key: cord-0894520-fgp416iw authors: nan title: Abstracts of the XXVI Congresso Nazionale - Società Italiana di Neonatologia: Venezia, Italy. 7-10 October 2020 date: 2021-04-29 journal: Ital J Pediatr DOI: 10.1186/s13052-021-01039-y sha: 6b41e7a001593b094d7030096c90215525e0547f doc_id: 894520 cord_uid: fgp416iw nan We examined also feeding difficulties in the first year of life and the incidence of GER, following in the weaning phase and at 12 months of life. We compare infant born GA≤28 with those ≥29 to understand the role of extreme prematurity in the development of feeding disorders. The demographic characteristics and clinical data were collected from electronic medical records by investigators. Prism 8 (GraphPad Software, San Diego, CA, USA) was used for statistical processing. Results: We included 85 VLBW infants born in 2017-2018. The incidence of eating disorders in the first year of life was 29.4%. A statistically significant increase in feeding difficulties was found in VLBWIs with extreme prematurity (44.7% vs 17.0%, p <0.05), but there was no statistically significant difference in specific disorders (difficulty in weaning phase, difficulties at 12 months and GER). Conclusions: Feeding disorders affect about one third of preterm babies in the first year of life. Poor feeding skills in infancy can continue to be problematic later on, for months or even years and become a serious concern for caregiver. This work helps to raise awareness among NICU staff, to reduce as much as possible the exposure to invasive procedures and to rehab these subjects early. KEYWORDS: Feeding disorders; food aversion; sensory overstimulation; preterm; newborns. Patient permission Authors didn't obtain written informed consent from parents for publication, since only anonymous unrecognizable patient data was used to fulfill the database. Abstract (word count 388) Background: A reappraisal of the guidelines for management of infants with early onset sepsis (EOS) advocates for close observation of well-appearing newborn infants ≥35 weeks' gestation with maternal risk factors, rather than empiric antibiotic treatment [1] [2] [3] [4] [5] [6] [7] [8] . EOS calculator represents a useful and safe tool to guide an individualized management of EOS, without any significant increases in adverse outcomes [9] [10] [11] [12] [13] [14] [15] [16] . Data on its clinical application is still limited. Our primary outcome was the rate of empiric antibiotics for suspected EOS in the first 72 hours. Secondary outcomes included the frequency of close or intensive monitoring of vital parameters, the rate of blood withdraw, the number of antibiotic use days per 100 live births. Methods: We included newborn infants born at ≥35 weeks' gestation at Treviso hospital in 2018 and 2019, with maternal EOS risk factors or EOS clinical signs. We compared 3 periods, before and after the introduction of EOS calculator, including a learning period and a fully application period. We described the effect of this calculator on clinical practice. The demographic characteristics and clinical data were collected from electronic medical records by investigators. Prism 8 (GraphPad Software, San Diego, CA, USA) was used for statistical processing. Results: The study cohort included 4354 newborn infants with GA ≥35 weeks, respectively 826 in baseline period, 1426 in the learning period and 2102 in the EOS calculator period. Among them 1040 (23,8%) infants presented maternal risk factors for neonatal sepsis, including 216 (26,15%) in baseline period, 164 (11,5%) in learning period and 660 (31,3%) in EOS calculator period. Characteristics of the infants born in these 3 periods were similar for sex, gestational age, birth weight and delivery method. The incidence of cultureconfirmed EOS was very low across 3 periods. Empirical antibiotic administration in the first 72 hours decreased respectively from 13,4% to 6,4% (p< 0,05). Blood culture and laboratory evaluations had fallen from 30,6% to 12,9% (p< 0,05). Close monitoring of vital parameters decreased from 99,1% to 13,8% (p< 0,05). The number of antibiotic days per 100 live births decreased from 17,07 to 8,94 days (p<0,05). We had no readmissions for EOS. Conclusions: Application of EOS calculator is useful to standardize clinical practice as well as to reduce the use of antibiotics without compromising safety in a population with a relatively low incidence of culture-proven EOS and good access to follow-up care. Keywords: Antibiotics; early onset sepsis; infection; newborns; sepsis calculator Patient permission Authors didn't obtain written informed consent from parents for publication, since only anonymous unrecognizable patient data was used to fulfill the database. 