Publications by authors named "Carlo V Bellieni"

37 Publications

The Congress "Yes to Life": A Hand Offered in Dialogue.

Authors:
Carlo V Bellieni

Perspect Biol Med 2020 ;63(3):506-508

The Congress "Yes to Life," devoted to the ethical problems in perinatology, has been an important carrefour for the intercultural dialogue on these themes. This paper describes the aim of the Congress and why it was proposed.
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http://dx.doi.org/10.1353/pbm.2020.0038DOI Listing
January 2020

Analgesia for fetal pain during prenatal surgery: 10 years of progress.

Authors:
Carlo V Bellieni

Pediatr Res 2020 Sep 24. Epub 2020 Sep 24.

Neonatal Intensive Care Unit, University Hospital, Viale M Bracci, 53100, Siena, Italy.

Some doubts on the necessity and safety of providing analgesia to the fetus during prenatal surgery were raised 10 years ago. They were related to four matters: fetal sleep due to neuroinhibitors in fetal blood, the immaturity of the cerebral cortex, safety, and the need for fetal direct analgesia. These objections now seem obsolete. This review shows that neuroinhibitors give fetuses at most some transient sedation, but not a complete analgesia, that the cerebral cortex is not indispensable to feel pain, when subcortical structures for pain perception are present, and that maternal anesthesia seems not sufficient to anesthetize the fetus. Current drugs used for maternal analgesia pass through the placenta only partially so that they cannot guarantee a sufficient analgesia to the fetus. Extraction indices, that is, how much each analgesic drug crosses the placenta, are provided here. We here report safety guidelines for fetal direct analgesia. In conclusion, the human fetus can feel pain when it undergoes surgical interventions and direct analgesia must be provided to it. IMPACT: Fetal pain is evident in the second half of pregnancy. Progress in the physiology of fetal pain, which is reviewed in this report, supports the notion that the fetus reacts to painful interventions during fetal surgery. Evidence here reported shows that it is an error to believe that the fetus is in a continuous and unchanging state of sedation and analgesia. Data are given that disclose that drugs used for maternal analgesia cross the placenta only partially, so that they cannot guarantee a sufficient analgesia to the fetus. Safety guidelines are given for fetal direct analgesia.
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http://dx.doi.org/10.1038/s41390-020-01170-2DOI Listing
September 2020

Apgar Score-It Is Time to Avoid Pain.

Authors:
Carlo V Bellieni

JAMA Pediatr 2021 Feb;175(2):206-207

Department of Pediatrics, University Hospital of Siena, Siena, Italy.

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http://dx.doi.org/10.1001/jamapediatrics.2020.2551DOI Listing
February 2021

The Limitations of Pain Scales.

Authors:
Carlo V Bellieni

JAMA Pediatr 2020 06;174(6):623

Pediatric Intensive Care Unit, University Hospital, Siena, Italy.

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http://dx.doi.org/10.1001/jamapediatrics.2020.0076DOI Listing
June 2020

New insights into fetal pain.

Authors:
Carlo V Bellieni

Semin Fetal Neonatal Med 2019 08 6;24(4):101001. Epub 2019 Apr 6.

Neonatal Intensive Care Unit, University Hospital of Siena, Italy. Electronic address:

Fetal pain is difficult to assess, because the main feature needed to spot pain, is the subject's capability of declaring it. Nonetheless, much can be affirmed about this issue. In this review we first report the epochs of the development of human nociceptive pathways; then we review since when they are functioning. We also review the latest data about the new topic of analgesia and prenatal surgery and about the scarce effect on fetal pain sentience of the natural sedatives fetuses produce. It appears that pain is a neuroadaptive phenomenon that emerges in the middle of pregnancy, at about 20-22 weeks of gestation, and becomes more and more evident for bystanders and significant for the fetus, throughout the rest of the pregnancy.
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http://dx.doi.org/10.1016/j.siny.2019.04.001DOI Listing
August 2019

Using the pain principle to provide a new approach to invasive treatments and end-of-life care.

