Analysis of outcome of pregnancy in type 1 diabetics treated with insulin pump or conventional insulin therapy.

We evaluated the outcome of pregnancies followed between 1990 and 2000 in 93 women with type 1 diabetes, treated with conventional intensive insulin therapy (n=68) or continuous subcutaneous insulin infusion (n=25). We evaluated metabolic control (fasting and 1-hour post-prandial plasma glucose and HbA1c levels), spontaneous or induced abortions, time and mode of delivery, maternal outcome (pregnancy-induced hypertension, preeclampsia, placental insufficiency, hydramnios, hypoglycemic coma, ketoacidosis) and fetal outcome (weight, hypoglycemia, hypocalcemia, hyperbilirubinemia, fetal distress, asphyxia, hyaline membrane disease, polycythemia, shoulder dystocia, malformations). Patients treated with insulin pump more frequently had background retinopathy and clinical neuropathy. No significant differences were observed between the two groups in metabolic control and maternal outcome. Glycemic control, non-optimal in the prepregnancy state, improved significantly during pregnancy, as shown by the progressive reduction in HbA1c levels. As regards fetal outcome, no differences were observed between the two groups in morbidity and especially in malformation rate. Patients with malformed babies did not have optimal metabolic control at conception. Thus, maternal and perinatal outcomes were comparable in patients treated with insulin pump and continuous subcutaneous insulin therapy, and depended on metabolic control. In patients in higher White's class and with more unstable glycemia, we achieved metabolic control and outcomes comparable with those of women of lower White's class and more stable glycemic values using the insulin pump. Our data suggest that insulin pump therapy is useful in problematic, complicated cases of women who want a baby.

Antepartum and early postpartum predictors of type 2 diabetes development in women with gestational diabetes mellitus.

OBJECTIVES: This study aimed at identifying ante-partum and early post-partum (one year) clinical and metabolic characteristics capable of predicting the future development of type 2 diabetes in pregnant women of Mediterranea area affected by gestational diabetes mellitus (GDM). MATERIAL AND METHODS: Seventy GDM patients were evaluated: mean age during pregnancy, plasma glucose levels under OGTT (100 gr. glucose), fasting, 1-h post-prandial plasma glucose levels, HbA(1c) at the third trimester, gestational week of GDM diagnosis, insulin therapy, and weight gain were all taken into consideration. Some maternal risk factors such as pre-pregnancy BMI, and maternal and fetal outcome of index pregnancy were also assessed. One year after delivery in the same patients, BMI, fasting and 1-h post-prandial plasma glucose, plasma glucose and insulinemia under OGTT (75 gr. glucose) were measured. We focused our attention on women who presented type 2 diabetes 5 years after pregnancy or IGT and those who, one year after pregnancy, were normal. RESULTS: Five years after pregnancy 49 women were normal, 5 had developed type 1 diabetes and were not considered, 6 had developed IGT, and 10 type 2 diabetes. Analysis of variables during pregnancy showed that those variables predicting type 2 diabetes were pre-pregnancy BMI, gestational week of diagnosis, need for insulin therapy, obesity, and plasma glucose at 60' OGTT. Analysis of variables evaluated one year after pregnancy showed that BMI, fasting and post-prandial plasma glucose, plasma glucose at each point of the OGTT, and plasma insulin at 30' OGTT were predictive of the development of type 2 diabetes. Furthermore, age, post-partum fasting plasma glucose, and plasma glucose under OGTT post-partum were predictive of the development of IGT. Our data show for the first time that, also in a Caucasian Mediterranean population, markers of the future development of diabetes do exist, as reported in literature. They also stress the importance of correct identification of GDM patients, in order to screen those at greater risk of developing diabetes, for whom it is imperative to set up prevention programs.

Preferential orienting to faces in newborns: a temporal-nasal asymmetry.

