Search

Objective. To compare the estimates of preterm birth (PTB; 22-36 weeks gestational age, GA) and stillbirth rates during COVID-19 pandemic in Italy with those recorded in the three previous years. Design. A population-based cohort study of liveborn and stillborn infants was conducted using data from Regional Health Systems and comparing the pandemic period (March 1st, 2020-March 31st, 2021, N= 362,129) to an historical period (January 2017- February 2020, N=1,117,172). The cohort covered 84.3% of the births in Italy. Methods. Logistic regressions were run in each Region and meta-analyses were performed centrally. We used an interrupted time series regression analysis to study the trend of preterm births from 2017 to 2021. Main Outcome Measures. The primary outcomes were PTB and stillbirths. Secondary outcomes were late PTB (32-36 weeks’ GA), very PTB (

to evaluate the impact of the SARS-CoV-2 epidemic on the access to the emergency services of the Lazio Region (Central Italy) for time-dependent pathologies, for suspected SARS-CoV-2 symptoms, and for potentially inappropriate conditions.observational study.accesses to the emergency departments (EDs) of Lazio Region hospitals in the first three months of 2017, 2018, 2019, and 2020.total number of accesses to the emergency room and number of specific accesses for cardio and cerebrovascular diseases, for severe trauma, for symptoms, signs, and ill-defined conditions, and for symptoms related to pneumonia.in the first 3 months of 2019, there were 429,972 accesses to the EDs of Lazio Region; in the same period of 2020, accesses arise to 353,806, (reduction of 21.5%), with a 73% reduction in the last three weeks of march 2020 as compared with the corresponding period of 2019. Comparing the first 3 months of the 2017-2019 with 2020, the accesses for acute coronary syndrome and acute cerebrovascular disease decreased since the 10th week up to more than 57% and 50%, respectively. The accesses due to symptoms, signs, and ill-defined conditions, proxy of potentially inappropriate conditions, decreased since the 8th week, with a maximum reduction of 70%. Access to severe trauma decreased by up to 70% in the 11th week. The accesses for pneumonia increased up to a 70% increment in the 12th week.the evaluation of accesses to emergency services during the SARS-CoV-2 epidemic can provide useful elements for the promotion and improvement of the planning, for the management of critical situations, and for the reprogramming of the healthcare offer based on clinical and organizational appropriateness.

Background In Italy live about 8.7% immigrants, which contribute to more than 15% of all deliveries taking place in Italy. We aimed to investigate whether newborns from high migratory pressure countries (HMPC) mothers have a different macrosomia and post-term pregnancy incidence compared to Italian newborns. Methods In this retrospective observational study, we analyzed data on 404.863 babies born between 2010 and 2017. Italian mothers delivered 309.658 (76.5%), HMPC mothers 88.179 (21.8%) and developed country (DC) mothers 7.026 (1.7%) babies. We analyzed the incidence of macrosomia and post term pregnancy. We estimated incidence rate (IR), unadjusted incidence rate ratio (IRR) and 95% confidence intervals (CIs) to evaluate the association between these perinatal parameters and the mother’s region of birth. Results HMPC compared to Italian newborns showed a significantly higher incidence of birthweight > 4000 g (53.3‰ vs 39.1‰, p-value 41 weeks (19.9‰ vs 12.8‰, p-value The macrosomia incidence between HPMC and Italian newborns was significantly increased at all gestational ages (Fig. 1), especially for mothers coming from Central Eastern Europe (121.79‰ vs 91.1‰, p-value Conclusion In Italy immigrant status represents a risk factor for macrosomia and post-term birth, which could be related to socio-economic status and unfavorable life conditions of immigrant mothers during pregnancy.