Acta Paediatr 2019 02 17;108(2):206-207. Epub 2018 Sep 17.

Department of Pediatrics, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/apa.14535DOI Listing
February 2019

Consents or waivers of responsibility? Parents' information in NICU.

Minerva Pediatr 2018 May 14. Epub 2018 May 14.

Department of Pediatrics, University of Siena, Siena, Italy.

Background: Informing the patient is a base of modern medicine; nonetheless, a great discrepancy exists between hospitals on the way this information should be administered. This is particularly important when the patient are babies: the information should be given to their parents who should approve or disapprove the treatment. Aim of this study is to assess the adequacy of the information administered to the parents of babies admitted into the Neonatal Intensive Care Units.

Methods: We analyzed the consent forms of center-north Italy NICUs. To this aim, we assessed if the forms had acceptable length and other features; we then asked some volunteers to simulate an information process and to score the forms for their easiness, comprehensibility and explicability to others.

Results: Twenty-one NICUs accepted to participate. Only 7 out of 21 had an adequate information form; the other 14 could be described as "waiver of responsibility " (WOR), because they were too prolix and contained too many hypothetical procedures. The overall level of easiness, comprehensibility and explicability to others was suboptimal, being lower in those forms we defined WOR.

Conclusions: The results are far to be optimal. More care should be devoted to the process of informing parents at the admission into the NICU: an information overload should be avoided and information should be tailored on the baby's state. Further analysis should be devoted to whether the use of WOR is routine in other countries.
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http://dx.doi.org/10.23736/S0026-4946.18.05084-3DOI Listing
May 2018

Consumerism: a threat to health?

Authors:
Carlo V Bellieni

J R Soc Med 2018 04 1;111(4):112. Epub 2018 Mar 1.

Neonatal Intensive Care Unit, Policlinico Le Scotte, Siena 53100, Italy.

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http://dx.doi.org/10.1177/0141076818763332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900838PMC
April 2018

What we do in neonatal analgesia overshadows how we do it.

Acta Paediatr 2018 Mar 10;107(3):388-390. Epub 2017 Nov 10.

Department of Pediatrics, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/apa.14125DOI Listing
March 2018

Response to Mortazavi's comment.

Acta Paediatr 2017 12 25;106(12):2064. Epub 2017 Sep 25.

University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/apa.14074DOI Listing
December 2017

Are electromagnetic fields in incubators a risk factor for autism?

Acta Paediatr 2017 12 13;106(12):2062. Epub 2017 Aug 13.

Neonatal Intensive Care Unit, University Hospital, Siena, Italy.

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http://dx.doi.org/10.1111/apa.14001DOI Listing
December 2017

Normal values of creatine kinase and of MB-creatine kinase at birth in healthy babies.

Minerva Pediatr 2017 Apr 20. Epub 2017 Apr 20.

Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.

Background: Today, few studies have been accomplished in order to determine serum creatine kinase (CK) activity in newborns by considering small groups of babies and without taking into account gestational age (GA) differences. Some authors have demonstrated that neonatal CK activity value at birth is higher than the normal range of CK activity considering for adults or older children. The objective of this study is to assess normal values of CK and MB-CK in neonatal blood, according to babies' GA.

Methods: We retrieved the clinical files of 140 babies admitted into Siena Hospital NICU in a 2-years period, when CK was assessed routinely to all babies at birth. We selected files from 114 newborns and we divided the cohort into group A (non-stressed; n=41) and group B (stressed; n=73) on the basis of Apgar score and signs of neurological lesions. We compared CK and MB-CK values in the two groups according to GA.

Results: Mean CK value of the 41 non-stressed babies' samples: 413 IU/L (232 SD). CK significantly increases with GA. No differences are present in total CK activity between stressed vs non-stressed babies; but a significant difference appears in these two groups for MB-CK (mean values: 456 vs 175 IU/L).

