Diaphragm Thickness and Contraction During Non-Invasive Ventilation: An Ultrasound Study Stefano Nobile, Annamaria Sbordone, Nicola Salce, Giovanni Scognamiglio, Alessandro Perri, Simona Fattore, Giorgia Prontera, Lucia Giordano, Milena Tana, Giovanni Vento Children, 2025 Objectives: Non-invasive ventilation (NIV) is a widely used treatment for neonatal respiratory distress syndrome (RDS). Data on diaphragm contractility and thickness during NIV is scarce. We aimed to describe changes in diaphragm thickness/contractility during NIV and to explore associations with NIV discontinuation failure. Methods: This is a single-center prospective study. Diaphragmatic ultrasound was performed weekly during NIV, then within 7 days from NIV discontinuation. Diaphragm thickness was measured at end-inspiration (DTI) and end-expiration (DTE). Diaphragm thickening fraction (DTF) was calculated as (DTI-DTE/DTE). The clinical characteristics of patients and NIV discontinuation failure were recorded. Univariate analysis, logistic regression and linear regression were performed to describe diaphragm features during NIV and associations with NIV discontinuation failure. Results: We studied 17 NIV cycles (median duration 21 days). Median DTE increased from 0.12 cm (SD 0.05) at the start of NIV to 0.15 cm (SD 0.04) at NIV discontinuation. The mean DTF decreased from 32.8 (SD 16.8) at the start of NIV to 25.6 (SD 8.9) at NIV discontinuation. NIV discontinuation failure occurred in 23.5% of infants and was associated with higher DTI and DTE at the start of NIV and with a more pronounced decrease in DTI and DTE over the NIV cycle, compared to infants with NIV discontinuation success. There were no differences in neonatal outcomes between the infants with NIV discontinuation failure vs. success. We did not find any significant predictors of NIV failure. Conclusions: Diaphragm thickness increased, whereas DTF decreased over time on NIV in preterm infants with RDS. NIV duration was not associated with changes in diaphragm trophism. NIV discontinuation failure was associated with thicker diaphragm at the start of NIV, as well as with a reduction in diaphragm trophism over the NIV cycle.
Case Report: Hepatopulmonary fusion: to separate or not to separate? From a clinical case to A literature review Marta Tedesco, Simonetta Costa, Pierpaolo Agresti, Francesca Priolo, Alessandro Perri, Annamaria Sbordone, Stefano Nobile, Filomena Valentina Paradiso, Maria Vittoria Stern, Riccardo Rizzo, Maria Cristina Giustiniani, Lorenzo Nanni, Giovanni Vento Frontiers in Pediatrics, 2025 ObjectiveHepatopulmonary fusion (HPF) is a rare congenital malformation, frequently associated to right-sided congenital diaphragmatic hernia (CDHR). The presence of HPF often leads to a fatal outcome. The most effective approach to managing this condition remains uncertain due to the limited number of documented cases in the literature.Study designThis case presents a 11-day old full-term female neonate with HPF associated to CDHR. The definitive diagnosis of HPF was made during surgery for CDHR. Our team opted for a simple repair of the diaphragmatic defect and no attempts were made to separate the liver from the right lung.ResultsOur approach was successful, as our patient not only survived the procedure but also showed favorable cardiorespiratory adaptation, consistent growth, and regular neurodevelopment, according to follow-up data, available at six months of life.ConclusionThe adopted surgical management strongly suggests that when the diagnosis is made intraoperatively and detailed knowledge of the vascularization is lacking, partial separation of the viscera, preserving the medial hepatopulmonary fusion and suturing the diaphragm, is the successful approach.