15 Since its establishment, the Meyer's HMB has processed more than 80,000 litres of milk, donated by more than 12,000 women, and supplied to more than 16,500 children [1] . The HMBs, functionally linked to paediatric departments, collect, store and distributes donor breast milk on medical prescriptions. Women who choose to become a donor agree to undergo a simple but necessary screening, similar to that carried out at blood transfusion centres. The aim of this practice is to identify any clinical conditions or behaviour of the donor that may be harmful to the children who receive the donated milk [2] . The HMB follows the recommendations of international scientific associations [3, 4] and European Union directives on food hygiene (HACCP) in order to provide a product that meets the highest possible safety and integrity requirements for biologically active components. The quality of the product is guaranteed by well-established procedures regarding donor screening, milk collection and storage methods, physical and bacteriological controls, pasteurisation and documentation of medical-administrative acts. Donated, pasteurized milk is mainly provided to children admitted to the Meyer's (about 300 patients per year); 20-25% of the bank milk is required by other public and private healthcare facilities. The use of fresh human milk is temporarily contraindicated for newborns < 32 weeks (completed) of gestational age and/or immunodeficient neonates (T-cell deficiency) in case of women who contracted a CMV infection before pregnancy. Positivity for HIV, HBV, HCV, drug use and alcoholism are conditions that permanently contraindicate the use of donated breast milk. Women with an ongoing syphilis and tuberculosis are temporarily excluded as donors. The consequent adoption of the method described above ensured the total absence of infectious diseases caused by the use of donor breast milk. The reason for investing significant resources in a HMB is summarised by the main advantages of using human milk [5] : low incidence of necrotizing enterocolitis reduced incidence of sepsis and other infections reduced incidence of bronchopulmonary dysplasia high food tolerance prevention of hypertension and insulin resistance. The SARS-CoV-2 pandemic has heavily impacted the Italian public health system, highlighting the urgency of guidelines for the mothernewborn dyad management. Droplets and close contact are known to be a common route of viral transmission [1] , while little is known about other routes, including the transplacental one. Transplacental transmission of SARS-CoV-2 infection is possible during the last weeks of pregnancy, but this remains still controversial [2] [3] . Methods Unlike other institutions, the Italian Society of Neonatology (SIN) reviewed the current scientific knowledge and assured that the mother-newborn dyad to the extent possible [4] . Breastfeeding is not considered a transmission vehicle, neither for SARS-CoV-2 nor for other known respiratory viral infections (WHO, 2020). On the contrary, it has been found to be vehicle of specific SARS-CoV-2 antibodies within a few days following the onset of the disease in the mother, possibly modulating the clinical expression of infants' infection. Consequently, SIN's indications [5] , endorsed by the Union of European Neonatal & Perinatal Societies (UENPS) are: Allow rooming-in and breastfeeding in asymptomatic mothers (Table1) [6] [7] ; Separate symptomatic mothers from their baby until they are able to take care of her/him it; Expressed breast milk when possible, unpasteurised, to not reduce its biological and immunological value [8] ; Background. The awareness that hospitalized infants might be at high risk of developing pressure injuries has increased in the last years. This is due to immature skin, compromised perfusion, decreased mobility, altered neurological responsiveness, fluid retention and medical devices. [1, 2] Pressure injuries can be classified using the National Pressure Injuries Advisory Panel staging system based on the depth and severity of tissue injury. They can be also divided into conventional (caused by pressure on a bony prominence) or device-related (caused by pressure on the tissues from a medical device). [3] Materials and methods. A systematic review was performed. The aims of the study were: 1) to investigate incidence and risk factors of pressure injuries in neonatal population and 2) to analyze the most frequent neonatal pressure injuries. Secondary, preventive and therapeutic strategies were analyzed. Results. Studies show that the incidence of pressure injuries is very variable in infants admitted to the Neonatal Intensive Care Units. [4] Infants develop both conventional and device pressure injuries: conventional pressure injuries are often located at the occiput because of the large dimension of this area, while device-pressure injuries are frequently caused by non-invasive ventilation devices on infants' noses, particularly by Nasal Continuous Positive Airway Pressure (Ncpap). [2, 4, 5] Infants with Ncpap lesions are younger, have a lower weight and a lower gestational age than those with occipital pressure injuries [1, 2, 5] who are usually intubated, deeply sedated, in the post-surgery period and very edematous. [6, 7, 8] Proper identification of at-risk infants and the implementation of preventive strategies are crucial to reduce the incidence of pressure injuries. [9] Neonatal