Conclusions: This is the first study that compares CK and MB-CK values at birth according to the GA of the babies. CK values increase with GA, and stressed babies have higher MB-CK values than the non-stressed babies. These reference values are important for clinical practice.
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http://dx.doi.org/10.23736/S0026-4946.17.04852-6DOI Listing
April 2017

Is fetal analgesia necessary during prenatal surgery?

J Matern Fetal Neonatal Med 2018 May 16;31(9):1241-1245. Epub 2017 Apr 16.

b Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology , University of Siena , Siena , Italy.

Fetal pain and fetal anesthesia are still matter of debate: some authors hypothesize that several intrauterine endocrine neuroinhibitors (ENIn) anesthetize the fetus, keeping it in a constant state of sleep, and making pharmacological fetal anesthesia useless for fetal surgery, while others argue fetal pain is possible and shoud be prevented with fetal anesthesy.

Aim: To retrieve evidences about fetal pain, fetal arousability and about the level of sedation induced by the ENIn, in order to assess the necessity of direct fetal anesthesia during prenatal fetal surgery.

Methods: We performed a careful literature review (1990-2016) on fetal arousability, and on the possibility that ENIn at the average fetal blood levels induce actual anesthesia. We retrieved the papers that fulfilled the research criteria, with particular attention to the second half of pregnancy, the period when most fetal surgery is performed.

Results: Fetuses are awake about 10% of the total time in the last gestational weeks, and they can be aroused by external stimuli. ENIn have not an anesthetic effect at normal fetal values, but only when they areartificialy injected at high doses; their blood levels in the last trimester of average pregnancies are not dissimilar either in the fetus or in the mother.

Conclusions: During the second half of the pregnancy, external stimuli can awake the fetuses, although they spend most of the time in sleeping state; the presence of ENIn is absolutely not enough to guarantee an effective anesthesia during surgery. Thus, direct fetal analgesia/anesthesia is mandatory, though further studies on its possible drawbacks are necessary.
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http://dx.doi.org/10.1080/14767058.2017.1311860DOI Listing
May 2018

Analgesia, nil or placebo to babies, in trials that test new analgesic treatments for procedural pain.

Acta Paediatr 2016 Feb 30;105(2):129-36. Epub 2015 Oct 30.

McGill University, Montreal, QC, Canada.

Unlabelled: This review assessed how often neonates in control groups experienced unnecessary pain during clinical trials involving procedural pain. We retrieved 45 studies in the 30 months up to June 2015 and found that in 29 (64%) the control babies received either placebos or no treatment. Placebos were used in 15/25 (60%) studies involving heel pricks and in 6/8 (75%) involving venepuncture.

Conclusion: Despite international guidelines, neonates included in control groups during painful procedures do not receive analgesia in the majority of cases. Several historical reasons can explain this, but in the light of present knowledge, this should not continue. Ethical committees are thereof invited since now to not permit clinical trials that do not explicitly rule out pain during treatments and journals are invited to not publish them.
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http://dx.doi.org/10.1111/apa.13210DOI Listing
February 2016

Blue Light and Ultraviolet Radiation Exposure from Infant Phototherapy Equipment.

J Occup Environ Hyg 2015 ;12(9):603-10

a Regional Public Health Laboratory - Physical Agents Sector , Siena , Italy.