It has been proposed that newborns' preferential orienting to faces is primarily controlled by a subcortical mechanism. As an index of subcortical, extrageniculate mediation, the asymmetry between the temporal and nasal hemifields was exploited. In Experiment 1, under monocular viewing conditions, newborns were presented with a pattern that had 3 blobs in the appropriate locations for the eyes and the mouth or a pattern that had an inverted position of the blobs. Results showed that newborns preferentially oriented to the facelike pattern only when it was presented in the temporal hemifield. In Experiment 2, both patterns had the blobs in the inverted position. For one pattern the blobs were black, and for the other they were striped. Newborns preferentially oriented to the striped blobs in either hemifield. The results support the hypothesis that in newborns, preference for facelike patterns reflects the activity of a subcortical mechanism.

Outcome of fifty-five newborns of antiphospholipid antibody-positive mothers treated with calcium heparin during pregnancy.

OBJECTIVE: The outcome of 55 infants born to 53 antiphospholipid antibody (aPL)-positive mothers treated during pregnancy with calcium heparin is described. METHODS: The clinical state of the children was evaluated immediately after delivery by a clinical examination, and a neonatological check-up was performed no later than 24 hours after birth. Neonates with problems were transferred to the neonatal intensive care unit. After their discharge from hospital the clinical state of the babies was followed by means of interviews with the pediatricians and mothers for a period varying between 1.33 and 5.66 years (mean 2.51 +/- 0.92 SD). RESULTS: The newborns comprised 30 females and 25 males, including 2 sets of twins, delivered between the 25th and 40th weeks of gestation (mean 36.69 +/- 2.91 SD). They had a mean birth weight of 2.828 g +/- 706.50 SD (range 800-4.000) and a mean Apgar score at 5 minutes of 9.60 +/- 0.68 SD (range 7-10). Soon after delivery, 12 children (21.81%) were admitted to the neonatal intensive care unit for periods varying between 2 and 120 days (mean 30.33 +/- 33.40 SD), after which the clinical course was normal. All of these neonates suffered from complications exclusively due to prematurity. Malformations and signs of thrombosis or other aPL-related disorders were not observed in any of the newborns. During the follow-up, none of the diseases suffered by the 55 children differed from those of the normal pediatric population; in particular, aPL-related manifestations were never observed. CONCLUSION: These data indicate the absence of aPL-related problems in the offspring of aPL-positive mothers treated during pregnancy with calcium heparin.

The Neurobehavioral Assessment Scale as an instrument for early long-term prognosis and intervention in major disability in high-risk infants.

Evaluated the hypothesis that more effective prognosis is achieved by assessing the modifiability of infants' reactions than by evaluating the presence or absence of normal/abnormal reactions. To evaluate this hypothesis the Neurobehavioral Assessment Scale (NAS) was developed. The NAS assesses the extent to which infants can change their responses in functional contexts. The NAS was administered to 102 high-risk infants repeatedly over the first 16 months of life. Analysis confirmed that the modifiability of performance was predictive of outcome significantly earlier in development than scoring the same items in terms of their normalcy or abnormalcy.

[Communication in the neonatal intensive therapy unit: the opinions of parents and of medical personnel compared]. / La comunicazione in terapia intensiva neonatale: opinioni dei genitori e del personale sanitario a confronto.

Within the framework of an European international project, the issue of parents-staff communication in Neonatal Intensive Care Units was explored. 5 Italian unit participated in the project. 80 mothers and 62 fathers of singleton, not malformed, very low birthweight babies were interviewed during the fourth week of their baby's life, while the views of the health personnel (60 doctors and 106 nurses) were collected through an anonymous, self-administered questionnaire. Most of the staff feels that parents should be informed completely about their baby's conditions and prognosis, while the actual practices about transmission of information are reported differently according to professional status: more nurses than doctors feel that the information is not as complete as it should be. Uncertainty of prognosis is the most commonly quoted reason for restricting the information. Parents, on the other hand, are generally satisfied about the information received, although some of them complain about the style of communication, and especially the need to ask repeatedly in order to be informed. These results show some of the gaps existing in communication both within the staff and with parents, and suggest possible ways of improvement.