Italy was the first country in Europe violently affected by the COVID-19 pandemic. The total lockdown of 3 months was necessary and effective to stem the infection. However, it has determined a series of effects that changed the life of millions of people. The objective of this retrospective study is to analyse some perinatal data during the lockdown and to compare them with the same months of 2019. The data refer to the Lazio region where Rome is located with 5.8 million people and where about 10% of Italian births take place every year. We obtained data from the Lazio hospital discharge database, which records perinatal information on all newborns. We have considered only singletons to limit the influence of other determinants of premature birth. The total numbers of all very preterm, late preterm, at term, late term, stillbirths, …

Background Size at birth is an important predictor of neonatal outcomes, but there are inconsistencies on the definitions and optimal cut-offs. Aims The aim of this study is to compute birth size percentiles for Italian very preterm singleton infants and assess relationship with hospital mortality. Study design Prospective area-based cohort study. Subjects All singleton Italian infants with gestational age 22–31weeks admitted to neonatal care in 6 Italian regions (Friuli Venezia-Giulia, Lombardia, Marche, Tuscany, Lazio and Calabria) (n. 1605). Outcome measure Hospital mortality. Methods Anthropometric reference charts were derived, separately for males and females, using the lambda (λ) mu (μ) and sigma (σ) method (LMS). Logistic regression analysis was used to estimate mortality rates by gestational age and birth weight centile class, adjusting for sex, congenital anomalies and region. Results At any gestational age, mortality decreased as birth weight centile increased, with lowest values observed between the 50th and the 89th centiles interval. Using the 75th–89th centile class as reference, adjusted mortality odds ratios were 7.94 (95% CI 4.18–15.08) below 10th centile; 3.04 (95% CI 1.63–5.65) between the 10th and 24th; 1.96 (95% CI 1.07–3.62) between the 25th and the 49th; 1.25 (95% CI 0.68–2.30) between the 50 h and the 74th; and 2.07 (95% CI 1.01–4.25) at the 90th and above. Conclusions Compared to the reference, we found significantly increasing adjusted risk of death up to the 49th centile, challenging the usual 10th centile criterion as risk indicator. Continuous measures such as the birthweight z-score may be more appropriate to explore the relationship between growth retardation and adverse perinatal outcomes.

The aim of this population-based study was to estimate the risk of postpartum maternal complications associated with mode of delivery in a population of low-risk pregnancies. Data from 324,883 full-term singleton births between 2001 and 2007 were retrieved from birth and hospital discharge databases of the Lazio Region, Central Italy. Women with breech presentation births and those with chronic/pregnancy-related diseases in the mother/fetus were excluded. The association between mode of delivery and maternal outcome was estimated for women by odds ratios (ORs), adjusted for potential confounders. Of nulliparous women 78.6% intended vaginal delivery, while for multiparous this was 68.6%. Elective cesarean section was associated with a higher risk of hysterectomy, obstetric shock and anesthetic complications compared with women in the intended vaginal delivery group. This suggests there is a need for a program to reduce unnecessary elective cesarean sections.

The aim of the study is to examine the epidemiology of anaphylaxis in hospitalized children in Lazio (Central Italy) and to evaluate the incidence and case fatality rate. We also verified the concordance of diagnosis between the Emergency Department and Ordinary Hospitalizations. In order to obtain these results, we reviewed all ICD-9 codes indicative of anaphylaxis in all primary and secondary diagnoses from 2000 to 2003 in all Emergency Departments, Ordinary Hospitalizations and Day Hospitals in Lazio. We then identified 203 ICD-9 diagnoses of anaphylaxis in children aged between 0 and 17 years. Anaphylactic shock (995.0) accounted for 109 (53.7%) of cases. Food anaphylaxis (995.60 onwards) accounted for 87 (43.0%) of cases. Food anaphylaxis was more frequent in the first years of life. In fact, it decreased from 12.5/100,000 resident children/year in the first year of life to 6.1/100,000 resident children/year in the first two years of life, and less than 3/100,000 resident children/year after the seventh year (p