Phototherapy is the use of light for reducing the concentration of bilirubin in the body of infants. Although it has become a mainstay since its introduction in 1958, a better understanding of the efficacy and safety of phototherapy applications seems to be necessary for improved clinical practices and outcomes. This study was initiated to evaluate workers' exposure to Optical Radiation from different types of phototherapy devices in clinical use in Italy. During infant phototherapy the staff monitors babies periodically for around 10 min every hour, and fixation of the phototherapy beam light frequently occurs: almost all operators work within 30 cm of the phototherapy source during monitoring procedures, with most of them commonly working at ≤25 cm from the direct or reflected radiation beam. The results of this study suggest that there is a great variability in the spectral emission of equipments investigated, depending on the types of lamps used and some phototherapy equipment exposes operators to blue light photochemical retinal hazard. Some of the equipment investigated presents relevant spectral emission also in the UVA region. Taking into account that the exposure to UV in childhood has been established as an important contributing factor for melanoma risk in adults and considering the high susceptibility to UV-induced skin damage of the newborn, related to his pigmentary traits, the UV exposure of the infant during phototherapy should be "as low as reasonably achievable," considering that it is unnecessary to the therapy. It is recommended that special safety training be provided for the affected employees: in particular, protective eyewear can be necessary during newborn assistance activities carried out in proximity of some sources. The engineering design of phototherapy equipment can be optimized. Specific requirements for photobiological safety of lamps used in the phototherapy equipment should be defined in the safety product standard for such equipment.
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http://dx.doi.org/10.1080/15459624.2015.1029611DOI Listing
April 2016

Abortion and subsequent mental health: Review of the literature.

Psychiatry Clin Neurosci 2013 Jul;67(5):301-10

Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Siena, Italy.

The risk that abortion may be correlated with subsequent mental disorders needs a careful assessment, in order to offer women full information when facing a difficult pregnancy. All research papers published between 1995 and 2011, were examined, to retrieve those assessing any correlation between abortion and subsequent mental problems. A total of 36 studies were retrieved, and six of them were excluded for methodological bias. Depression, anxiety disorders (e.g. post-traumatic stress disorder) and substance abuse disorders were the most studied outcome. Abortion versus childbirth: 13 studies showed a clear risk for at least one of the reported mental problems in the abortion group versus childbirth, five papers showed no difference, in particular if women do not consider their experience of fetal loss to be difficult, or if after a fetal reduction the desired fetus survives. Only one paper reported a worse mental outcome for childbearing. Abortion versus unplanned pregnancies ending with childbirth: four studies found a higher risk in the abortion groups and three, no difference. Abortion versus miscarriage: three studies showed a greater risk of mental disorders due to abortion, four found no difference and two found that short-term anxiety and depression were higher in the miscarriage group, while long-term anxiety and depression were present only in the abortion group. In conclusion, fetal loss seems to expose women to a higher risk for mental disorders than childbirth; some studies show that abortion can be considered a more relevant risk factor than miscarriage; more research is needed in this field.
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http://dx.doi.org/10.1111/pcn.12067DOI Listing
July 2013

Analgesia for infants' circumcision.

Ital J Pediatr 2013 Jun 13;39:38. Epub 2013 Jun 13.

Department of Paediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci 2, Siena, Italy.

Male circumcision (MC) is one of the oldest and most common operations performed all over the world. It can be performed at different ages, using different surgical techniques, for different religious, cultural and medical reasons.Our aim is to examine and compare the various methods of analgesia and different surgical procedures reported in literature that are applied in infant MC. We performed a PubMed, MEDLINE, EMBASE and Cochrane search in the papers published since 2000: 14 studies met the inclusion criteria, most of them showing that a combined pharmacological and non-pharmacological intervention is the best analgesic option, in particular when the dorsal penile nerve block is combined with other treatments. The Mogen surgical procedure seems to be the less painful surgical intervention, when compared with Gomco clamp or PlastiBell device. Only 3 papers studied groups of at least 20 babies each with the use of validated pain scales. Data show a dramatic decrease of pain with dorsal penile nerve block, plus acetaminophen associated to oral sucrose or topic analgesic cream. However, no procedure has been found to definetively eliminate pain; the gold standard procedure to make MC totally painfree has not yet been established.
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http://dx.doi.org/10.1186/1824-7288-39-38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702488PMC
June 2013

Should an IRB approve a placebo-controlled randomized trial of analgesia for procedural pain in neonates?

