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1. Lowering of the Neonatal Lung Ultrasonography Score after nCPAP Positioning in Neonates over 32 Weeks of Gestational Age with Neonatal Respiratory Distress

Author

Perri, Alessandro, Fattore, Simona, D'Andrea, Vito, Sbordone, A., Patti, M. L., Nobile, Stefano, Tirone, Chiara, Giordano, Lucia, Tana, Milena, Priolo, Francesca, Serrao, Francesca, Riccardi, Riccardo, Prontera, Giorgia, Vento, Giovanni, Perri A., Fattore S., D'Andrea V. (ORCID:0000-0002-0980-799X), Nobile S. (ORCID:0000-0002-5304-1485), Tirone C., Giordano L., Tana M., Priolo F., Serrao F., Riccardi R. (ORCID:0000-0001-7515-6622), Prontera G., Vento G. (ORCID:0000-0002-8132-5127), Perri, Alessandro, Fattore, Simona, D'Andrea, Vito, Sbordone, A., Patti, M. L., Nobile, Stefano, Tirone, Chiara, Giordano, Lucia, Tana, Milena, Priolo, Francesca, Serrao, Francesca, Riccardi, Riccardo, Prontera, Giorgia, Vento, Giovanni, Perri A., Fattore S., D'Andrea V. (ORCID:0000-0002-0980-799X), Nobile S. (ORCID:0000-0002-5304-1485), Tirone C., Giordano L., Tana M., Priolo F., Serrao F., Riccardi R. (ORCID:0000-0001-7515-6622), Prontera G., and Vento G. (ORCID:0000-0002-8132-5127)

Abstract

Respiratory distress (RD) is one of the most common causes of admission to the neonatal intensive care unit. Correct diagnosis and timely intervention are crucial. Lung ultrasonography (LU) is a useful diagnostic tool for the neonatologist in the diagnosis of RD; the neonatal lung ultrasonography score (nLUS) can be used in the diagnostic process, but some authors hypothesise that it is also useful for the management of some neonatal RD. The aim of this study is to analyse the changes in nLUS score before (T0) and after (T1) the start of respiratory support with nasal CPAP in neonates over 32 weeks of age with RD. Thirty-three newborns were enrolled in this retrospective study. LU was performed before and after the start of CPAP. The median nLUS scores at T0 and T1 were 9 (IQR 7–12) and 7 (IQR 4–10), respectively, and showed a significant difference (p < 0.001). The magnitude of reduction in nLUS score, expressed as a percentage, was inversely related to the need for subsequent administration of exogenous surfactant. The study suggests the usefulness of the nLUS score in assessing the response to CPAP in neonates over 32 weeks gestational age.

