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M Stronati

Publications and source records attributed to M Stronati.

At least 19 recordsLinked to original sources
PubMed2006

Rates of neonatal death and cerebral palsy associated with fetal growth restriction among very low birthweight infants. A temporal analysis.

OBJECTIVE: To assess whether changes over time in neonatal survival and infants' neurodevelopmental outcome among very low birthweight (VLBW) infants was correlated with the obstetric aetiology of VLBW. DESIGN: A cohort study of 773 VLBW infants. SETTING: A University hospital in Northern Italy. POPULATION: All the VLBW infants born over a 20-year period (1983-2002) at a single institution. METHODS: Evaluation of neonatal mortality and neurodevelopmental outcome of the surviving infants at 2 years of corrected age. Logistic regression analysis was used to compare the improvements of neonatal outcome associated with obstetric risk factors over time. MAIN OUTCOME MEASURES: The risk reduction of neonatal death or cerebral palsy associated with each obstetric category responsible for VLBW over time. RESULTS: The overall rates of neonatal mortality and cerebral palsy were 38.7% (43/111) and 17% (9/53) in the period 1983-87 and 13.7% (34/24) and 6.3% (13/205) in the period 1998-2002, respectively. The adjusted decrement per 5-year period was 33.1% (95% CI = 7.9-51.4) for neonatal death and 29.1% (95% CI = 25.3-32.7) for cerebral palsy, respectively. The adjusted rise in the rate of intact survival at 2 years of corrected age was 7.6% (95% CI = 3.1-12.3) per quinquennium. In logistic models with neonatal death or cerebral palsy as a combined outcome variable, and gestational age, corticosteroid use, surfactant use, and time of birth as explanatory variables, fetal growth restriction (P < 0.001) and pre-eclampsia (P= 0.011) interacted significantly with period of birth. The adjusted decrement in the rate of neonatal death or cerebral palsy as a combined variable was 27.5% per 5 years (95% CI = 13-39.6) in the overall population, 54.5% per 5 years (95% CI = 46.8-61.2) (P < 0.001 compared with overall population) among growth-restricted infants and 50.3% per 5 years (95% CI = 42.5-57.1) (P= 0.003 compared with overall population) in infants born to mothers with pre-eclampsia. CONCLUSIONS: Over a period of 20 years, the decrement in the rate of neonatal death or cerebral palsy was higher in growth-restricted fetuses than in other VLBW infants. This reduction was not obtained at the expense of an increased rate of neurodevelopmental impairments in surviving infants.

Cerebral Palsy↗
PubMed2006

Neonatal invasive candidiasis.

Over the last two decades, systemic fungal infections have emerged to play a primary role in hospital-acquired infections. C. albicans is involved in 75% of neonatal candidiasis; however, the incidence of infection from C. parapsilosis is also increasing significantly. The higher incidence observed in the high-risk group of very low birth weight (VLBW) infants is linked to their special physical characteristics and the diagnostic and therapeutic invasive procedures they undergo. Colonization is a relevant risk factor depending on the colonized site , the fungal species and the type of colonization. Serological tests have a low specificity and sensitivity; in many cases, they do not distinguish between colonization and infection. Blood culture, although the best diagnostic test for determining systemic infection, can result negative, even in cases of deep organ involvement. In addition, fungi grow more slowly than bacteria in cultures. So, the difficulty in diagnosing systemic candidiasis and its aspecific clinical features may make empirical therapy appropriate. Amphotericin B (AmB) alone or combined with 5-fluorocytosine remains the drug of choice. Fluconazole represents a valid alternative. Recently developed new formulations of amphotericin incapsulated in liposomes can avoid possible adverse effects. Prognosis depends on the specific micro-organism involved; mortality is higher in the presence of C. albicans. As prognosis is associated with high mortality, prevention measures to reduce risk factors are of critical importance.

Age Factors↗
PubMed2005

[Congenital cytomegalovirus infection].

