Francesca Moscuzza

In neonatal endotracheal intubation, excessive pressure on soft tissues during laryngoscopy can determine permanent injury. Low-fidelity skill trainers do not give valid feedback about this issue. This study describes the technical realization and validation of an active neonatal intubation skill trainer providing objective feedback. We studied expert health professionals’ performances in neonatal intubation, underlining chance for procedure retraining. We identified the most critical points in epiglottis and dental arches and fixed commercial force sensors on chosen points on a ©Laerdal Neonatal Intubation Trainer. Our skill trainer was set up as a grade 3 on Cormack and Lehane’s scale, i.e. a model of difficult intubation. An associated software provided real time sound feedback if pressure during laryngoscopy exceeded an established threshold. Pressure data were recorded in a database, for subsequent analysis with non-parametric statistical tests. We organized our study in two intubation sessions (5 attempts each one) for everyone of our participants, held 24 h apart. Between the two sessions, a debriefing phase took place. In addition, we gave our participants two interview, one at the beginning and one at the end of the study, to get information about our subjects and to have feedback about our design. We obtained statistical significant differences between consecutive attempts, with evidence of learning trends. Pressure on critical points was significantly lower during the second session (p < 0.0001). Epiglottis’ sensor was the most stressed (p < 0.000001). We found a significant correlation between time spent for each attempt and pressures applied to the airways in the two sessions, more significant in the second one (shorter attempts with less pressure, rs = 0.603). Our skill trainer represents a reliable model of difficult intubation. Our results show its potential to optimize procedures related to the control of trauma risk and to improve personnel retraining.

Incomplete Kawasaki disease represents a diagnostic challenge for pediatricians. In the absence of classical presentation, the laboratoristic evaluation of systemic inflammation can help in placing the correct diagnosis to promptly start adequate therapy. Erythema multiforme is an acute, self-limiting condition considered to be a hypersensitivity reaction commonly associated with various infections or medications. This aspecific skin condition has been rarely described as a sign of Kawasaki disease. We report on the case of a 4 years old boy presenting high-grade fever associated with erythema multiforme and evidence of systemic inflammation who showed a good response to prompt treatment with intravenous immunoglobulins.

Esophageal atresia (EA) and imperforate anus are congenital disorders with an incidence that ranges between 1/4000 and 1/5000 births. The aim of this work was to assess the incidence of these malformations in northwest Tuscany and the associated anomalies in comparison with the data published by the Tuscan Congenital Diseases Registry. A retrospective study was made analyzing the cases of these malformations in the years 1994-2007 on a total of 25051 births at the Division of Neonatology of S. Chiara Hospital, Pisa. The authors found 14 cases of EA and 5 cases of imperforate anus. In these case histories of EA and imperforate anus the incidence was 1/1800 and 1/5000 respectively in comparison with the data issued by the Tuscan Congenital Diseases Registry with an incidence of 1/6644 and 1/1403 in all Tuscany. Five cases of EA (35%) and 2 cases of imperforate anus (40%) were associated with other congenital malformations. Our retrospective study shows a higher incidence of EA in northwest Tuscany than in all the rest of Tuscany unlike the incidence of imperforate anus that it is the same of the rest of Tuscany. In both cases isolated form is most frequent than syndromic one.

Introduction. Placental anatomopathologic lesions are usually associated with pregnancy complications and neonatal impaired outcome. Patients and methods. We included in our study 122 patients with gestational age of 26–35 weeks. From the analysis of three pathological aspects (chorioamnionitis, funisitis and chronic hypoxia), a score was assigned to each lesion depending on the severity of the alteration, to establish a correlation with an impaired neonatal outcome in preterm newborns. Results. We found a correlation between chronic hypoxia and preeclampsia, intrauterine growth restriction and/or small-for-gestational age status at birth. Our results also showed the strong association of fetal placental inflammatory status (chorioamnionitis and funisitis) with premature rupture of membranes, very low birth weight, birth at/before 32 gestational weeks, late-onset sepsis, patent duct arteriosus, intraventricular haemorrhage (IVH) and retinopathy of prematurity (ROP). Conclusions. We confirm that placental lesions are associated with impaired pregnancy and neonatal outcome. During pregnancy it may be useful to identify some markers of inflammatory status and chronic hypoxia for an early diagnosis and a detailed monitoring of pregnancy course. Placental pathological analysis is very important to predict the risk of developing serious complications of preterm birth as ROP and IVH.