Pediatrics 2012 Sep 13;130(3):550-3. Epub 2012 Aug 13.

Department of Neonatology, Siena University Hospital, Siena, Italy.

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http://dx.doi.org/10.1542/peds.2011-2910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074620PMC
September 2012

Use of fetal analgesia during prenatal surgery.

J Matern Fetal Neonatal Med 2013 Jan 27;26(1):90-5. Epub 2012 Sep 27.

Department of Pediatrics, University of Siena, Italy.

Objective: Recent progresses in fetal surgery have raised concern on fetal pain, its long-term consequences and the risks of sudden fetal movements induced by pain. In several studies, surgeons have directly administered opioids to the fetus, while others have considered sufficient the maternally administered analgesics. We performed a review of the literature to assess the state of the art.

Methods: We performed a PubMed search to retrieve the papers that in the last 10 years reported studies of human fetal surgery and that described whether any fetal analgesia was administered.

Results: We retrieved 34 papers. In three papers, the procedure did not hurt the fetus, being performed on fetal annexes, in two papers, it was performed in the first half of pregnancy, when pain perception is unlikely. In 10 of the 29 remaining papers, fetal surgery was performed using direct fetal analgesia, while in 19, analgesia was administered only to the mother. In most cases, fetal direct analgesia was obtained using i.m. opioids, and muscle relaxant. Rare drawbacks on either fetuses or mothers due to fetal analgesia were reported.

Conclusion: Fetal direct analgesia is performed only in a minority of cases and no study gives details about fetal reactions to pain. More research is needed to assess or exclude its possible long-term drawbacks, as well as the actual consequences of pain during surgery.
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http://dx.doi.org/10.3109/14767058.2012.718392DOI Listing
January 2013

Assessing burnout among neonatologists.

J Matern Fetal Neonatal Med 2012 Oct 10;25(10):2130-4. Epub 2012 May 10.

Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Sienna, Italy.

Objectives: To measure burnout in a cohort of neonatologists and to explore its association with several psychological and biographic factors.

Materials And Methods: A total of 110 neonatologists filled in a personal questionnaire composed of four parts: (a) biographic data, (b) personal beliefs, (c) attitudes toward clinical decisions and (d) a validated tool (the Link Burnout Questionnaire [LBQ]) to assess their burnout. The LBQ categorizes burnout into four subscales: psycho-physical exhaustion, relationship deterioration, sense of professional failure and disillusion. Scores of each subscale range from 6 (minimum) to 36 (maximum). Burnout values were matched with the data of the personal questionnaire.

Results: Most neonatologists (60%-65%) were in the "at risk" range for burnout. High burnout was experienced by 30% of the neonatologists. Having no children is associated with low rates of burnout; work experience of less than 5 years, believing that living with a physical disability is unworthy and having recurrent death ideation are associated with high rates of burnout. The attitude to resuscitating a 24-week baby is inversely correlated with the disillusion rate.

Conclusion: In our cohort, burnout exceeds the alarm threshold in one-third of cases. Some of the risk factors we examined were correlated with burnout and should be considered in future prevention programs.
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http://dx.doi.org/10.3109/14767058.2012.666590DOI Listing
October 2012

Why do we treat the newborn differently?

J Matern Fetal Neonatal Med 2012 Apr 8;25 Suppl 1:73-5. Epub 2012 Mar 8.

Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Siena, Italy.

End-of-life decisions are often taken in neonatology, based on widely accepted guidelines, to avoiding futile therapies. Usually, the criteria upon which these guidelines rely are different from those used for older patients, even when patients require a guardian to decide on their behalf. Main differences are the weight of parental interests and the probabilistic base of the choice. A careful analysis of the literature found three main reasons of this difference: the obsolescence of the guidelines criteria, the difficulty to distinguish between parents' and babies' interests and the neonatologist's responsibility to prolong a life with the prospective of severe disability. In conclusion, the future guidelines for newborn end-of-life decisions should follow at least the same moral criteria used for older patients.
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http://dx.doi.org/10.3109/14767058.2012.663178DOI Listing
April 2012

The ethics of pain clinical trials on persons lacking judgment ability: much to improve.

