[Psychosocial intervention model of neonatal intensive care in Modena]. / Il modello di intervento psicosociale della Terapia Intensiva Neonatale di Modena.

Many authors agree that psychosocial factors influence the psychophysical development of the infant. These factors must be taken into account in the neonatal care. At the neonatal intensive care unit (NICU) of the University Hospital of Modena, physicians, psychologist and nurses cooperate to take care of each newborn with a difficult psychosocial background. Together they individuate and select newborns with psychosocial difficulties, plan an integrated action and, eventually, address the family to the community services. We describe our experience with 106 cases from 1996 to 1999. The integrated action included observation of parental behavior within the NICU and psychological support for parents by means of psychological counselling. Many meetings among physicians, nurses, psychologist and the social worker were needed to achieve good results. The aim of the project was to define a method to provide individualized actions in order to favour psychophysical health of newborns and their families.

[Model of integrated hospital project for the management of patients at risk of sudden death syndrome]. / Modello di progetto integrato Ospedale-Territorio per la gestione dei pazienti a rischio di SIDS.

Home cardiorespiratory monitoring (HM) is an accepted practice in infants at high risk for Sudden Infant Death Syndrome (SIDS) as those with the following conditions: 1) Siblings of SIDS; 2) Apparent Life Threatening Events (ALTE); 3) Apneas of prematurity. From 1998 the Division of Neanotology of the Policlinico of Modena has followed prospectively infants at high risk for SIDS, in collaboration with the General Health Service. To support the clinical trial 10 apnea monitors were provided by the General Health Service and managed from the Department of Neonatology. During 18 months 24 infants have been followed by HM, and among then 20 were at risk of SIDS (11 female and 9 male): 7 were siblings of SIDS (35%); 10 had previous episodes of ALTE (50%); 3 were born prematurely and had persistent apneas before discharge (15%). The mean period of HM was 5.85 months. None of the infants died for SIDS or had episodes of ALTE that required resuscitation measures. In only one case parents stopped earlier than recommended, but personal interview to parents showed that all the others families gained benefits and reassurance from HM.

[Evaluation of the risk of neuropsychological damage from lead exposure in childhood]. / Valutazione del rischio di danno neuropsicologico per esposizione al piombo nell'infanzia.

Potential neurotoxicity of lead in children has been explored in many recent epidemiological studies carried out all over the world. Within a multicentric European study, an investigation was carried out also in Italy on children living in an industrial area and characterised by a non steady-state exposure condition with higher exposure at the early stages of life. This peculiar feature allowed to observe interesting associations between neurobehavioural functions and the levels of Pb measured in teeth, but not in blood. Indeed, Pb in teeth was associated with the results of psychometric tests which evaluate the discriminant ability and the attention. Other associations, like those found between the intelligence quotient (IQ) scores and Pb in teeth disappeared after correction for the socioeconomical status of parents. In general, in children exposed to environmental Pb, more consistent associations were found with visual-motor integration and attention than with IQ measurements. In agreement with literature data from other countries, we suggest that the relevance of neurotoxic effects of Pb is limited, at least at the current exposure levels, but also that a threshold Pb level associated with no effect cannot be identified.

[Head injuries in the pediatric emergency department: a 5-year experience at the Pediatric Clinic of Modena]. / Il trauma cranico in accettazione pediatrica: esperienza di cinque anni nella clinica pediatrica di Modena.

We re-evaluated the cases of 436 children with minor head injury admitted in the paediatric department of Modena University Hospital in the years 1991-1995 in order to revise diagnostic and therapeutic protocols. The external lesions, the presence of loss consciousness, vomiting, vegetative reactions, late complications, skull X ray, TC scan and EEG were considered. Signs and symptoms at admission have been faced with instrumental findings and eventual late complications to evaluate the prognostic significance. External lesions and vomiting did not correspond to TC scan and EEG positivity or significant sequelae. A more close connection to these parameters was found when an history of immediate loss of consciousness after trauma, or presence of vegetative reactions. Skull X ray appeared useless both to judge the seriousness of the lesion and to formulate a prognosis. EEG appeared a sensible tool to evaluate the gravity of the trauma and its late consequences. TC has confirmed to be the unique instrument able to solve any diagnostic or prognostic doubt. When symptoms suggest a bad prognosis, diagnostic procedures should be limited to TC and EEG. By our point of view, patients that at admission have a normal neurological examination at the Glasgow Coma Scale, no significant symptoms and signs, an history of a minor impact dynamic and no signs of child abuse, can be discharged from the emergency department; in this case parents should be instructed how to do an observation at home in order to evaluate eventual complications.

