Effects of hospital policies and practices on initiation and duration of breastfeeding.

BACKGROUND: The aim of this study was to verify if hospital policies and practices, independently of main maternal sociodemographic determinants, influence initiation and duration of breastfeeding. METHODS: The study was carried out at the Immunization Centre of Messina where all infants born in the four maternity wards of Messina are vaccinated, using a structured questionnaire, constructed in conformity with the methodology suggested by the WHO. RESULTS: Data analysis, performed by non-parametric and multivariate analysis of variance and by Kaplan-Meier curves, showed that the highest probability rate (P < 0.001) of initiation and duration of breastfeeding, independently of maternal age, parity, education levels, smoke and work was found in infants born in a University Hospital, characterized by earlier times of first suckling, longer hospital stay and higher rate of exclusive breastfeeding at discharge. CONCLUSION: Our data emphasize the role and responsibility of hospital policies and practices in the promotion, and in the duration of breastfeeding.

[Comparison between pre- and postnatal echographic screening of malformative uropathies]. / Confronto tra lo screening ecografico pre- e postnatale delle uropatie malformative.

AIM: The aim of this study has been to compare the validity of postnatal echographic screening in respect of prenatal echography in early diagnosis of malformative uropathies (MU). METHODS: In 6578 infants, who have been submitted to fetal echography, and to a postnatal screening of MU in our Neonatal Service of Echography (University of Messina), we have compared the diagnostic agreement of prenatal with postnatal echography. RESULTS: Our comparison demonstrates that, in respect of postnatal screening, only 35.71% of pyelectasies and 73.17% of hydronephrosis have been diagnosed by fetal echography, and, in particular, only 18.75% of no-dilated MU. CONCLUSIONS: These data confirm that, in our country, the postnatal screening of MU has still significance and suggest that, before excluding this screening, it is necessary to verify everywhere the validity of fetal echography.

Plasma leptin, insulin, and neuropeptide Y concentrations in infants.

Changes in plasma leptin, insulin, and neuropeptide Y (NPY) concentrations were determined by radioimmunological methods in healthy infants. Compared with umbilical concentrations, on the 4th day of life plasma leptin and insulin were significantly decreased, and NPY was significantly increased. No correlation was observed between leptin, insulin, and NPY.

Incidence of dehydration and hypernatremia in exclusively breast-fed infants.

OBJECTIVES: To verify in exclusively breast-fed, term infants the incidence of hypernatremic dehydration and identify possible maternal and/or infant factors that interfere with successful breast-feeding. STUDY DESIGN: We prospectively included all healthy breast-fed neonates referred to our Neonatology Unit between October 1999 and March 2000. All neonates with a weight loss > or = 10% of birth weight had a breast-feeding test and a determination of serum sodium, urea, and base excess. Student t test and chi-square test were used for statistical analysis of the data. RESULTS: Of 686 neonates, 53 (7.7%) had a weight loss > or = 10% of the birth weight, and 19 also had hypernatremia. These 53 neonates had a significantly higher incidence of caesarean delivery and lower maternal education than neonates with a weight loss < 10%. CONCLUSION: Our prospective study demonstrates that a weight loss > or = 10% during the first days of life is frequent. Daily weight evaluation, careful breast-feeding assessment, and early routine postpartum follow-up are effective methods to prevent hypernatremic dehydration and promote breast-feeding.

Incidence of meconium aspiration syndrome in term meconium-stained babies managed at birth with selective tracheal intubation.

The delivery room management of infants born through meconium stained amniotic fluid (MSAF) remains controversial. The aim of this prospective study was to evaluate maternal and neonatal characteristics of MSAF infants and the incidence of meconium aspiration syndrome (MAS) in routine delivery room management which reserved selective intubation for depressed/asphyxiated babies. Between October 1993 and September 1997, a consecutive sample of 3745 full-term infants was analyzed. Of these, 361 were MSAF infants. No significant difference in maternal age, parity, gestational age, sex, low 1 and 5 minute Apgar scores, metabolic acidemia, or need for endotracheal intubation was found between MSAF and non-MSAF infants. Only one of the MSAF infants (0.28%), who needed intubation, developed MAS. Identification of postterm pregnancy and prenatal asphyxia is the best prevention of MAS.

[Diabetes and pregnancy. Maternal risk factors and neonatal morbidity]. / Diabete e gravidanza. Fattori di rischio materni e morbilità neonatale.