The cytomegalovirus (CMV) is responsible for the most common congenital infection and represents the most important cause of mental disability and non hereditary sensorineural deafness in infants. One percent to 5% of women show symptoms of infection during pregnancy. Forty thousand newborns are affected by this infection in the United States every year, at a cost of 1.9 billion dollars; in Italy, approximately 5,500 infected newborns are expected each year, including 350 in Lombardia alone. In 90% of the cases, the infected newborns present no symptoms at birth, but, in 10% to 15% of these cases, they are not immune to future manifestations of the infection. Ten percent of newborns with congenital infection, however, show symptoms that lead to a strongly unfavourable prognosis. The authors describe the most important pre and post natal diagnostic findings and emphasize the importance of counseling in this pathology. They also point out the least frequent clinical manifestations of the infection in newborns, which can cause problems of differential diagnosis. In light of the most recent literary data, the article outlines the most recent therapeutic schemes as well as their effectiveness. Lastly, the authors discuss the sequels of the congenital infection, which can present themselves in infected newborns even after a long period of time. This corresponds to one of the most important aspects of the topic and the authors propose a follow-up program that applies to those children until the age of 6. There is currently no effective or safe vaccine for the CMV, therefore hygienic-health measures constitute the principal form of prevention of the CMV congenital infection, which represents a significant problem for newborns, their families, and society.

Antiviral Agents↗
PubMed2001

Human cytomegalovirus immediate-early messenger RNA in blood of pregnant women with primary infection and of congenitally infected newborns.

Human cytomegalovirus (HCMV) immediate-early messenger RNA (IEmRNA) in sequential blood samples from 32 pregnant women with primary infection and from 14 congenitally infected newborns was qualitatively investigated by nucleic acid sequence-based amplification. IEmRNA was detected in 100%, 75%, 36.3%, 22.2%, and 0% of samples collected 1, 2, 3, 4-6, and >6 months after onset of primary HCMV infection, respectively, showing 83.7% sensitivity and 92.2% specificity, compared with results of quantitative DNAemia (detection of viral DNA in blood). In infected newborns, IEmRNA was positive in 100% of samples collected 1-7 days (median, 1.5 days) and in 46.4% of samples collected 27-260 days (median, 88 days) after birth, showing 75.7% sensitivity and 100% specificity, compared with DNAemia results. IEmRNA was not detected in HCMV-immune individuals with remote or recurrent HCMV infection or in uninfected newborns. IEmRNA determination appears to be a valuable tool for early diagnosis of both primary and congenital HCMV infection.

Adolescent↗
PubMed2001

Extracranial radiosurgery: immobilizing liver motion in dogs using high-frequency jet ventilation and total intravenous anesthesia.

PURPOSE: Extracranial radiosurgery requires control of organ motion. The purpose of this study is to quantitatively determine the extent of liver motion in anesthetized dogs with continuous i.v. propofol infusion with or without muscle relaxants and high-frequency jet ventilation. METHODS AND MATERIALS: Five dogs were used in the experiment. Each dog was restrained while anesthetized in the supine position using an alpha cradle. Surgical metal clips were implanted around the liver periphery so that its motion could be visualized using a fluoroscopic imaging device in a conventional simulator. Initially, two orthogonal simulation films were taken to correlate locations of implanted clips. Two orthogonal views of fluoroscopic images for each anesthetized dog were recorded on a magnetic tape and analyzed from the post-imaging data. Liver motion was documented under the following three conditions: 1) ventilated with a conventional mechanical ventilator, 2) ventilated with a high-frequency jet ventilator, and 3) ventilated with a high-frequency jet ventilator and total muscle paralysis (with vecuronium injection). The maximum liver motion for each dog was analyzed in three orthogonal directions: the inferior-to-superior direction, the anterior-to-posterior direction, and the right-to-left direction. RESULTS: When the anesthetized dogs were ventilated with a conventional mechanical ventilator, the average liver motions were 1.2 cm in the inferior-to-superior direction, 0.4 cm in the anterior-to-posterior direction, and 0.2 cm in the right-to-left direction, respectively. After the introduction of high-frequency jet ventilation, the average liver motions were reduced to 0.2 cm in the inferior-to-superior direction, 0.2 cm in the anterior-to-posterior direction, and 0.1 cm in the right-to-left direction. The maximum liver motion was dependent on ventilator settings. There was no additional measurable motion reduction with the addition of the muscle relaxant. CONCLUSION: The liver motion in each anesthetized dog was controlled under 3.0 mm in all directions with the use of high-frequency jet ventilation. No detectable advantage was identified by the injection of muscle relaxant in terms of further reducing the liver motion. The preclinical animal study indicated that the use of high-frequency jet ventilation (HFJV) would be able to limit the liver motion to an extent acceptable for the application of extracranial radiosurgery in humans. Radiosurgery for localized liver tumors warrants further investigation.