[The preterm infant in the nursery?]. / Il pretermine al nido?

We evaluated 250 newborns, GA less than or equal to 37 weeks, admitted to the Nursery of the Pediatric Department of Padua, between 1.1.1990 and 31.7.1991. We considered particularly three groups of newborns with 35, 36 and 37 weeks gestation respectively. Other 80 fullterm newborns were included in the study as control group. The postnatal adaptation (table 1) is regular in 96.2% of the fullterm newborns, and in 62.9% of the 35 wks. Jaundice is the main cause of irregular postnatal adaptation in the preterm newborns (22.8% in the 35 wks group, and 16% of the control group). When we considered the feeding modalities (table 2), we found that only the 21.7% of the 36 wks group and the 11.4% of the 35 wks group were breast fed, against the 86.3% of the control group. The discharge from the Nursery was earlier (less than or equal to 4th day of life) in the term groups and later in the preterm, who often stay in the Nursery for a longer period because of their feeding, growth and postnatal adaptation problems. These results could be certainly improved introducing the rooming-in method, which at the moment is not fully applied in our Nursery.

[Modalities of adaptation to extrauterine environment of newborn infants during sleep]. / Modalità di adattamento all'ambiente extrauterino nel neonato in stato di sonno.

Three groups of healthy full term neonates, differing in delivery modalities (elective caesarean section, labor of greater than or less than 7 hours) were investigated during sleep to evaluate postnatal adaptation. Adaptation modalities were assessed by NBAS, using the cluster of the decrements. It was found that neonatal responses change during sleep in relation to delivery modalities and to type of stimuli applied.

Locomotor strategies preceding independent walking: prospective study of neurological and language development in 424 cases.

Locomotor strategies used before the acquisition of independent walking were studied in 424 infants. 270 were survivors of neonatal intensive care (the index group); the other 154 (controls) had had no perintal complications. Five forms of locomotion were distinguished: crawling on hands and knees, creeping on the stomach, bottom-shuffling, other, and none before independent walking. Crawling was the most common form of locomotion in both groups. A higher percentage in the index group were late crawlers (greater than 10 months), but similar proportions in both groups were bottom-shufflers or simply stood up and walked. One of the most important factors influencing locomotor strategies was asymmetry. Analysis of the influence of locomotor strategies on psychomotor and linguistic outcome up to five years showed no significant relationships within the index group. However, within the control group, infants who crawled had a statistically greater incidence of later motor delay, which is in contrast to the findings of other studies.

Periventricular intraparenchymal cystic lesions: critical determinant of neurodevelopmental outcome in preterm infants.

During a four-year period, 154 surviving preterm infants of 32 weeks gestation or less were prospectively examined by cerebral ultrasound for periventricular-intraparenchymal cystic lesions (IPCL) subsequent to ischemic and/or haemorrhagic damage. Neurological and developmental outcome was assessed with examinations at 0, 3, 6, 12, 18, 24, 36, 48 months of age corrected for prematurity. Twenty-four (15.5%) patients were found to have IPCL changes at ultrasound. In 8 cases, a porencephalic cyst subsequent to grade IV IVH (Papile's classification) was found; all had cerebral palsy and severe developmental deficit was present in 4. Diffuse bilateral PVL was found in 8 cases: 1 was not evaluable, 7 developed cerebral palsy; the developmental delay was severe in 4, moderate in 2 patients, and only 1 was normal. Four patients had localized bilateral PVL: 3 patients had mild diplegia and 1 was normal; the developmental outcome was normal only in 1 case, 1 had a severe cognitive delay, and 2 were moderate. In the remaining 4 cases, the ultrasound showed a monolateral localized PVL: 1 patient had mild diplegia and moderate cognitive delay, 3 were normal. - This study confirms the important role of the ultrasonographic diagnosis of IPCL in preterm infants to foresee later neurodevelopmental outcome. Extensive parenchymal lesions were strongly associated with major neurodevelopmental handicaps, while localized and small lesions were correlated with more favorable neurological as well as developmental prognosis.