BACKGROUND: To verify in our population the incidence of infants of mother with insulin dependent diabetes mellitus (IDDM) or gestational diabetes (GD) and to evaluate the maternal characteristics influencing neonatal outcome. METHODS: The study was retrospectively performed on 6179 infants born between 1995 and 1998 at the Obstetric Clinic of the University of Messina and referred the Division of Neonatology. The following groups have been selected: group A (offsprings of IDDM mothers), group B (offsprings of DG mothers), group C and group D, controls, (2 infants of the same sex and gestational age born before and after the infants of group A and group B, respectively). The parameters analyzed were: diabetic familiarity, age, weight and body mass index (BMI) of the mothers, delivery, gestational age, weight at birth, neonatal outcome. RESULTS: The infants of IDDM mothers were 3% and the infants of GD mothers were 0.8%. Group A and group B present a significantly higher incidence of: diabetic familiarity, cesarean section, macrosomia, hypoglycemia, hypocalcemia, hyperbilirubinemia. The GD mothers had weight and BMI higher than IDDM mothers. The infant weight did not correlate with maternal weight and BMI. CONCLUSIONS: These data suggest that in our population GD is underestimated, metabolic control in pregnancy is insufficient, obstetric practices are too invasive, neonatal outcome is verosimely correlated only to metabolic control.

[Health status of neonates born to immigrants at the University Polyclinic of Messina in 1993-1998. A case-control study]. / Stato di salute dei neonati figli di immigrati nati presso il Policlinico Universitario di Messina negli anni 1993-1998. Studio-caso-controllo.

The aim of the present case-control study was to verify the incidence and the state of health of the neonates born of extracommunity parents (E.C.) in the our hospital throughout the years 1993-1998. For every neonate born of E.C. we have analyzed two italian neonates born immediately before and after. The parameters analyzed were: nationality, age, and job of the parents, abortions, number of ecography carried out during pregnancy, parity, delivery, gestational age (G.A.), weight at birth, Apgar score, malformations, perinatal mortality and neonatal morbidity. Statistical analyses were performed with the T Student test and the chi-square test. Throughout the 1993-1998 years are born 9285 neonates. Of these 199 (2.4%) were E.C. The 45% of the E.C. derived from the Far East and only the 10% were nomad. The 86% of the E.C. had a job. In the E.C. group the multiparity was significantly higher than in italian group. G.A., birth weight, number of malformation, neonatal morbidity, and perinatal mortality were the same in the E.C. and in the italian neonates. Our data, in disagreement with other Authors, demonstrate that in our hospital the state of health of the E.C. and italian neonates is not different. Because in the our analysis it results that the greater number of E.C. parents had a job, it is likely that the non-observed increased of perinatal mortality and morbidity in the neonates born of E.C. depends on the social integration of E.C.

[Brachial plexus paralysis: its incidence, predisposing factors and outcome]. / Paralisi del plesso brachiale: incidenza, fattori predisponenti ed esiti.

METHODS: We have studies, retrospectively, the risk factors, incidence and outcome of obstetric palsy in all infants delivered between January 1990 and December 1994 at the Obstetric and Gynecological Department and afferent to the Neonatological Division of the University of Messina. Twenty-eight of the 5556 live born full term infants (5/1000) were at birth diagnosed as having a brachial plexus paresis. Of these eight (1.6/1000) had persistent palsy. RESULTS: In about 40-50% of the infants with brachial plexus palsy the obstetric history was characterized by high birthweight, shoulder dystocia, and parity 1. The infants who recovered totally did so during the first 12 months of life. All infants had upper brachial plexus, or Erb's palsy, which is more favorable than entire brachial plexus palsy. At follow-up (15 months-5 years), all infants with persistent palsy were afflicted by varying degrees of arm function compromise. CONCLUSIONS: We stress that, in several cases, obstetric brachial plexus palsy results in life-long handicap, and that prevention, early diagnosis and therapy need to be the goals of the obstetrical and pediatric management.

[Infants born to hypertensive mothers: a clinical-epidemiological study]. / I figli di madre ipertesa: studio clinico-epidemiologico.

The aim of this prospective study was to evaluate the frequency of the hypertensive disorders of pregnancy and their effects on the newborn infants. The study was performed between January 1992 and December 1994 on the 4793 infants born at the Obstetric Divisions of the University of Messina. These 123 infants were born of hypertensive women and 4670 were control infants. Between the two groups of infants there were significant differences with regard to the incidence of nulliparity, prematurity, low Apgar scores at birth and low birth weight. The blood pressure and the haematic parameters were not different between the two groups of infants. Five of the infants born to hypertensive women were referred to the Division of Neonatal Pathology. The low frequency of infants born to hypertensive women observed by us suggests that in our population the hypertensive disorders of pregnancy are understimated. Moreover, the high incidence of preterm and LBW infants confirms that in infants born to hypertensive women the neonatal risks are consequent to fetal growth retardation.

The validity of the Apgar scores in the assessment of asphyxia at birth.

A prospective study was performed in 613 consecutively live born infants to investigate the validity of 1- and 5-min Apgar scores as an index for asphyxial assessment at birth. The independent and combined relationship between Apgar scores, metabolic acidemia, pulse oximeter (SaPO2) measurements and neonatal outcome were determined. In the term infants 1-min Apgar score was more influenced by the mode of delivery and by gestational age than by asphyxia. Instead, 5-min Apgar score had a high concordance with metabolic acidemia. Infants with low Apgar scores, metabolic acidemia and arterial desaturation have the highest incidence of neonatal intensive care unit admission and poor neonatal outcome. The study suggests that the 5-min Apgar score is useful for immediate clinical assessment and care of the neonate.