Anesthesia, Intravenous↗
PubMed1998

Preeclampsia, preterm delivery and infant cerebral palsy.

OBJECTIVE: To evaluate the association between preeclampsia and cerebral palsy among preterm infants. STUDY DESIGN: A cohort study of 345 singleton preterm (24 to 33 weeks gestation) infants delivered at an institution where no mothers received magnesium sulphate. We investigated the relationship of preeclampsia to the development of infant cerebral palsy (spastic quadriplegia, hemiplegia or diplegia) at two years' corrected age. Potential confounders were controlled for by politomous logistic regression analysis. RESULTS: The prevalence of cerebral palsy in surviving infants from normotensive and preeclamptic pregnancies was 13.4% (38/284) and 3.3% (2/61), respectively (P=0.026 by Fisher exact test). After control for potential confounders (gestational age, infant gender, birthweight standard deviation score, mode of delivery), the likelihood of infant cerebral palsy was reduced by preeclampsia (odds ratio 0.16, 95% confidence interval=0.04-0.74 for infants from preeclamptic versus normotensive pregnancies being palsied). CONCLUSION: Among preterm infants, the protective effect of preeclampsia against cerebral palsy is manifest in the absence of magnesium sulphate utilization.

Adult↗
PubMed1998

Obstetric risk factors for periventricular leukomalacia among preterm infants.

OBJECTIVE: To evaluate the obstetric antecedents of cystic periventricular leukomalacia and transient echodense periventricular lesions among preterm infants. DESIGN: A cohort study of preterm singleton infants born between 25 and 33 weeks gestation. SETTING: Pavia, Italy. POPULATION: Three hundred and forty-nine infants admitted to a Division of Neonatal Intensive Care who were screened for periventricular leukomalacia. METHOD: The obstetric factors in infants with either cystic periventricular leukomalacia or transient echodense periventricular lesions were compared to those in infants with negative cranial ultrasonographic findings. Stepwise multiple logistic regression analysis was used to evaluate the association between risk factors and outcomes adjusting for confounders. RESULTS: The prevalence of cystic periventricular leukomalacia and transient echodense lesions was 5.7% (20/349) and 14% (49/349), respectively. The main risk factors for cystic leukomalacia were first trimester haemorrhage (OR 4.49; 95% CI 1.63-12.39), maternal urinary tract infection on admission (OR 5.71; 95% CI 1.91-17.07), and neonatal acidosis (pH < 7.2) at birth (OR 5.97; 95% CI 1.93-18.52). Meconium-stained amniotic fluid (OR 3.95; 95% CI 1.42-10.98) and long term (> 72 hours) ritodrine tocolysis (OR 2.54; 95% CI 1.28-5.05) were associated with an increased risk of echodense lesions. The likelihood of overall leukomalacia (cystic plus echodense periventricular lesions) was increased among cases with meconium-stained amniotic fluid (OR 4.06; 95% CI 1.65-10.0), long-term ritodrine tocolysis (OR 2.56; 95% CI 1.38-4.72), maternal infection (OR 1.73; 95% CI 1.0-3.0), and acidosis at birth (OR 1.98; 95% CI 1.0-3.98). CONCLUSIONS: This study confirms that maternal infection, acidosis at birth, and meconium-stained amniotic fluid increase the risk of periventricular leukomalacia in preterm infants. Long-term ritodrine use seems to increase the risk for transient echodense lesions.