nurses should use validate neonatal skin risk assessment scales and develop protocols for the standardization of skin inspection and care, nutritional management and pressure management through specific dressings or special support surfaces. All nursing staff should know the basic rules for pressure injuries prevention, the possible support surfaces and the available options for treatment. [7, 9, 10] When a pressure injury unfortunately occurs, it is necessary to use the proper dressing. Few products are approved in newborns' care due to the risk of possible adverse reactions using adult treatments. [8] Conclusions. Pressure injuries are a nursing care quality indicator and represent a relatively frequent, potentially preventable and critical event. [9] Implementation of an effective pressure injury prevention and treatment strategies program based on available scientific evidence is needed to reduce the variability of care. The benefits of standardized care include early risk identification and increasing and improving adherence to evidence-based preventive interventions. [11] Conflicts of interest The authors have no conflicts of interest to disclose. The quality of nursing care derives from the development of the knowledge that this discipline 1, 2 Research plays e central role. The goal of nursing research is to strengthen and broaden current knowledge regarding nursing in order to contribute to performance improvement. Research is critical to meet the challenging goal of the delivering quality results in collaboration with clients, their families/ their loved ones 1,2,3,4 By analyzing the literature produced in a specific sector, it is possible to have a picture of the cultural evoluttion Pasteurization is not indicated § Room divider or tent, face mask for the mother when she is breastfeeding or in intimate contact with the newborn, careful hand washing, arrangement of the baby's cradle at a distance of 2 meters from the mother's head, suspension of visits from relatives and friends°I n addition, adequate protection measures by health personnel, according to ministerial indicationŝ The mother's fresh milk must be expressed with a manual or dedicated electric breast pump. The mother should always wash her hands before touching the bottles and all components of the breast pump, following the recommendations for proper washing of the breast pump after each use of a science and its theoretical elaboration. The priorities of nursing research, identified in the study by Wielenga et al. 5 on the European NICUs, confirm identified neonatal intensive care nursing research priority provide a roadmap for future collaborative research efforts. The top nursing research priorities identified in our study relate to prevention and reduction of pain, medication errors, end-of-life care, the needs of parents and family, implementing evidence into nursing practice and pain assessment. The study aims to describe the publications' to nursing care in the neonatal setting, published in Europe in journals indexed in the main database. Methods A bibliometric search was conducted in july 2020 selecting the studies published between 2010 and 2020in international journals were searched on databases biomedical: PUB MED, EMBASE, and CINA HL.Each study has been classified on the base of qualitative and quantitative parameters. Results 97 publications have been included. Results show the studies' focus, the top nursing research priorities identified in the publications relate to: breastfeeding, palliative care /ethics, developmental care, education/ training, organization, pain, procedures. The main destination of the publications were national journals. The quantitative approach is more developed. In Italy and mainly concern single-center studies 6 . Qualitative, experimental and second research studies are still limited 7 . The results suggest e development of Italian nursing research in the last decade. However, more reading and publications in international scientific journals should be encouraged. Key words: nurse's role, nursing care, neonatal nursing, neonatal, newborn, infant, premature infant . Background Neonatal bonding is that particular bond between mother and her newborn that begins in the mother's womb and is consolidated at birth immediately after childbirth. It is an important practice, which has a significant influence on the psychological component of the newborn. Indeed, it plays an essential role in supporting early neonatal social interactions, which can influence the neuro-behavioral outcomes of late childhood. Bonding consists of different elements that interact with each other: skin to skin contact, early and exclusive breastfeeding, eye contact and rooming-in. The aim of this study is to assess glucose stability, breastfeeding rates at discharge and nutritional needs comparing groups of women who gave birth vaginally and by caesarean section. For this purpose, the responses of a group of 224 women were examined. We a randomly selected sample of women who had given birth from September 2019 and February 2020 in