Environmental maternal exposures and the risk of premature birth and intrauterine growth restriction: The Generation Gemelli study protocol of newborn exposome Leonardo Villani, Angelo Maria Pezzullo, Roberta Pastorino, Alessandra Maio, Francesca Stollagli, Chiara Tirone, Marta Barba, Angela Maria Cozzolino, Denise Pires Marafon, Martina Porcelli, Annamaria Sbordone, Maria Letizia Patti, Anthea Bottoni, Angela Paladini, Simona Fattore, Domenico Marco Romeo, Ornella Parolini, Wanda Lattanzi, Guido Rindi, Luca Tamagnone, Marco Marazza, Maurizio Genuardi, Elisabetta Tabolacci, Eugenio Maria Mercuri, Antonio Chiaretti, Tina Pasciuto, Maurizio Sanguinetti, Vincenzo Valentini, Giovanni Scambia, Walter Ricciardi, Giovanni Vento, Antonio Lanzone, Stefania Boccia Plos One, 2025 Background The study of women exposures and child outcomes occurring in the first 1,000 days of life since conception enhances understanding of the relationships between environmental factors, epigenetic changes, and disease development, extending beyond childhood and spanning the entire lifespan. Generation Gemelli is a recently launched case-control study that enrolls mother-newborns pairs in one of the largest university hospitals in Italy, in order to examine the association between maternal environmental exposures and intrauterine growth restriction (IUGR) and the risk of premature birth. The study will also evaluate the association of maternal exposures and the health and growth of infants and children up to 24 months of age. Methods The study entails the set-up of a case-control study within a birth cohort. With approximately 4,000 annual deliveries, we aim to enroll 140 cases (newborns with IUGR and premature birth) and 280 controls per year, from September 2022. A comprehensive questionnaire will be used to gather information about various types of maternal environmental exposures before and during pregnancy. We will collect biological samples from both mothers and newborns (including vaginal swab, placenta sample, blood, saliva, meconium, and bronchoalveolar lavage fluid) at birth and within the early hours of the newborn’s life. We will perform laboratory examinations including dosage of heavy metals and essential elements, investigation of placental distress and fetal brain damage of biomarkers, analysis of microbiota and of DNA methylation profile. We will conduct clinical follow-up assessments in both cases and controls at months 12 and 24 and we will collect anthropometric data, feeding types with particular reference to breastfeeding and its duration, pediatric emergency room visits, hospitalizations, medication usage, known allergies, and neuropsychological development. Discussion The Generation Gemelli case-control study holds the promise of significantly enhancing our comprehension of how maternal environmental exposures relate to the health of children and the broader population. The study of the exposome will provide insights into the relationships between environmental exposures, epigenetic changes and health outcomes during the first 1000 days of life and onward.
Diagnostic Accuracy of Lung Ultrasound in Neonatal Diseases: A Systematized Review Stefano Nobile, Lucia Sette, Claudia Esposito, Francesca Riitano, Chiara Di Sipio Morgia, Annamaria Sbordone, Giovanni Vento, Alessandro Perri Journal of Clinical Medicine, 2024 Background: Respiratory problems are frequent in newborns, and are mainly studied with chest X-rays, whereas CT scans are usually needed for the evaluation of rare malformations and diseases. Lung ultrasound (LUS] has been proposed as an alternative method of diagnosing a variety of respiratory conditions. In recent years, there has been a rapid increase in LUS studies, thanks to the ability of LUS to rapidly exclude complications and significantly reduce radiation exposure in this fragile population. We aimed to summarize the current knowledge about LUS. Methods: A literature search was conducted on the Medline and Cochrane databases using appropriate terms. The inclusion criteria were: English language and human species. Exclusion criteria were: non-English language, animal species, case reports, case series, non-systematic reviews, and editorials. Results: The search returned 360 results. No Cochrane reviews were found. Titles and abstracts were screened, and 37 were finally considered. Studies concerning the use of lung ultrasound for the following conditions were presented: neonatal respiratory distress syndrome, transient tachypnea of the newborn, pneumothorax, pulmonary hemorrhage, pneumonia, bronchopulmonary dysplasia, and prediction of extubation success. Conclusions: We discussed the utility of LUS for the diagnosis and treatment of neonatal diseases according to the most recent literature.
Diaphragm atrophy during invasive mechanical ventilation is related to extubation failure in preterm infants: An ultrasound study Stefano Nobile, Annamaria Sbordone, Nicola Salce, Maria Letizia Patti, Alessandro Perri, Simona Fattore, Giorgia Prontera, Lucia Giordano, Milena Tana, Giovanni Vento Pediatric Pulmonology, 2024 BackgroundDiaphragm dysfunction is associated with poor outcomes in critically ill patients. Ventilator‐induced diaphragmatic dysfunction (VIDD), including diaphragm atrophy (DA), is poorly studied in newborns. We aimed to assess VIDD and its associations in newborns.MethodsSingle‐center prospective study. Diaphragm thickness was measured at end‐inspiration (TDI) and end‐expiration (TDE) on the right midaxillary line. DA was defined as decrease in TDE ≥ 10%. Daily measurements were recorded in preterm newborns on invasive mechanical ventilation (IMV) for ≥2 days. Clinical characteristics of patients and extubation failure were recorded. Univariate analysis, logistic regression, and mixed models were performed to describe VIDD and associated factors.ResultsWe studied 17 patients (median gestational age 270/7 weeks) and 22 IMV cycles (median duration 9 days). Median TDE decreased from 0.118 cm (interquartile range [IQR] 0.094–0.165) on the first IMV day to 0.104 cm (IQR 0.083–0.120) on the last IMV day (p = .092). DA occurred in 11 IMV cycles (50%) from 10 infants early during IMV (median: second IMV day). Mean airway pressure (MAP) and lung ultrasound score (LUS) on the first IMV day were significantly higher in patients who developed DA. DA was more frequent in patients with extubation failure than in those with extubation success within 7 days (83.3 vs. 33.3%, p = .038).ConclusionsDA, significantly associated with extubation failure, occurred in 58.8% of the study infants on IMV. Higher MAP and LUS at IMV start were associated with DA. Our results suggest a potential role of diaphragm ultrasound to assess DA and predict extubation failure in clinical practice.