Acidosis↗
PubMed1997

Antenatal and delivery risk factors simultaneously associated with neonatal death and cerebral palsy in preterm infants.

To evaluate the simultaneous effects of antenatal and delivery risk factors on neonatal death and cerebral palsy in preterm infants, we conducted a cohort study of 363 singleton pregnancies delivered between 24 and 33 weeks gestation. Neurodevelopmental outcome of the infants was evaluated at 2 years of corrected age. Risk factors associated with death or cerebral palsy were analysed by politomous logistic regression. Overall, the mortality rate was 14.6% (53/363) and the prevalence of cerebral palsy among surviving infants was 12.3% (38/310). Decreasing gestation and meconium-stained amniotic fluid were the only antenatal factors associated with increased odds for both death and cerebral palsy. The effect magnitude and the predictive value of gestational age were greater for death than for cerebral palsy. After adjustment for confounders, prolonged (> or = 48 h) rupture of membranes (odds ratio 2.98, 95% confidence interval 1.12-7.96) and male sex of the infant (odds ratio 3.01, 95% confidence interval 1.32-6.71) were significantly associated only with cerebral palsy. We conclude that neonatal death and cerebral palsy share few common antenatal risk factors. The characteristics of antenatal risk factors for cerebral palsy suggest that bacterial infestation of the amniotic cavity may be implicated in the etiology of the cerebral impairment.

Birth Weight↗
PubMed1997

Meconium-stained amniotic fluid and risk for cerebral palsy in preterm infants.

OBJECTIVE: To estimate the risk for cerebral palsy in preterm infants in relation to the presence of meconium in the amniotic fluid (AF). METHODS: A cohort study was conducted of 404 consecutive preterm infants delivered between 24 and 33 weeks' gestation at a single institution. Sociodemographic and clinical data were collected at birth. The diagnosis of cerebral palsy was made at 2 years' corrected age. Politomous logistic regression models were used to evaluate the odds for cerebral palsy while adjusting for potential confounders. RESULTS: The overall prevalence of cerebral palsy among survivors was 11.6% (40/345). The cerebral palsy rate was 41.2% (7/17) among infants who were meconium-stained at birth and 10% (33/328) among those who were not (P = .006 by Fisher exact test). After adjustment for potential confounders (gestational age and fetal gender), the odds ratio of cerebral palsy among infants delivered to women with meconium-stained AF was 6.9 (95% confidence interval 2.32, 20.81, P = .001) relative to those delivered to women with clear AF. CONCLUSION: The results of the present study support the view that the presence of meconium in the AF is a gestational age-independent risk factor for cerebral palsy among preterm infants.

Amniotic Fluid↗
PubMed1997

Significance of low birthweight for gestational age among very preterm infants.

OBJECTIVE: To estimate the risk of specific adverse neonatal events resulting from the combined effects of prematurity and low birthweight in very preterm infants (delivered at 24-31 weeks of gestation). DESIGN: A cohort study of specific adverse neonatal events in preterm infants born at between 24 and 31 weeks of gestation. SETTING: Pavia, Italy. POPULATION: Two hundred and thirty singleton infants with sonographically confirmed gestational age, delivered at 24 to 31 weeks of gestation. METHODS: To evaluate the impact of a lower than expected birthweight on selected neonatal events independently of gestational age, we calculated birthweight standard deviation scores (differences between actual birthweight and fitted birthweight divided by fitted standard deviation) for each week of gestation. RESULTS: After adjustment for gestational age and other confounders, there was a significant linear trend relating a decreasing birthweight SDS to an increased likelihood of neonatal death, intraventricular haemorrhage, severe respiratory distress syndrome, and acidosis. Compared with infants with SDS > or = 0 (> or = 50th centile of birthweight), infants with birthweight SDS < -1 (< 16th centile) had increased odds for neonatal death [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.42-9.6], grade III-IV intraventricular haemorrhage (OR 17.5, 95% CI 4.04-75.9), and neonatal acidosis (OR 3.22, 95% CI 1.41-7.4). The significance of birthweight SDS as a predictor of neonatal outcome, however, was lower than that of gestational age. CONCLUSIONS: A lower than expected birthweight affects the likelihood of several adverse neonatal events in very preterm infants. However, a decreasing birthweight SDS affects neonatal outcome less than decreasing gestation does.