[Gastroesophageal reflux in children. A combined radiologic and scintigraphic study]. / Il reflusso gastroesofageo nel bambino. Studio combinato radiologico e scintigrafico.

Thirty-one children examined for gastroesophageal (GE) reflux were studied with both barium meal X-ray and gastroesophageal scintigraphy. The study was performed with a double-blind method. The children with negative findings at both tests were submitted to intraluminal esophageal pH probe test. Barium X-ray detected GE reflux in 17/27 patients, whereas radionuclide scintigraphy was positive in 24/27 (positivity: 63% versus 89%; p less than 0.05). Their combined use provided positive findings in 26/27 cases. Scintigraphy appeared to be a safe and reliable screening test to detect GE reflux. Moreover, scintigraphy was superior to barium X-ray study for it had higher diagnostic accuracy, it could be easily performed on young patients, and delivered smaller radiation doses.

[Hypochromic hyposideremic anemia as the first symptom of gastroesophageal reflux]. / Anemia ipocromica iposideremica come primo sintomo di reflusso gastroesofageo.

In a five months infant is described by authors iron deficiency anaemia as early symptom of gastroesophageal reflux undiagnosed previously. Laboratory evaluation excluded any haematological pathology; thereafter clinical suspicion was confirmed by radiological exams and oesophageal PH-monitoring.

[Clinical considerations on cases of pneumonia caused by mycoplasma]. / Considerazioni cliniche su una casistica di polmoniti da mycoplasma.

Personal experience of a series of mycoplasma-induced pneumoniae is reported. The importance of early diagnosis for the purpose of speedy target antibiotic therapy is reiterated. Stress is laid on the absence of complications in all patients studied.

Relationship between lead exposure indicators and neuropsychological performance in children.

This study surveyed 237 schoolchildren in a lead-polluted industrial area in northern Italy to assess the relationship between various biological indicators (lead in blood, hair and teeth, and delta-aminolevulinic dehydratase [ALA-D] activity) and some neuropsychological functions, assessed by a battery of five psychometric tests. The geometric means of lead measured in blood, hair and teeth were 10.99 micrograms/dl, 6.79 micrograms/g and 6.05 micrograms/g, respectively. Mean ALA-D activity was 51 mU/ml RBC. By analysis of covariance, after regressing out the variance accountable to confounding variables (age, sex, occupation/education of parents), Total and Verbal WISC-R IQ and Toulouse Pieron test results were significantly affected by the levels of lead in teeth. ALA-D values also appeared to be related to WISC-R IQ results (Total, Verbal and Performance).

[Echographic examination in the screening of hip dysplasia in newborn infants and infants]. / L'indagine ecografica nello screening della displasia dell'anca del neonato e del lattante.

Sonography was employed to evaluate the accuracy of congenital hip dysplasia in 1014 cases, using Graf's methodology and classification in neonatal and infant age. Sonography appears useful to detect and monitor this disease. In fact all the acetabular development can be better revealed than by radiography.

[Intracranial hemorrhages in the full-term newborn infant. Psychomotor development and neurologic sequelae]. / Emorragie intracraniche del neonato a termine. Sviluppo psicomotorio e sequele neurologiche.

Recently increased utilization of high definition T. C. scan and U. S. has led, in recent years, to diagnose and to localize the intracranial haemorrhage of the term newborns. It has been possible to study the outlook of this disease. The neuro-psychological development of the children, affected by intracranial haemorrhage at the birth, is more impaired when the haemorrhage is intraparenchimal: intracerebellar or intracerebral. Our cases show that a haemorrhage causes only discord on the neuro-psycholological development. When, on the other hand, haemorrhage is associated with anoxicbrain damage, especially bilateral, take place major sequelae.

[Follow-up of children born from gestosis mothers]. / Follow-up di bambini nati da madri gestosiche.

Seventy children, born from mothers affected from EPH gestosis during pregnancy, were examined. They were two-ten years old, forty females and thirty males, nineteen preterms and fifty-one born at term. Their weight, and head circumference were estimated. Thirty-two children were submitted to terman Merril test and further thirty-eight to Picq Vayer test. The findings were evaluated according to term or preterm birth and to importance of mother's gestosis (EPH1, EPH2, EPH3). The auxological outcomes were satisfactory, particularly after the five-six years of age. Two children were heavily retarded. The others had a normal I.Q., but there was evident failure in immediate memory and in vocabulary's subtest. Moreover fifty % of heavier gestosis children revealed a discordant psycomotor behaviour due to specific failures.