Published
2022

2. Caution advised regarding lung recruitment before surfactant – Authors’ reply

Author

Vento, Giovanni, Ventura, M. L., Pastorino, Roberta, van Kaam, A. H., Carnielli, V., Cools, F., Dani, C., Mosca, F., Polglase, G., Tagliabue, P., Boni, L., Cota, Francesco, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Cost, S., D'Andrea, Vito, Lucente, Monica Christine, Nigro, G., Giordano, Lucia, Roma, V., Villani, P., Fusco, Francesca Paola, Fasolato, V., Colnaghi, M. R., Matassa, P. G., Vendettuoli, V., Poggi, C., Del Vecchi, A., Petrillo, F., Betta, P., Mattia, C., Garani, G., Solinas, A., Gitto, E., Salvo, V., Gargano, G., Balestri, E., Sandri, F., Mescoli, G., Martinelli, Silvia, Ilardi, L., Ciarmoli, E., Di Fabio, S., Maranella, E., Grassia, C., Ausanio, G., Rossi, V., Motta, A., Tina, L. G., Maiolo, K., Nobile, Stefano, Messner, H., Staffler, Alex, Ferrero, F., Stasi, I., Pieragostini, L., Mondello, I., Haass, C., Consigli, C., Vedovato, S., Grison, A., Maffei, G., Presta, G., Perniola, R., Vitaliti, M., Re, M. P., De Curtis, M., Cardilli, V., Lago, P., Tormena, F., Orfeo, L., Gizzi, C., Massenzi, L., Gazzolo, D., Strozzi, M. C. M., Bottino, R., Pontiggia, F., Berardi, A., Guidotti, I., Cacace, C., Meli, V., Quartulli, L., Scorrano, A., Casati, A., Grappone, L., Pillow, J. J., Vento G. (ORCID:0000-0002-8132-5127), Pastorino R. (ORCID:0000-0001-5013-0733), Cota F. (ORCID:0000-0002-9009-3997), Tana M., Tirone C., Aurilia C., Lio A., D'Andrea V. (ORCID:0000-0002-0980-799X), Lucente M., Giordano L., Fusco F. P., Martinelli S., Nobile S. (ORCID:0000-0002-5304-1485), Staffler A., Vento, Giovanni, Ventura, M. L., Pastorino, Roberta, van Kaam, A. H., Carnielli, V., Cools, F., Dani, C., Mosca, F., Polglase, G., Tagliabue, P., Boni, L., Cota, Francesco, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Cost, S., D'Andrea, Vito, Lucente, Monica Christine, Nigro, G., Giordano, Lucia, Roma, V., Villani, P., Fusco, Francesca Paola, Fasolato, V., Colnaghi, M. R., Matassa, P. G., Vendettuoli, V., Poggi, C., Del Vecchi, A., Petrillo, F., Betta, P., Mattia, C., Garani, G., Solinas, A., Gitto, E., Salvo, V., Gargano, G., Balestri, E., Sandri, F., Mescoli, G., Martinelli, Silvia, Ilardi, L., Ciarmoli, E., Di Fabio, S., Maranella, E., Grassia, C., Ausanio, G., Rossi, V., Motta, A., Tina, L. G., Maiolo, K., Nobile, Stefano, Messner, H., Staffler, Alex, Ferrero, F., Stasi, I., Pieragostini, L., Mondello, I., Haass, C., Consigli, C., Vedovato, S., Grison, A., Maffei, G., Presta, G., Perniola, R., Vitaliti, M., Re, M. P., De Curtis, M., Cardilli, V., Lago, P., Tormena, F., Orfeo, L., Gizzi, C., Massenzi, L., Gazzolo, D., Strozzi, M. C. M., Bottino, R., Pontiggia, F., Berardi, A., Guidotti, I., Cacace, C., Meli, V., Quartulli, L., Scorrano, A., Casati, A., Grappone, L., Pillow, J. J., Vento G. (ORCID:0000-0002-8132-5127), Pastorino R. (ORCID:0000-0001-5013-0733), Cota F. (ORCID:0000-0002-9009-3997), Tana M., Tirone C., Aurilia C., Lio A., D'Andrea V. (ORCID:0000-0002-0980-799X), Lucente M., Giordano L., Fusco F. P., Martinelli S., Nobile S. (ORCID:0000-0002-5304-1485), and Staffler A.

Abstract

N/A

Published
2021

3. ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

Author

La Greca, Antonio, Iacobone, E., Elisei, D., Biasucci, Daniele Guerino, D'Andrea, Vito, Barone, Giovanni, Marinosci, G. Z., Pittiruti, Mauro, La Greca A. (ORCID:0000-0002-7587-7427), Biasucci D. G., D'Andrea V. (ORCID:0000-0002-0980-799X), Barone G., Pittiruti M. (ORCID:0000-0003-4541-7566), La Greca, Antonio, Iacobone, E., Elisei, D., Biasucci, Daniele Guerino, D'Andrea, Vito, Barone, Giovanni, Marinosci, G. Z., Pittiruti, Mauro, La Greca A. (ORCID:0000-0002-7587-7427), Biasucci D. G., D'Andrea V. (ORCID:0000-0002-0980-799X), Barone G., and Pittiruti M. (ORCID:0000-0003-4541-7566)

Abstract

Central venous access devices are routinely used in clinical practice for administration of fluids and medications, for drawing blood samples and for hemodynamic monitoring. The adoption of ultrasound guided venipuncture has significantly reduced procedure-related complications, as documented by the recommendations of most recent guidelines. Ultrasound has also an important role also in other aspects of central venous catheterization, such as in the pre-procedural evaluation of the venous patrimony and in the detection of early and late non-infective complications. Recently, bedside ultrasound has been regarded as a promising tool also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in adult patients, and to suggest a structured standardized protocol for clinical practice.