Adult↗
PubMed1995

Value of antenatal corticosteroid therapy in preterm birth.

This prospective observational study was designed to evaluate the magnitude of the corticosteroid-related reduction in the risk of respiratory distress syndrome (RDS), intraventricular hemorrhage and neonatal death according to different etiologic subgroups of preterm delivery. Of 380 patients delivered before 35 weeks' gestation, 155 received a complete course of dexamethasone or betamethasone to promote fetal lung maturation. In logistic models, the steroid-related reduction of RDS was greater among patients with intact membranes as opposed to patients with premature rupture of membranes (excess risk = 0.31; 95% confidence interval (C.I.) = 0.13-0.73; P = 0.007) and in patients with spontaneous preterm labor as compared with other etiologic groups (excess risk = 0.33; 95% C.I. = 0.11-0.98, P = 0.04). On the other hand, the steroid-related reduction of severe (grade III-IV) intraventricular hemorrhage was more marked in growth retarded as opposed to well-grown fetuses (excess risk = 0.15; 95% C.I. = 0.03-0.96, P = 0.04), and in planned as compared with spontaneous preterm deliveries (excess risk = 0.15; 95% C.I. = 0.03-0.96, P = 0.04). Results show that the greatest benefit from antenatal steroids appears to be in preterm deliveries with intact membranes and in planned preterm deliveries.

Adrenal Cortex Hormones↗
PubMed1995

Epidemiologic association between maternal smoking during pregnancy and intracranial hemorrhage in preterm infants.

The objective of this study was to evaluate the effect of maternal smoking during pregnancy on the risk of intracranial hemorrhage in preterm infants (born at 24 to 33 weeks of gestation). We conducted a case-control study of 96 preterm infants with intracranial hemorrhage and 96 gestational age-matched control subjects with negative cranial ultrasonographic findings. In conditional multiple logistic regression models, heavy maternal smoking ( > 10 cigarettes per day) during the latter half of pregnancy was associated with an increased risk of mild (grade I or II) intracranial hemorrhage (odds ratio = 5.96, 95% confidence interval 1.72 to 20.76; p = 0.005). After adjustment for the confounding effect of birth weight and respiratory distress syndrome, the risk of any intracranial hemorrhage (grade I to IV) was three times higher (adjusted odds ratio = 3.63, 95% confidence interval 1.37 to 9.63; p = 0.009) in infants of heavy smokers ( > 10 cigarettes per day) than in control subjects. The results of this study indicate that cigarette smoking during the latter half of pregnancy increases the risk of intracranial hemorrhage in preterm infants. The deleterious effect of smoking was greater for mild hemorrhages (grade I or II) and was confined to infants of heavy smokers.

Case-Control Studies↗
PubMed1995

Effect of preterm premature rupture of membranes on neurodevelopmental outcome: follow up at two years of age.

OBJECTIVE: To evaluate the impact of preterm premature rupture of membranes on the neurodevelopmental outcome of infants, assessed at two years of age. DESIGN: A prospective observational study of surviving preterm infants born after premature rupture of membranes and of infants born after spontaneous preterm labour with intact membranes. The study was carried out in the period 1986 to 1991. SETTING: Pavia, Italy. SUBJECTS: One hundred and forty singleton infants born prematurely after premature rupture of membranes between 24 and 34 weeks of gestation and 120 controls of similar gestational age born after spontaneous preterm labour with intact membranes. MAIN OUTCOME MEASURES: Infant neurodevelopmental outcome at two-year follow up. RESULTS: After adjustment, by logistic analysis for the effect of gestational age and birthweight, infants born after premature rupture of membranes were more likely to have severe neurodevelopmental impairment (spastic tetraplegia and/or Bayley mental developmental index < 71) than controls (adjusted OR 5.75, 95% CI 1.22-27.18). Multivariate analysis of linear trend showed a statistically significant relation of duration of membrane rupture to occurrence of severe intraventricular haemorrhage, cystic periventricular leucomalacia and moderate to severe infant neurodevelopmental impairment. CONCLUSION: Infants born after prolonged premature rupture of membranes are at higher risk of subsequent moderate to severe neurodevelopmental impairment than those born after spontaneous labour with intact membranes.