Pain Med 2012 Mar 7;13(3):427-33. Epub 2012 Feb 7.

Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Siena, Italy.

Aim: People lacking judgmental ability (newborn infants [NIs] and persons with mental impairment [PMI]) are reported to receive less analgesic treatments than people who can give adequate informed consent. We performed the present study to assess whether this also happens in clinical trials that should statutorily guarantee basic patients' rights. We examined those trials in which patients undergo painful minor procedures (PMP) because these procedures are frequent and severely stressful for NI and PMI.

Materials And Methods: We performed a Medline search to retrieve the studies published in 2009 and 2010, in which NI and PMI underwent PMP.

Results: We retrieved 46 studies that exposed NI to PMP; only in 14.2% of the studies, a validated analgesic treatment was administered to the control group. We retrieved only one article where PMP was performed in PMI for clinical reasons (venipuncture); in 13 more studies, pain was experimentally provoked by noxious stimuli such as heat, electricity, or arm mobilization. All these studies were not performed to evaluate a possible analgesic strategy but to assess PMI's pain responsiveness and no analgesia was used.

Conclusion: PMI and NI enrolled in clinical trials as controls rarely receive analgesia; and few studies exist to find out analgesic treatments shaped on PMI's exigencies. These data raise concern about the actual guarantees for persons lacking judgmental ability enrolled in potentially painful trials. We also recommend more effort to find out analgesic treatments tailored to the specific exigencies of PMI.
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http://dx.doi.org/10.1111/j.1526-4637.2011.01325.xDOI Listing
March 2012

Distracting effect of TV watching on children's reactivity.

Eur J Pediatr 2010 Sep 14;169(9):1075-8. Epub 2010 Mar 14.

Dipartimento di Pediatria, Ostetricia e Medicina della Riproduzione, Università di Siena, Siena, Italy.

The experiment, aimed to evaluate the distracting effect of television, was carried out on 122 children, divided into three groups. All groups performed the auditory vigilance test (AVT) to assess reaction time (RT) to an auditory stimulus and the number of errors in responding to the stimulus. Children in group 1 performed the AVT while in front of a blank TV set and listening to the soundtrack of a movie (SO test), then watching a black and white cartoon (BW test). Children in group 2 performed the AVT while in front of a blank TV set and listening to the soundtrack of a movie (SO test), then watching a color cartoon (CC test). Group 3 performed SO, BW, and CC tests consecutively. RT and the number and type of errors were measured. In each group, 30 days separated one session from the following. A significant increase of median RTs (more than 10%) and errors (twice and more) was observed both in the case of BW and CC tests with respect to SO test. RT increased throughout all tests. During SO test, errors are mainly "false reactions", but in BW and CC tests, errors are more numerous, and they are mainly "omissions". TV movies have a significant distracting and attention-capturing effect, which increases throughout the vision of the show. No advantage in decreasing this effect is offered by removing color from the movie.
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http://dx.doi.org/10.1007/s00431-010-1180-0DOI Listing
September 2010

No analgesia to the control group: is it acceptable?

Pediatrics 2010 Mar;125(3):e709; author reply e709-10

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http://dx.doi.org/10.1542/peds.LTE.0310aDOI Listing
March 2010

Effects of lutein on oxidative stress in the term newborn: a pilot study.

Neonatology 2010 7;97(1):36-40. Epub 2009 Jul 7.

Division of Neonatology, Department of Pediatrics, Obstetrics and Reproductive Medicine, Policlinico Le Scotte University of Siena, Siena, Italy.

Background: Oxidative stress (OS) plays a crucial role in pathological conditions during the early neonatal period. The newborns are susceptible to oxidative damage due to high metabolic rate and low levels of antioxidant enzymes. Lutein has been found to have protective functions in adult humans as antioxidant.