Published
2021

4. Centrally inserted central catheters in preterm neonates with weight below 1500 g by ultrasound-guided access to the brachio-cephalic vein

Author

Barone, Giovanni, Pittiruti, Mauro, Ancora, G., Vento, Giovanni, Tota, F., D'Andrea, Vito, Barone G., Pittiruti M. (ORCID:0000-0003-4541-7566), Vento G. (ORCID:0000-0002-8132-5127), D'Andrea V. (ORCID:0000-0002-0980-799X), Barone, Giovanni, Pittiruti, Mauro, Ancora, G., Vento, Giovanni, Tota, F., D'Andrea, Vito, Barone G., Pittiruti M. (ORCID:0000-0003-4541-7566), Vento G. (ORCID:0000-0002-8132-5127), and D'Andrea V. (ORCID:0000-0002-0980-799X)

Abstract

Objective: Central venous access in critically ill newborns can be challenging. Ultrasound-guided brachio-cephalic vein catheterization is a relatively new procedure, recently introduced in several neonatal intensive care units. The aim of this study is to evaluate the safety and feasibility of such a technique in preterm babies. Design: Retrospective analysis of prospectively collected data on ultrasound-guided central venous catheter insertion in preterm neonates. Setting: Neonatal intensive care unit. Patients: Critically ill preterm neonates with weight below 1500 g requiring a central access. Interventions: Ultrasound-guided brachio-cephalic vein catheterization. Main Results: Thirty centrally inserted catheters were placed in 30 neonates. The success rate of the procedure was 100%. No case of accidental arterial or pleural puncture was registered during the study period. Conclusion: The brachio-cephalic vein can be safely catheterized in preterm newborns requiring intensive care after appropriate training.

Published
2020

5. Lung recruitment before surfactant administration in extremely preterm neonates with respiratory distress syndrome (IN-REC-SUR-E): a randomised, unblinded, controlled trial

Author

Vento, Giovanni, Ventura, M. L., Pastorino, Roberta, van Kaam, A. H., Carnielli, V., Cools, F., Dani, C., Mosca, F., Polglase, G., Tagliabue, P., Boni, L., Cota, Francesco, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Costa, Simonetta, D'Andrea, Vito, Lucente, M., Nigro, G., Giordano, Liliana, Roma, V., Villani, P. E., Fusco, Francesca Paola, Fasolato, V., Colnaghi, M. R., Matassa, P. G., Vendettuoli, V., Poggi, C., Del Vecchio, Arianna, Petrillo, F., Betta, P., Mattia, C., Garani, G., Solinas, A., Gitto, E., Salvo, V., Gargano, G., Balestri, E., Sandri, F., Mescoli, G., Martinelli, S., Ilardi, L., Ciarmoli, E., Di Fabio, S., Maranella, E., Grassia, C., Ausanio, G., Rossi, V., Motta, Alessandro, Tina, L. G., Maiolo, K., Nobile, Stefano, Messner, H., Staffler, Alex, Ferrero, Mattia Francesco, Stasi, I., Pieragostini, L., Mondello, I., Haass, C., Consigli, C., Vedovato, S., Grison, A., Maffei, G., Presta, G., Perniola, R., Vitaliti, M., Re, M. P., De Curtis, M., Cardilli, V., Lago, P., Tormena, F., Orfeo, L., Gizzi, C., Massenzi, L., Gazzolo, D., Strozzi, M. C. M., Bottino, R., Pontiggia, F., Berardi, A., Guidotti, I., Cacace, C., Meli, V., Quartulli, L., Scorrano, A., Casati, A., Grappone, L., Pillow, J. J., Vento G. (ORCID:0000-0002-8132-5127), Pastorino R. (ORCID:0000-0001-5013-0733), Cota F. (ORCID:0000-0002-9009-3997), Tana M., Tirone C., Aurilia C., Lio A., Costa S., D'Andrea V. (ORCID:0000-0002-0980-799X), Giordano L., Fusco F. P., Del Vecchio A., Motta A., Nobile S. (ORCID:0000-0002-5304-1485), Staffler A., Ferrero F., Vento, Giovanni, Ventura, M. L., Pastorino, Roberta, van Kaam, A. H., Carnielli, V., Cools, F., Dani, C., Mosca, F., Polglase, G., Tagliabue, P., Boni, L., Cota, Francesco, Tana, Milena, Tirone, Chiara, Aurilia, Claudia, Lio, Alessandra, Costa, Simonetta, D'Andrea, Vito, Lucente, M., Nigro, G., Giordano, Liliana, Roma, V., Villani, P. E., Fusco, Francesca Paola, Fasolato, V., Colnaghi, M. R., Matassa, P. G., Vendettuoli, V., Poggi, C., Del Vecchio, Arianna, Petrillo, F., Betta, P., Mattia, C., Garani, G., Solinas, A., Gitto, E., Salvo, V., Gargano, G., Balestri, E., Sandri, F., Mescoli, G., Martinelli, S., Ilardi, L., Ciarmoli, E., Di Fabio, S., Maranella, E., Grassia, C., Ausanio, G., Rossi, V., Motta, Alessandro, Tina, L. G., Maiolo, K., Nobile, Stefano, Messner, H., Staffler, Alex, Ferrero, Mattia Francesco, Stasi, I., Pieragostini, L., Mondello, I., Haass, C., Consigli, C., Vedovato, S., Grison, A., Maffei, G., Presta, G., Perniola, R., Vitaliti, M., Re, M. P., De Curtis, M., Cardilli, V., Lago, P., Tormena, F., Orfeo, L., Gizzi, C., Massenzi, L., Gazzolo, D., Strozzi, M. C. M., Bottino, R., Pontiggia, F., Berardi, A., Guidotti, I., Cacace, C., Meli, V., Quartulli, L., Scorrano, A., Casati, A., Grappone, L., Pillow, J. J., Vento G. (ORCID:0000-0002-8132-5127), Pastorino R. (ORCID:0000-0001-5013-0733), Cota F. (ORCID:0000-0002-9009-3997), Tana M., Tirone C., Aurilia C., Lio A., Costa S., D'Andrea V. (ORCID:0000-0002-0980-799X), Giordano L., Fusco F. P., Del Vecchio A., Motta A., Nobile S. (ORCID:0000-0002-5304-1485), Staffler A., and Ferrero F.