[Fetal macrosomia. Maternal and fetal implications]. / Macrosomia fetale. Implicazioni materne e neonatali.

Ninety-six cases of fetal macrosomia have been tested to focus on the factors necessary to select women running the risk of delivering macrosomic fetuses. The results of these studies are the following ones: a) pregnant women with pathology are multiparas; b) they are usually characterized by peculiar weight increase in pregnancy; c) they have gone beyond pregnancy term; d) they have previously delivered macrosomic fetuses. The Authors focus on the necessity to anticipate diagnosis and to plan caesarean section in order to avoid the traumatic lesions this kind of babies are frequently affected by.

[Neonatal familial benign convulsions]. / Les convulsions néonatales familiales bénignes.

BACKGROUND: Some neonatal benign convulsions are genetic in origin, with a dominant mode of inheritance. CASE REPORT: A girl was placed on continuous EEG recording from her 2d day of life because of her family history. The first clonic seizures occurred on the 4th day; they appeared again on the 6th day and became prolonged with an abnormal EEG pattern. The seizures were well controlled with phenobarbital, that was gradually discontinued when the child was 3 months old. Seizures occurred again when she was 4 months old and were again controlled with phenobarbital. Her father had had neonatal convulsions which were not well analysed. Her brother also had clonic seizures at the 4th day of life; they disappeared after 1 month. Her sister suffered from clonic seizures when she was 3 days old, and these became prolonged. She was given phenobarbital until she was 1 year old. She developed benign rolandic epilepsy at the age of 10 years. CONCLUSION: This family suffers from neonatal familial benign convulsions and rolandic epilepsy. The frequency of neonatal familial benign epilepsy is probably under-estimated.

Effects of the mode of delivery on ANP and renin-aldosterone system in the fetus and the neonate.

Plasma ANP and aldosterone levels, plasma renin activity (PRA), haematocrit, systolic and diastolic blood pressure (BP), were evaluated in 15 full-term infants delivered by elective Caesarean section (CS group) and in 15 full-term infants delivered vaginally (vaginal group). The mode of delivery did not influence the cord blood levels of ANP and their increase at the 24th hour of life. Instead, PRA was lower and plasma aldosterone levels were higher in the CS group than in the vaginal group. Also haematocrit and BP were influenced by mode of delivery. The haematocrit values were lower in the CS group than in the vaginal group at birth as well at the 24th hour of life. The values of systolic and diastolic BP were the same in both groups, at birth, but at the 24th hour of life increases were observed only in the vaginal group. On the fourth day of life weight loss was the same in both groups. Our findings suggest that the mode of delivery has more influence on neonatal BP adaptation than on neonatal volume homeostasis.

The effect of feeding on plasma immunoreactive ACTH and beta-endorphin levels in newborn infant.

In order to clarify whether an interaction between endogenous opioids and feeding occurs at birth, we studied Beta-endorphin (beta-EP) and ACTH plasma levels in response to a feed of 10% glucose, or formula, in 120 healthy full-term infants. Neither postprandial beta-EP nor ACTH increases were found at the 24th hour or on the fourth day of life. beta-EP physiology in newborn infants seems to be different from adults.

[Immunoprophylaxis in the prevention of perinatal transmission of hepatitis virus B. Analysis of limiting factors]. / L'immunoprofilassi nella prevenzione della trasmissione perinatale del virus dell'epatite B. Analisi dei fattori limitanti.

The significance of obstetric anamnesis in neonatal risk identification and efficiency of a vaccinal schedule were investigated in order to verify the condition which limited the efficiency of immunoprophylaxis in the prevention of perinatal hepatitis B virus transmission. The data suggested that the lack of obstetric screening is the highest limitative factors in the realization of hepatitis B neonatal prevention. The immunoprophylaxis is surely a substantial method in the prevention of hepatitis B virus perinatal transmission, but the vaccinal schedule and follow-up should be improved.

[Analysis of factors associated with very low birth weight (less than or equal to 1500 g)]. / Analisi dei fattori associati con la nascita di neonati di peso molto basso (meno o uguale a 1500 g).

In 7675 deliveries performed at the University of Messina between November 1, 1983 and October 31, 1988 we determined the incidence and obstetric factors specifically associated with the birth of very low weight infants (less than or equal to 1500 gm) (VLBW). Our purpose was to characterize these factors in order to determine what may be done to limit delivery rate of VLBW. Information obtained concerning the mothers' included socioeconomic status, age, parity, previous obstetric history, any maternal conditions affecting the pregnancy, route of delivery (vaginal or operative). The incidence of infants under 1500 gm was 1.1 per cent of live births. The etiologic analysis showed that preterm labor is more frequent cause of VLBW. In women under 17 years of age the incidence of VLBW was 5.2 per cent as opposed to 1.1 per cent in the total population. Absence of prenatal care was shown in 40.8 per cent of VLBW. The previous obstetric history reported 1 or more abortions in the 53 per cent and 1 or more perinatal deaths in 17 per cent of VLBW. The clinical implications of these results are discussed.