maternity and neonatology ward of the San Leonardo Hospital of Castellammare di Stabia, which has about 1000 births a year with a strong prevalence of vaginal births compared to caesarean ones. The sample included mothers of healthy and full-term infants. The women had an average age of 31 years with a range from 16 to 47 years old. In particular, 80,36% of women gave birth vaginally, 14,29% planned caesarean section and 5.35% by emergency caesarean birth. Statistical analysis was conducted by means of the Chi-square tests to estimate, with 95% confidence intervals, differences between categorical variables. This work showed the correlation between the practice of bonding and the absence of glycemic changes in infants born from vaginal birth compared to those born from caesarean section, for which bonding is not performed. No differences between the two types of birth were found, with a confidence interval of 95%, both in terms of breastfeeding and the nutritional needs of each newborn. Background: Congenital heart disease (CHD) represent an important cause of morbidity and mortality in the neonatal period but also in later ages. [1] Prenatal diagnosis remains a very important tool in the diagnosis of these pathologies. Literature shows that only 50% of CHD is recognized during fetal life, [2] with wide variability from center to center and depending on the type of CHD. Neonatologist therefore plays a fundamental role in the diagnosis and management of these conditions. Discussion: Congenital heart defects can occur with acute clinical onset, immediately after birth or in the first hours or days of life. In these cases the cardiopathies involved are generally those characterized by non-duct dependent mixing circulation (i.e. total pulmonary anomalous venous return or transposition of the great arteries) or by ductus dependencies of the systemic or pulmonary circulation. These heart diseases generally manifest themselves clinically with cyanosis or shock. The neonatologist can use various tools to reach the diagnosis such as: clinical history, physical examination (finding of murmurs, reduction or absence of femoral pulses, etc.), hyperoxia test, etc. However in an emergency setting echocardiography remains essential. The use of this tool by the neonatologist has become widespread in recent years, as shown by recent literature. [3, 4] Recently, European scientific societies have also drawn up guidelines in an attempt to standardize the use of this method. [5] Certain types of CHD could manifest themselves later in life, even after months or years from birth. For these conditions, proactive research by the pediatrician who follows the child is essential. Thus oximetry screening has entered in current clinical practice. [6] However, this instrument has some limitations such as the low detection rate for CHD characterized by left ventricle outflow obstructive defects (i.e. aortic coarctation, aortic stenosis, hypoplastic left heart, etc.). [7] In later ages, CHD can manifest with variable symptoms such as growth retardation, poor exercise tolerance, electrocardiographic modifications. Conclusion: It is important for the pediatrician to always remember, at any age, that the child may be suffering from a congenital heart disease. The proactive research of these diseases, using all available tools, will ensure the best possible care for children. The imbalance between oxygen delivery (D02) and consumption (V02) leads to morbidity, mortality and adverse neurodevelopmental outcomes in premature infants.Central and peripheral factors define the amount of oxygen available to cells. Haemoglobin concentration, arterial oxygen partial pressure and, above all, cardiac index and output (CO) are the central factors, while microcirculation, haemoglobin affinity and CO redistribution are the peripheral factors. In the prematurenewborn, the cardiovascular system is immature and frequently leads to low-systemic blood flow (LSBF) states (35% of <30-week-old and61% of <27-week-old-infants). The low cardiac output syndrome (LCOS) is defined as a condition caused by a transient decrease in the systemic perfusion withVO2/DO2 imbalance at the cellular level. Immature organs are vulnerable to hypoxic damage and a differential diagnosis between LSBF and LCOS is crucial. The transitional circulation makes the CO monitoring particularly difficult. Treating low mean arterial pressure without signs of organ hypoperfusion represents an oversimplification of the physiopathology and can beevena damaging intervention. The neonatologists should adopt all the diagnostic tools (eco-functional, Non-Invasive CO Monitor, Near-infrared spectroscopy) to try to detect inadequate tissue perfusion and oxygenation at an early stage. In the suspicion of LCOS, clinicians should think to the possible contributing factors and the clinical context and should consider adaptation/maladaptation to a dynamic cardiocirculatory change. Contributing factors include reduced preload, reduced contractility, increased afterload and reduced vascular resistances. Moreover, it