Background Violence against women is a significant health problem and a hidden phenomenon, in Italy that about 31% of the women have been victims of violence once in life. Aims of this study are to describe characteristics of women victims of violence (VV) attending the EDs in the Lazio region in 2008 and to illustrate the frequency and characteristics of previous ED visits. Methods Using the Emergency Information System, visits of women, (15–49 years), in the 60 EDs, for a violent trauma have been analysed. For each VV identified, we considered the last episode and searched for ED attendances in a six year period (2003–08) in order to identify other visits. We performed descriptive analyses of socio-demographic and clinical factors of VV and we analyzed the impact previous ED visits. We compared ED utilization of women VV with a random sample of women with the same age distribution who gave birth in 2008. Results In 2008, 7,725 ED attendances of women VV were found (1.1% of the ED visits) corresponding to 6,936 women (prevalence = 52.0x10,000). The mean number of ED visits for each woman in five years was 5.0 (1–190). Prevalent diagnoses were contusions (45.8%), neurotic disorders (5.4%) complications of medical care (6.3%). The women were young, approximately 70% were residents in Rome or the surrounding areas. Foreign women were three times more likely to visit the ED for intentional injuries than were Italian women (114.1 vs 44.4 per 10.000). Conclusions This study shows high prevalence of violence against women in Lazio region, Italy. Most of the women have been visited by the ED several times before the violent episode, often with traumas. ED medical and nursing staff should be prepared and trained to successfully manage victims of violence.

Background The aim of this study was to evaluate the association between different primary paediatric practice models (individual, network -affiliated but in separate office-, and group practice) and non urgent utilization of the Emergency Department (ED). Methods The data sources were: the 2006 Regional Paediatric Patient files (0-6 years old), the Regional Community-based paediatrician (CBP) file and the 2006 Emergency Information System. We recorded and studied the ED visits of children, excluding planned ED visits, visits for trauma/poisoning and those that were assigned non deferrable/critical triage codes. A multivariate logistic regression was applied to estimate the adjusted odds ratio of an ED visit. The exposure was the type of paediatric practice that served the child: individual, network or group practice. Various characteristics of the child were considered. Results The cohort was composed of 293,662 children. In the 2006, 43,347 ED visits occurred (147.6 per 1000). Multivariate logistic models showed lower ED use for group paediatrician patients (OR 0.84; 95%CI 0.73-0.96) and for network paediatrician patients (OR 0.92; 95%CI 0.85-1.00) compared to patients served by an individual practice. Conclusions This study shows that there is a weak association between the type of paediatrician primary practice and emergency department use. Our results highlight the necessity to continue to improve the organization of paediatrician primary practice, in order to increase patient access to primary paediatric care.

Compared with other industrialised countries, Italy has one of the highest caesarean delivery rates, which increased from 26.1% in 1995 to 38.3% in 2005.1 While the overall effect of this mode of delivery on neonatal respiratory outcomes among term newborns is well known,2 few studies have compared the impact of gestational age at delivery on respiratory morbidity (ie, at 37 and 38 weeks’ gestation vs 39 weeks3). We conducted this analysis in the Lazio region (53 000 births/year), where the caesarean delivery rate was 42.7% in 20054; the proportion of term elective caesarean …

The aim of this study is to evaluate the association between the mode of delivery and the risk of neonatal respiratory complications in a cohort of term newborns in the Lazio region, Italy. Data on 139,379 term singleton infants born in 2003–2005 were retrieved from birth and hospital discharge database. Odds Ratios (ORs) adjusted by age, parity, birth weight, gestational age, and gender were calculated using logistic regression models. The rate of prelabor cesarean section (CS) was 26.2%. The rates of neonatal respiratory morbidity were 29.6/1,000 in infants delivered by prelabor CS and 17.4/1,000 in infants delivered vaginally or by CS in labor. The adjusted risk of neonatal respiratory morbidity associated with prelabor cesarean birth at 37 weeks is four times higher than in intended vaginal birth after 37 weeks. Prelabor cesarean delivery should be performed after at least 38 weeks’ of gestation in order to minimize neonatal respiratory morbidity.