Cord blood presepsin as a predictor of early-onset neonatal sepsis in term and preterm newborns Francesca Priolo, Luca Maggio, Simona Fattore, Marta Tedesco, Domenico Umberto De Rose, Alessandro Perri, Giorgia Prontera, Roberto Chioma, Annamaria Sbordone, Maria Letizia Patti, Giovanni Vento Italian Journal of Pediatrics, 2023 Background To date, no studies on presepsin values in cord blood of term infants with risk factors for early-onset sepsis (EOS) are available, whereas only one study reported presepsin values in cord blood of preterm infants at risk. In this study, we investigated the presepsin values in cord blood of term and preterm infants with documented risk factors for EOS. Methods In this single-center prospective pilot study, we enrolled neonates presenting with documented risk factors for EOS. P-SEP levels were assessed in a blood sample collected from the clamped umbilical cord after the delivery in 93 neonates, using a point-of-care device. The primary outcome of our study was to evaluate the role of cord blood P-SEP in predicting clinical EOS in term and preterm infants. Results During the study period, we enrolled 93 neonates with risk factors for EOS with a gestational age ranging between 24.6 and 41.6 weeks (median 38.0). The median P-SEP value in all infants was 491 pg/ml (IQR 377 – 729). Median cord P-SEP values were significantly higher in infants with clinical sepsis (909 pg/ml, IQR 586 – 1307) rather than in infants without (467 pg/ml, IQR 369 – 635) (p = 0.010). We found a statistically significant correlation between cord P-SEP value at birth and the later diagnosis of clinical sepsis (Kendall's τ coefficient 0.222, p = 0.002). We identified the maximum Youden’s Index (best cut-off point) at 579 pg/ml, corresponding to a sensitivity of 87.5% and a specificity of 71.8% in predicting clinical sepsis. Conclusions Maximum Youden’s index was 579 pg/ml for clinical EOS using cord P-SEP values. This could be the starting point to realize multicenter studies, confirming the feasibility of dosing P-SEP in cord blood of infants with risk factors of EOS to discriminate those who could develop clinical sepsis and spare the inappropriate use of antibiotics.
Early Respiratory Physiotherapy versus an Individualized Postural Care Program for Reducing Mechanical Ventilation in Preterm Infants: A Randomised Controlled Trial Milena Tana, Anthea Bottoni, Francesco Cota, Patrizia Papacci, Alessia Di Polito, Arianna Del Vecchio, Anna Laura Vento, Benedetta Campagnola, Sefora Celona, Laura Cricenti, Ilaria Bastoni, Chiara Tirone, Claudia Aurilia, Alessandra Lio, Angela Paladini, Stefano Nobile, Alessandro Perri, Annamaria Sbordone, Alice Esposito, Simona Fattore, Paola Emilia Ferrara, Gianpaolo Ronconi, Giovanni Vento Children, 2023 Background: Tactile stimulation manoeuvres stimulate spontaneous breathing in preterm newborns. The aim of this study is to evaluate the effect of early respiratory physiotherapy on the need for mechanical ventilation during the first week of life in preterm infants with respiratory failure. Methods: This is a monocentric, randomised controlled trial. Preterm infants (gestational age ≤ 30 weeks) not intubated in the delivery room and requiring non-invasive respiratory support at birth were eligible for the study. The intervention group received early respiratory physiotherapy, while the control group received only a daily physiotherapy program (i.e., modifying the infant’s posture in accordance with the patient’s needs). Results: between October 2019 and March 2021, 133 preterm infants were studied, 68 infants in the study group and 65 in routine care. The study group showed a reduction in the need for mechanical ventilation (not statistically significant) and a statistically significant reduction in hemodynamically significant patent ductus arteriosus with respect to the control group (19/68 (28%) vs. 35/65 (54%), respectively, p = 0.03). Conclusions: early respiratory physiotherapy in preterm infants requiring non-invasive respiratory support at birth is safe and has proven to be protective against haemodynamically significant PDA.
Impact of Distressing Media Imagery on Children Pietro Ferrara, Giovanni Corsello, Francesca Ianniello, Annamaria Sbordone, Jochen Ehrich, Massimo Pettoello-Mantovani Journal of Pediatrics, 2016
Femicide and murdered women's children: Which future for these children orphans of a living parent? Pietro Ferrara, Olga Caporale, Costanza Cutrona, Annamaria Sbordone, Maria Amato, Giulia Spina, Francesca Ianniello, Giovanna Carmela Fabrizio, Chiara Guadagno, Maria Cristina Basile, Francesco Miconi, Giacomo Perrone, Riccardo Riccardi, Alberto Verrotti, Massimo Pettoello-Mantovani, Alberto Villani, Giovanni Corsello, Giovanni Scambia Italian Journal of Pediatrics, 2015
School bullying: An international public health emergency correlated to psychosomatic problems as long-term sequelae Minerva Psichiatrica, 2015