Aim: To evaluate the effects of lutein on OS in newborns. We tested the hypothesis that lutein would act both by increasing antioxidant capacity and inhibiting OS.

Methods: This was a randomized, double-blind, placebo-controlled, single-center study. 20 healthy term newborns were assigned to receive lutein or placebo (lutein and control group, respectively) at 12 and 36 h after birth. Total hydroperoxides (TH), as marker of OS, and biological antioxidant potential (BAP), as marker of antioxidant power, were detected on cord blood and at 48 h of life in all babies.

Results: TH significantly increased from birth to 48 h in the control group (p = 0.02), but not in the lutein group. In the lutein group, BAP significantly increased after 48 h (p = 0.02), showing a strengthening of antioxidant activity due to lutein. At 48 h of life, compared with those in the control group, neonates assigned to receive lutein had significantly lower TH levels (p = 0.04) and higher BAP levels (p = 0.028).

Conclusions: Lutein administration in newborns increases the levels of BAP decreasing TH. The enhancement of antioxidant activity in plasma clearly results in protecting newborn from perinatal OS. These preliminary results, adding a new contribution in antioxidant strategies, strongly require to be confirmed by RCT.
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http://dx.doi.org/10.1159/000227291DOI Listing
March 2010

Biomarkers of oxidative stress in babies at high risk for retinopathy of prematurity.

Front Biosci (Elite Ed) 2009 Jun 1;1:547-52. Epub 2009 Jun 1.

Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.

Oxygen-induced oxidative stress (OS) has damaging effects in the perinatal period. For now there is a lake of evidence that OS occurs in babies with retinopathy of prematurity (ROP) We tests the hypothesis that a strict oxygen policy may minimize postnatal OS reducing severity of ROP. Multicenter prospective cohort study (72 newborns), using a common clinical management protocol with a strict control of oxygen administration. Assessment of biochemical markers of OS in blood samples at birth and on days 7, 14, and 21. Sixteen babies (22.2 per cent) developed ROP stage 1-2. No severe form of ROP was observed. Birth weight and O2 administration in delivery room were the factors significantly associated with the development of ROP stage 1-2. Prematurity and O2 administration in delivery room are the main factors coming into play in the course of ROP. Because room air is richer in oxygen than intrauterine environment, higher OS can be minimized, as well as incidence and severity of ROP, using standardized management with a restricted oxygen breathing policy.
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http://dx.doi.org/10.2741/e52DOI Listing
June 2009

Flaws in the assessment of the best interests of the newborn.

Acta Paediatr 2009 Apr 22;98(4):613-7. Epub 2009 Jan 22.

Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Italy.

Unlabelled: We examined the literature on ethical decisions regarding neonates, to assess whether personal beliefs and prejudices influence end-of-life decisions taken by caregivers. Studies show that religion and familiarity with disability influence caregivers' decisions, whereas the influx of already being a parent, age, sex and professional experience is controverse. Caregivers' attitudes towards end-of-life decisions are also affected by personal concerns about litigation, prejudices and their view of disability. The concept of 'poor quality of life' is widely used as a reference in end-of-life decisions, but this can be interpreted differently, leaving room for a wide range of personal viewpoints. In most cases, parents' opinions are considered important and are sometimes the main determinant in decision making. However, it is unclear whether parents' decisions are based on their own wishes or on the best interests of the newborn.

Conclusion: In neonatal end-of-life decisions, patients may not receive cures based only on their best interests.
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http://dx.doi.org/10.1111/j.1651-2227.2008.01185.xDOI Listing
April 2009

Oxidative stress and nutrition in the preterm newborn.

J Pediatr Gastroenterol Nutr 2007 Dec;45 Suppl 3:S178-82

Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Italy.