Long-term neurological and psychological outcome of babies with low birthweight (less than or equal to 1500 g) admitted to the neonatal intensive care unit of Padua University.

Mortality and long-term outcome in low birthweight infants (less than or equal to 1500 g) treated in the neonatal intensive care unit of the Department of Pediatrics of the University of Padua in 1975, 1978/79, and 1983 were analysed. Mortality rates fell from 75% in 1975 to 58% in 1978/79 and to 33% in 1983. Incidence of sequelae decreased from 1975 to 1978/79 and did not change between 1978/79 and 1983. No perinatal pathology (RDS, hyperbilirubinemia, endocranial hemorrhage) was statistically related with long-term outcome, but some associations (RDS + endocranial hemorrhage + seizures) appeared more frequently in cases which presented major neurological sequelae.

Bronchopulmonary dysplasia: a longitudinal study of 20 cases.

Of 20 patients with bronchopulmonary dysplasia (BPD), 17 survived (85%) and were followed prospectively up to one year post-term. Lower respiratory tract infections occurred in 12 patients (70.5%), and in 7 (41%) at least one hospital admission was required. At one year post-term follow-up, 9 patient (52.9%) continued to present respiratory symptoms, and 5 out of 13 (38.4%) radiographic changes. Six cases (35%) presented chronic cor pulmonale. Only 6 children (35%) showed normal growth, while the others showed deficits in one or more growth parameters. Cerebral palsy occurred in 41% of the children; 3 cases of severe tetraparesis and 4 of moderately severe palsy (hemiparesis or diplegia). Developmental quotient (DQ) was less than 70 in 6 cases (35%), from 70-90 in 4 (23.5%), and greater than 90 in 7 (41%). The severe neurodevelopmental outcomes were significantly correlated with the presence of important neonatal cerebral pathology (3-4 degrees IVH or periventricular leukomalacia). Retinopathy due to prematurity was diagnosed in 7 patients (41%), and in 5 it progressed to retrolental fibroplasia. Ten cases (58.8%) showed strabism, of which 8 had previous eye background involvement. Hearing deficit was not detected in any patient. Esthetic and functional sequelae consisted of scalp eschar (3 cases), post-thoracotomy scar (1 case), pleural drainage scars (3 cases), nasal deformity due to prolonged intubation (1 case), laryngeal stenosis (1 case), and post-tracheostomy stenosis (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

Parental structure and ways of interaction in relation to the development of impaired newborns in the first year of life.

In a follow-up study of 144 newborns at high neuropsychic risk the parents were interviewed during the hospital stay and the infants were followed up one week after discharge and at 3, 6, 9 and 12 months of corrected age. The protocol included pediatric examination, neuromotor assessment, caring observation and assessment on the Brunet-Lézine developmental scale at 16 and 12 months of corrected age. An attempt was made to correlate the parents' personality structure, present experience and capacity for attunement with the infant to his development and wellbeing. After the exclusion of 11 infants with severe neuropsychic sequelae, the sample was made up of 133 infants. It was found that: despite prolonged hospitalization, in some cases for over 3 months, most of the parents by the end of the hospital stay and nearly all within a month of discharge, even if their own structures were pathological or they were suffering from reactive depression, managed (sometimes with the help of the staff) to achieve attunement with their child. This enabled him to fulfil his competences, catching up quickly in performances as soon as the parents were able to understand his messages; after 6 months of corrected age blocks and regressions emerged, related to the pathological structures of the parents or to problems bearing on their own conflicts with adverse effects on the child when he started his separation-individuation process.