Abstract

Background: The importance of lung recruitment before surfactant administration has been shown in animal studies. Well designed trials in preterm infants are absent. We aimed to examine whether the application of a recruitment manoeuvre just before surfactant administration, followed by rapid extubation (intubate-recruit-surfactant-extubate [IN-REC-SUR-E]), decreased the need for mechanical ventilation during the first 72 h of life compared with no recruitment manoeuvre (ie, intubate-surfactant-extubate [IN-SUR-E]). Methods: We did a randomised, unblinded, controlled trial in 35 tertiary neonatal intensive care units in Italy. Spontaneously breathing extremely preterm neonates (24 + 0 to 27 + 6 weeks' gestation) reaching failure criteria for continuous positive airway pressure within the first 24 h of life were randomly assigned (1:1) with a minimisation algorithm to IN-REC-SUR-E or IN-SUR-E using an interactive web-based electronic system, stratified by clinical site and gestational age. The primary outcome was the need for mechanical ventilation in the first 72 h of life. Analyses were done in intention-to-treat and per-protocol populations, with a log-binomial regression model correcting for stratification factors to estimate adjusted relative risk (RR). This study is registered with ClinicalTrials.gov, NCT02482766. Findings: Of 556 infants assessed for eligibility, 218 infants were recruited from Nov 12, 2015, to Sept 23, 2018, and included in the intention-to-treat analysis. The requirement for mechanical ventilation during the first 72 h of life was reduced in the IN-REC-SUR-E group (43 [40%] of 107) compared with the IN-SUR-E group (60 [54%] of 111; adjusted RR 0·75, 95% CI 0·57–0·98; p=0·037), with a number needed to treat of 7·2 (95% CI 3·7–135·0). The addition of the recruitment manoeuvre did not adversely affect the safety outcomes of in-hospital mortality (19 [19%] of 101 in the IN-REC-SUR-E group vs 37 [33%] of 111 in the IN-SUR-E group), pneumothorax (

Published
2020

6. A Systematic Ultrasound Evaluation of the Diameter of Deep Veins in the Newborn: Results and Implications for Clinical Practice

Author

Barone, Gennaro, D'Andrea, Vito, Vento, Giovanni, Pittiruti, Mauro, Barone G., D'Andrea V. (ORCID:0000-0002-0980-799X), Vento G. (ORCID:0000-0002-8132-5127), Pittiruti M. (ORCID:0000-0003-4541-7566), Barone, Gennaro, D'Andrea, Vito, Vento, Giovanni, Pittiruti, Mauro, Barone G., D'Andrea V. (ORCID:0000-0002-0980-799X), Vento G. (ORCID:0000-0002-8132-5127), and Pittiruti M. (ORCID:0000-0003-4541-7566)

Abstract

Background: In adults and children, current guidelines recommend measuring the diameter of the vein before the insertion of central catheters, in order to match vein diameter with catheter caliber and thus reduce the risk of venous thrombosis. In the neonatal intensive care unit, central catheters are often used but the vein diameter is usually not considered. Method: We assessed the diameter of the most relevant deep veins in 100 newborns, using a strict protocol of ultrasound evaluation. Results: Mean gestational age of studied infants was 32 weeks and mean weight was 1,690 g. The mean diameter of the brachiocephalic vein was consistently ≥3 mm, with no significant difference between the right and the left side. The femoral vein diameter, on the other hand, was considerably smaller than 3 mm for infants with a weight < 2,000 g. Interobserver repeatability was found to be very high. Conclusion: Preprocedural ultrasound scan of veins is feasible and easy, also in newborns, and it should be recommended for optimizing central venous catheterization.