Oxidative stress occurs when the production of free radicals exceeds the cells' ability to eliminate them. Many events leading to overproduction of free radicals may easily induce oxidative stress in the earliest phases of human life. Given the growing role of oxidative stress in newborn preterm morbidity, one of the goals of modern neonatology is to minimize free radical production and promote the development of adequate antioxidant systems through an adequate nutritional strategy. Appropriate administration of total parenteral solutions and lipid emulsions with light protection can minimize the risk of peroxidation. Providing the baby with amino acid substrates for cellular glutathione synthesis immediately after birth promotes antioxidant defenses at the early stages of life. Breast milk has been found to have many advantages over formula, including the potential to provide antioxidant protection to infants. It is conceivable that these antioxidants in breast milk help to eliminate free radicals in infants. The role of vitamin administration in preterm nutrition has not yet been established. Clinical trials carried out to test the efficacy of antioxidant drugs or vitamins were inconclusive. At present, there are no evidence-based recommendations about the use of nutritional strategies or antioxidant drugs to minimize oxidative stress in the management of preterm infants.
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http://dx.doi.org/10.1097/01.mpg.0000302968.83244.d2DOI Listing
December 2007

Oxidative kidney damage in preterm newborns during perinatal period.

Clin Biochem 2007 Jun 26;40(9-10):656-60. Epub 2007 Jan 26.

Department of Paediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Le Scotte, V.le Bracci 36, 53100 Siena, Italy.

Background: Oxidative stress has recently been found to play a key role in post-ischemic kidney damage. We tested the hypothesis that oxidative kidney damage due to perinatal hypoxia in preterm newborns is associated with an increased production of oxidative free radicals in plasma.

Methods: Blood and urine samples were obtained at birth and on days 7 and 14, from 55 preterm newborns, without any known congenital abnormalities. Total hydroperoxides (TH) and advanced oxidation protein products (AOPP) as indices of oxidative stress, xanthine (Xa) and hypoxanthine (Hx) as indices of hypoxia, alpha1-microglobulin and N-acetyl-beta-D-glucosaminidase (NAG) as indices of kidney damage were assayed.

Results: Statistically significant correlations (p<0.05) were found between biochemical markers of hypoxia, oxidative stress and proximal tubules damage at days 7 and 14.

Conclusions: Perinatal oxidative stress is associated with a variable degree of kidney damage detectable at birth and continuing up to 14 days.
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http://dx.doi.org/10.1016/j.clinbiochem.2007.01.012DOI Listing
June 2007

Sensorial saturation for neonatal analgesia.

Clin J Pain 2007 Mar-Apr;23(3):219-21

Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy.

Aim: Sensorial saturation (SS) is a procedure in which touch, massage, taste, voice, smell, and sight compete with pain, producing almost complete analgesia during heel prick in neonates. SS is an apparently complex maneuvre, but when correctly explained it is easily learnt. In the present paper, we studied its feasibility, assessing whether a long training is really needed to achieve good results.

Materials And Methods: We enrolled 66 consecutive babies and divided them randomly into 3 groups which received the following forms of analgesia: glucose plus sucking (A), SS performed by nurses (B), SS performed by mothers (C). We did not use perfume on the caregivers' hands, so that babies could smell the natural scent of the hands. We assessed pain level by the ABC scale.

Results: Median scores of groups A, B, and C were: 1 (0 to 6), 0 (0 to 4), and 0 (0 to 6), respectively. Mean scores were: 0.6, 0.6, and 1.7 and standard errors were 0.38, 0.22, and 0.32, respectively. Scores of groups B and C were significantly lower than that of A (P=0.03 and 0.006, respectively). No significant difference was found between values of scores of groups B and C.

Conclusions: Even without the use of perfume on the hands, SS was effective as an analgesic maneuvre. It made no difference whether SS was performed by mothers who applied it for the first time or experienced nurses. SS is rapid to learn and any caregiver (mother, pediatrician or nurse) can effectively use it.
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http://dx.doi.org/10.1097/AJP.0b013e31802e3bd7DOI Listing
April 2007