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.

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.

[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.