Birth Weight↗
PubMed1995

Early neonatal complications after elective preterm delivery in hypertensive pregnancies.

We evaluated the rates of short-term neonatal complications, neonatal brain damage or mortality in a group of 96 singleton pregnancies complicated by hypertension and electively delivered before 36 weeks gestation. The neonatal outcome of these pregnancies was compared with that of a matched control group of 192 uneventful pregnancies delivered because of spontaneous preterm labor or premature rupture of membranes. Although the rates of acidosis, apneoic crises, bradycardia and ventilatory support were higher among cases than controls, the risk of intraventricular hemorrhage, severe brain damage (grade III-IV intraventricular hemorrhage or periventricular leucomalacia) or neonatal mortality were comparable between the two groups. Neonatal complications were more frequent among infants born to mothers with severe hypertension or severe proteinuria. In conclusion, this study has shown that short term neonatal complications after elective preterm delivery in hypertensive pregnancies are increased in comparison with low risk controls. However, these complications, which were well managed in our intensive care nursery, did not affected neonatal mortality or severe brain damage.

Acidosis↗
PubMed1994

Early morbidity and neurodevelopmental outcome in low-birthweight infants born after third trimester bleeding.

Neonatal mortality, morbidity, and neurodevelopmental sequelae were compared between a consecutive series of 77 liveborn, low-birthweight (less than 2500 g) infants delivered after third trimester bleeding and 154 appropriate control infants of similar gestational age. Infants born after abruptio placentae had lower Apgar scores at 1 minute and higher rates of acidosis in comparison with control infants. In multivariate analysis, the infants in this group had higher risks of severe intraventricular hemorrhage and poor outcome (neonatal death or cerebral palsy) in comparison with control infants. In placenta previa, the infants had a higher prevalence of respiratory distress syndrome, whereas unclassified antepartum bleeding was associated with a high rate of neonatal hypoglycemia. After adjustment, by logistic regression analysis, for the effect of confounding factors (gestational age, birthweight, social class, and education of the mother), the risk of minor infant neurodevelopmental abnormalities at 2-year follow-up was increased in infants delivered after total or partial placenta previa or after unclassified antepartum bleeding. Third trimester bleeding should be considered a strong risk factor for both short-term neonatal morbidity and subsequent infant neurodevelopmental impairment in the low-birthweight infant population.

Abruptio Placentae↗
PubMed1993

Severity of abruptio placentae and neurodevelopmental outcome in low birth weight infants.

The short term neonatal morbidity and 2-year neurodevelopmental outcome were evaluated in 40 low birthweight (< 2500 g) liveborn infants delivered after abruptio placentae and in 80 control infants of similar gestational age. Apgar scores at 1' and 5' were lower in infants born to mothers with severe abruption. The prevalence of intraventricular hemorrhage (Grades I-IV) was 17.5% (7/40) in the cases and 5% (4/80) in the controls (P = 0.035). Cystic periventricular leukomalacia was diagnosed in two cases (5%) and in none of the controls (P = 0.1). At 2-year follow-up, among surviving infants, cerebral palsy (spastic diplegia, hemiplegia or tetraplegia with or without mental retardation) was diagnosed in 11.1% (4/36) of the cases and in none of the 76 controls (P = 0.011). After adjustment by logistic regression analysis for the effect of confounders (gestational age, birthweight, social class and duration of mother's education) the odds ratio of a poor outcome defined as neonatal death or cerebral palsy was 4.4 (95% confidence interval, 1.2-17.0) in index cases as a whole and 8.0 (95% confidence interval, 1.5 to 43.0) in the subgroup of infants born after severe abruption. Mild abruption did not affect the 2-year infant outcome in both univariate and multivariate analysis.

Abruptio Placentae↗