To apply two different statistical methods to the live births of Lazio region in the years 2000-2003 and calculate updated estimate of the curves of percentiles of birth weight for gestational age.The data analysed, including clinical-epidemiological and obstetric-neonatal information, have been extracted from birth certificates for the Italian region of Lazio for the period 2000-2003. Two methods of analysis, previously used in two Italian studies, have been applied. In the first method the observed distribution for each gestational week has been decomposed as a mixture of two normal distributions with homoscedastic components. The percentiles obtained, relative to the estimate of the component with the greater weight, have been then used in a third degree polynomial regression with gestational age as covariate, to estimate the final smoothed values. The second method assumes that, for a fixed gestational age, the position of the percentiles can be obtained as a polynomial function of Normal scores. Initially, for both sexes, the percentiles for every gestational age have been estimated using quantile regressions restricted to windows of three weeks. These have been subsequently smoothed by a polynomial model using the logarithm of the birth weight as the dependent variable and gestational age (up to the third degree), the z-score corresponding to the percentiles observed in the three week windows (up to the second degree), sex and the interaction between sex, gestational age and z-score as independent variables.data relating to 157,335 single live births to Italian women resident in the Lazio region have been analysed. The raw curves of the birth weight percentiles for the preterm babies are very irregular for the more extreme percentiles because of the very low number of deliveries of live pre-term babies. The two methods have produced similar results. However, the first method was less influenced by extreme and potentially anomalous values. The second method tended to estimate percentiles beyond 41a week of gestation inferior to those of the previous weeks. A comparison has been made with the curves obtained in the two previous Italian studies and the new estimated percentiles tend to be inferior for the very preterm live births.this study has produced new curves of birth weight for gestational age. The analysis has been based on two different techniques, which have produced substantially similar results. For the tenth percentile, our estimates are lower than those obtained in previous studies suggesting a reduction in the late foetal mortality of babies who are not only pre-term but also of low weight. These results could be used in order to define new standards for birth weights in Italy.

Introduction. Health services and healthcare workers in hospitals that care for mothers and newborns, play an important role in the promotion and support of breastfeeding (BF). Despite all the knowledge regarding the advantages of breastfeeding, there are still numerous obstacles to its diffusion and promotion during the hospital stay for childbirth. Methods. In the year 2003 the Agency for Public Health of Lazio Region implemented a program to promote a regional network of hospitals to be accredited as Baby Friendly Hospitals (BFH)according to the 10 UNICEF/WHO steps . Seventeen hospitals out of 57 participated voluntarily; in these units about 23,000 births take place each year (45% of total births in the region). From September to November 2003, 61 healthcare workers (about four per unit) were trained with a 40-hour course. Throughout 2004, the 61 trainees trained 1,300 healthcare workers (midwives, physicians and nurses) at their units. To monitor the project two types of surveys were carried out, the first using the UNICEF Self Appraisal Tool, and the second, using a questionnaire on how the baby was fed during the hospital stay; both surveys were done in June 2003 and 2004. Results. In total, implementation of the 10 steps went from 38% in 2003 to 58% in 2004. At the baseline the most critical points were for the first step (11% of positive answers), the seventh (24%) and the tenth (21%). After one year, step 1 rose to 41%, step 7 to 41% and step ten to 52%. The percentage of exclusive BF during the hospital stay rose from 35% (2003) to 46% (2004). Conclusions. To our knowledge, this is the first BFH Italian initiative in which a such a large number of maternity units are involved on regional scale. Positive results were reached in BF rates but not as positive as results in the implementation of 10 steps. This demonstrates that the process of implementation of the 10 steps has to be carefully evaluated together with BF rates during hospital stay, at discharge and after.