities includes central nervous system anomalies, congenital heart diseases, cleft palate, and urogenital diseases. A 37-year-old Caucasian woman, gravida 2, para 1, was referred to our center of Prenatal Diagnosis for routine ultrasound at 21 weeks of gestation. We detected irregular head shape, dolicocephaly, prominent forehead, bilateral mild ventriculomegaly, suspicion of partial agenesis of the corpus callosum, hypertelorism, and midfacial hypoplasia, with a depressed nasal bridge and syndactyly, prompting a suspicion for Apert syndrome. Magnetic resonance excluded agenesis of corpus callosum and confirmed bilateral mild ventriculomegaly. A follow-up ultrasound, performed at 23 weeks, confirmed the anomalies showed in the previous scan. An amniocentesis was performed. The results showed a normal male karyotype, while the molecular genetic test confirmed a mutation in FGFR2 gene. Fetus macroscopic analysis showed compatible features. Our case underlines the complementary role of ultrasound and magnetic resonance imaging in the early prenatal diagnosis of Apert syndrome.
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- 2014
6. Abstracts of ESPNIC 2013, the 24th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care. June 12-15, 2013. Rotterdam, Netherlands PAEDIATRIC INTENSIVE CARE TRAINING FOR NEONATOLOGISTS: A NEW COURSE S58
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Pozzi, N., De Luca, M. G., Grappone, L., Tortorolo, L., Scoppa, A., Papoff, Paola, and Orfeo, L.
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Intensive Care Units ,Critical Care ,Neonatal ,Humans ,Infant ,Neonatology ,Child ,Newborn ,Pediatrics ,Infant, Newborn ,Intensive Care Units, Neonatal - Published
- 2013
7. Electroencephalogram and magnetic resonance imaging comparison as a predicting factor for neurodevelopmental outcome in hypoxic ischemic encephalopathy infant treated with hypothermia.
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Del Balzo, Francesca, Maiolo, Stella, Papoff, Paola, Giannini, Luigi, Moretti, Corrado, Properzi, Enrico, and Spalice, Alberto
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ELECTROENCEPHALOGRAPHY ,MAGNETIC resonance imaging ,NEURODEVELOPMENTAL treatment for infants ,HYPOTHERMIA ,PEDIATRICS - Abstract
Hypoxic-ischemic encephalopathy (HIE) is an important cause of acute neurological damage in newborns at (or near) term. Several trials in recent years have shown that moderate hypothermia by total body cooling or selective head is an effective intervention to reduce mortality and major disability in infants survived a perinatal hypoxic-ischemic attack. Follow-up in these patients is very important to establish neurodevelopmental outcome, and specific markers can lead us to detect predicting sign for good or poor outcome. We reported a few cases of newborn with HIE treated with hypothermia, in whom the comparison between electroencephalogram (EEG) and magnetic resonance imaging (MRI) represents the first marker for neurodevelopment outcome prediction. The continuous EEG monitoring showed a depressed EEG activity with diffuse burst depression in 7 patients. No epileptic abnormalities were registered. In 10 out of 20 patients no abnormalities of the background activity and no epileptic abnormalities were observed. We found that a depressed EEG activity during the first 72 h of life and a diffused alteration of basal ganglia at MRI were correlated with a poor neurodevelopmental outcome at 18 months of follow-up. [ABSTRACT FROM AUTHOR]
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- 2014
- Full Text
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8. Nasal flow-synchronized intermittent positive pressure ventilation to facilitate weaning in very low-birthweight infants: Unmasked randomized controlled trial.
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Moretti, Corrado, Giannini, Luigi, Fassi, Carla, Gizzi, Camilla, Papoff, Paola, and Colarizi, Patrizia
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INTERMITTENT positive pressure breathing ,INFANT weaning ,LOW birth weight ,PREMATURE infants ,RANDOMIZED controlled trials ,PEDIATRICS - Abstract
Background: Nasal flow-synchronized intermittent positive pressure ventilation (NFSIPPV) is a new non-invasive ventilatory mode that delivers synchronized mechanical breaths through the nasal prongs. An unmasked, prospective randomized controlled trial was conducted to compare the efficacy of NFSIPPV and conventional nasal continuous positive airway pressure (NCPAP) in increasing the likelihood for successful extubation in very low-birthweight infants. Methods: Consecutive infants who weighed <1251 g at birth, required endotracheal intubation within 48 h of birth and met specific predetermined criteria for extubation by day 14 of life were recruited. Each infant was randomized to receive either NFSIPPV or NCPAP soon after extubation. Extubation was deemed successful if re-intubation was not needed for at least 72 h. Criteria for re-intubation were persistent severe respiratory acidosis (arterial pH <7.20 with pCO2 >70 mmHg), severe recurrent apneic episodes not responding to increased ventilatory settings and then requiring bag ventilation, and hypoxemia (SaO2 <90% or pO2 <60 mmHg with FiO2 ≥0.70). Results: There were no significant differences in clinical characteristics between the two groups at randomization. Ninety-four percent (30/32) infants were successfully extubated to NFSIPPV but only 61% (19/31) to conventional NCPAP ( P > 0.005). Infants assigned to NCPAP failed extubation mainly because of apnea and hypercapnia, and those assigned to NFSIPPV because of hypoxia. Neither procedure induced major adverse effects. Conclusions: NFSIPPV in the post-extubation period is safe and more effective than NCPAP in preventing re-ventilation. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
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