Published
2019

7. Extubation from high-frequency oscillatory ventilation in extremely low birth weight infants: A prospective observational study

Author

Tana, M., Lio, A., Tirone, C., Aurilia, C., Tiberi, Eloisa, Serrao, F., Purcaro, Velia, Corsello, M., Catenazzi, P., D'Andrea, Vito, Barone, G., Ricci, C., Pastorino, Roberta, Vento, Giovanni, Tiberi E., Purcaro V., D'Andrea V. (ORCID:0000-0002-0980-799X), Pastorino R. (ORCID:0000-0001-5013-0733), Vento G. (ORCID:0000-0002-8132-5127), Tana, M., Lio, A., Tirone, C., Aurilia, C., Tiberi, Eloisa, Serrao, F., Purcaro, Velia, Corsello, M., Catenazzi, P., D'Andrea, Vito, Barone, G., Ricci, C., Pastorino, Roberta, Vento, Giovanni, Tiberi E., Purcaro V., D'Andrea V. (ORCID:0000-0002-0980-799X), Pastorino R. (ORCID:0000-0001-5013-0733), and Vento G. (ORCID:0000-0002-8132-5127)

Abstract

Objective To evaluate if weaning from high-frequency oscillatory ventilation (HFOV) directly to a non-invasive mode of respiratory support is feasible and results in successful extubation in extremely low birth weight (ELBW) infants. Design Prospective observational study. Setting Tertiary neonatal intensive care unit. Patients One hundred and eight ELBW infants of 26.2±1.4 weeks of gestational age (GA) directly extubated from HFOV. Interventions All infants were managed with elective HFOV and received surfactant after a recruitment HFOV manoeuvre. Extubation was attempted at mean airways pressure (MAP) ≤6 cm H 2 O with FiO 2 ≤0.25. After extubation, all infants were supported by nasal continuous positive airway pressure (6-8 cm H 2 O). Main outcome measures Extubation failure (clinical deterioration requiring reintubation) was defined as shorter than 7 days. Results Ninety patients (83%) were successfully extubated and 18 (17%) required reintubation. No significant differences were found between the two groups in terms of birth weight, day of life and weight at the time of extubation. Multivariable analysis showed that GA (OR 1.71; 95% CI 1.04, 2.08) and higher MAP prior to surfactant (OR 1.51; 95% CI 1.06, 2.15) were associated with successful extubation. Conclusions In ELBW infants, direct extubation from HFOV at MAP ≤6 cm H 2 O with FiO 2 ≤0.25 is feasible. Our extubation success rate (83%) is higher than conventional mechanical ventilation in this very vulnerable class of infants.

Published
2018

8. INTRANASAL LIDOCAINE AND MIDAZOLAM FOR PROCEDURAL SEDATION IN CHILDREN

Author

Chiaretti, Antonio, Pierri, F, Barone, G, Rigante, Donato, Ruggiero, Antonio, Giorgio, Valentina, D'Andrea, Vito, Riccardo, R, Chiaretti, A (ORCID:0000-0002-9971-1640), Rigante, D (ORCID:0000-0001-7032-7779), Ruggiero, A (ORCID:0000-0002-6052-3511), Giorgio, V, D'Andrea, V (ORCID:0000-0002-0980-799X), Chiaretti, Antonio, Pierri, F, Barone, G, Rigante, Donato, Ruggiero, Antonio, Giorgio, Valentina, D'Andrea, Vito, Riccardo, R, Chiaretti, A (ORCID:0000-0002-9971-1640), Rigante, D (ORCID:0000-0001-7032-7779), Ruggiero, A (ORCID:0000-0002-6052-3511), Giorgio, V, and D'Andrea, V (ORCID:0000-0002-0980-799X)

Abstract

The paper deals with the association of midazolam and lidocaine for pediatric sedation in the intensive care unit.

Published
2010

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