is important to consider the clinical context, the prenatal conditions and the time of LCOS onset. The management of LCOS include drugs that can be categorized as predominantly vasopressors (dopamine, norepinephrine) or inotropes (dobutamine, milrinone, levosimendan). Epinephrine is an inotropic drug with dose-dependent vasoactive action. The choice of the therapeutic agent should accurately follow the pathophysiology of the disease, considering the action on the heart and the peripheral receptor profile, with specific attention to the effect on systemic/pulmonary flows and resistances. In conclusion, newborns with hemodynamic compromise require careful approach, due to the peculiarity of their neonatal circulation, the immaturity of the organism and the different responses to stimuli. Further studies are required to improve the monitoring of patients and the understanding of the individual response to inotropic agents. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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We would like to thank all physicians and nurses of the Neonatal Intensive Care Unit at the Ca' Foncello Hospital, Treviso, Italy, for support, advice, and commitment to providing high-quality care for these young patients and their families. BACKGROUND. The management of human resources represents a fundamental organizational variable of healthcare companies that is reflected transversally and significantly on the assistance provided. For the scheduling of the shifts of healthcare workers, basic and manual tools are used such as spreadsheets or simple sheets of paper that do not allow timely changes, with the risk of exposing themselves to non-coverage of the service, to trace the changes made over time and to manage access according to permissions for privacy levels. Proper shift planning should take into account the internal rules of the organization, the legal and contractual regulations, the skills required in each shift and the preferences of individual people [1] . In fact, offering self-programmed control to health personnel (i.e. the ability to decide the hours / days of work) is a feasible intervention as a solution to increase employee satisfaction [2] . The aim of this work was to design, build and implement an application (App) for scheduling and managing work shifts, oriented towards self-programming, for healthcare personnel. METHODS. A multidisciplinary group was defined to create the App. It was composed by IT engineers/technicians, from the LINKS Foundation, and a representation of the health professions of the Obstetrics-Neonatal-Gynecological area of the Turin AOU Città della Salute e della Scienza. The App design and implementation regarded the limits analysis (regulatory, contractual and corporate); this was necessary to define the work shift and which method, in terms of application, could be more functional. Afterward, the study focused on the App validation, implementation and experimentation phase within the TIN-U department with sufficient knowledge in the use of the most common devices (PC, Tablet and Smartphone). RESULTS. The IT tool, called "Mamma Roster" (MR), was designed and developed as a web application, in order to permit the use any device, both desktop and mobile. A web browser was defined/used to favor the internet and intranet using. Users were able to access to the tool after authentication, with username and password, and could have one or more roles with different privileges and functions. In particular: nurses and OSS (users) were able to program only the personal planning (working days, rest and absences) and request shifts changes from colleagues; the coordinator, on the other hand, was able to access to the complete planning of all users, manage everyone shifts, start the automatic generation of a schedule, and create new users. To ensure the functioning of the system, rules managed by the server have been identified and inserted, saved in the database, settled by the nursing coordinator via a settings page. The needs request was structured by establishing a degree of priority to avoid a binding system and a diffuse unhappiness among users. In addition, the actions permitted within the reserved area of users were regulated by precise automatic timings to ensure adequate scheduling of shifts after entering of the needs. CONCLUSION. In computer science, creating a schedule for the shifts of healthcare workers is a typical decision-making problem that belongs to the NP-hard class, a range issues that are often impossible to solve efficiently. Management science, operations research and information technology offer many solutions ranging from simple algorithms to more complex systems but do not always take into account the needs of operators. A shiftwork organization model, that considers the preferences of health personnel, improves their attitude, towards shift work, and alleviates work stress [3] . The use of the "Mamma Roster" software will determine further advantages, thanks to imposed rules and the possibility of automatic generation of planning.