Mariateresa Sinelli

Advances in antiretroviral therapy (ART) have dramatically reduced the risk of mother-to-child transmission (MTCT) of HIV, leading to substantial changes in obstetric management. However, data describing the implementation of updated recommendations in routine clinical practice, particularly regarding mode of birth after a previous cesarean section (CS) and delayed cord clamping (DCC), remain limited. We aimed to evaluate temporal changes in intrapartum and postpartum management among women living with HIV (WLWH) over a 17-year period at a tertiary referral center. We conducted a retrospective cohort study including all WLWH who delivered at a university hospital between January 2009 and December 2025. Pregnancies were categorized into three periods according to major changes in national recommendations on mode of birth: 2009–2013, 2014–2018, and 2019–2025. Maternal HIV characteristics, ART, obstetric management, and delivery and neonatal outcomes were compared among study periods. Sixty-three women had 83 pregnancies during the study period. The proportion of women receiving ART at conception increased significantly over time (p < 0.001), paralleled by a shift toward contemporary antiretroviral regimens. At delivery, only three women had a viral load ≥50 copies/mL, all during the earliest study period. Planned pre-labor CS declined significantly (p < 0.001), whereas vaginal delivery increased, reaching 51.8% in 2019–2025, without any case of vertical HIV transmission. Among women with a previous CS managed after 2014, the acceptance rate of a trial of labor after CS (TOLAC) was 53.3%. All women declining TOLAC cited fear of HIV transmission despite viral suppression. DCC was performed in 89.4% of newborns, with no adverse neonatal outcomes attributable to the procedure. Contemporary multidisciplinary management of WLWH enables high rates of viral suppression, increasing use of vaginal birth, and implementation of DCC with no case of vertical transmission observed. Given the sample size and observational design, these findings are reassuring but not conclusive. Nevertheless, previous HIV-related cesarean delivery continues to influence women’s decisions regarding mode of birth in subsequent pregnancies, highlighting the need for individualized counseling to facilitate evidence-based shared decision-making.

Introduction: Very preterm infants have reduced nephron number, particularly with fetal growth restriction (FGR). We hypothesized that FGR infants show a different serum creatinine (SCr) trajectory in the first 30 days of life. Methods: We conducted a retrospective longitudinal study of infants <32 weeks’ gestation and/or <1500 g admitted between January 2016 and December 2024. FGR was defined as estimated fetal weight <3rd centile. Groups were matched by gestational age (GA). Results: Among 229 infants (31% FGR), SCr was higher at lower GA. Baseline SCr did not differ between groups. However, FGR infants showed a greater decline between postnatal days 2–5 compared to matched controls. Conclusion: SCr centiles were similar between groups, but FGR infants showed a faster early decline, suggesting differences in early renal adaptation.

Background To evaluate the incidence and potential predisposing factors for the development of acute kidney injury (AKI) in asphyxiated neonates undergoing hypothermic treatment. Methods This retrospective study was conducted at the Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. All neonates above 34 weeks of gestation diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with hypothermia, weighing more than 1800 g, admitted from January 1, 2013 to December 31, 2022, were included. AKI was defined according to the neonatal KDIGO classification. Results A total of 75 neonates were enrolled, including 13 (17%) with severe HIE. The incidence of AKI was 35%, with 62% of cases identified as a reduction in diuresis, 27% as changes in creatinine and oliguria, and only 11% as isolated creatinine elevation. The rate of AKI was significantly higher in infants with severe HIE (p < 0.001). The development of AKI added significantly (aOR = 41.2, p = 0.007) to the probability of death, even after adjusting for severe HIE. Infants who developed AKI required more inotropes, had higher rates of hyponatremia (serum sodium < 125 mEq/L), and were less likely to normalize lactate levels within 24 h of birth. Conclusions In asphyxiated newborns, reduced kidney perfusion can cause kidney impairment in nearly 40% of those undergoing treatment. Enhancing the detection of AKI is crucial for improving patient outcomes. We recommend proactive monitoring of lactate trends, urinary output, and serum sodium levels to enable early interventions that protect kidney function and improve outcomes for these vulnerable infants. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

Background To evaluate the incidence and potential predisposing factors for the development of acute kidney injury (AKI) in asphyxiated neonates undergoing hypothermic treatment. Methods This retrospective study was conducted at the Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. All neonates above 34 weeks of gestation diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with hypothermia, weighing more than 1800 grams, admitted from January 1, 2013, to December 31, 2022, were included. AKI was defined according to the neonatal KDIGO classification. Results A total of 76 neonates were enrolled: 13 (17%) with severe HIE. The incidence of AKI was 36%, with 64% of cases identified as a reduction in diuresis, 25% as changes in creatinine and oliguria, and only 10% as isolated creatinine elevation. The rate of AKI was significantly higher in infants with severe HIE (p < 0.001). Infants who developed AKI required more inotropes, had higher rates of serum hyponatremia (< 125 mEq/L) and were less likely to normalize lactate levels within 24 hours of birth. Conclusions In asphyxiated newborns, reduced kidney perfusion can cause kidney impairment in nearly 40% of those undergoing treatment. Enhancing the detection of AKI is crucial for improving patient outcomes. We recommend proactive monitoring of lactate trends, urinary output, and serum sodium levels to enable early interventions that protect kidney function and improve outcomes for these vulnerable infants.

Cytomegalovirus (CMV) is the leading infectious cause of brain defects and neurological dysfunctions, including sensorineural hearing loss (SNHL). Targeted screening in neonates failing the hearing screen is currently recommended in Italy according to national guidelines. However, SNHL may not be present at birth; also, congenital CMV (cCMV) may manifest with subtle signs other than SNHL. Therefore, the inclusion of additional criteria for cCMV screening appears clinically valuable. Starting January 2021, we have implemented expanded targeted cCMV screening at our center, with testing in case of maternal CMV infection during pregnancy, inadequate antenatal care, maternal HIV infection or immunosuppression, birthweight and/or head circumference < 10th centile, failed hearing screen, and prematurity. During the first three years of use of this program (2021–2023), 940 (12.3%) of 7651 live-born infants were tested. The most common indication was birthweight < 10th centile (n = 633, 67.3%). Eleven neonates were diagnosed as congenitally infected, for a prevalence of 1.17% (95%CI 0.48–1.86) on tested neonates and of 0.14% (95%CI 0.06–0.23) on live-born infants. None of the cCMV-infected newborns had a failed hearing screen as a testing indication. Implementation of an expanded cCMV screening program appears feasible and of clinical value.

Cytomegalovirus (CMV) is the leading infectious cause of brain defects and neurological dysfunctions, including sensorineural hearing loss (SNHL). A targeted screening in neonates failing the hearing screen is currently recommended in Italy according to national guidelines. However, SNHL may not be present at birth; also, congenital CMV (cCMV) may manifest with subtle signs other than SNHL. Therefore, inclusion of additional criteria for cCMV screening appears clinically valuable. Starting January 2021, we have implemented an expanded targeted cCMV screening at our center, with testing in case of maternal CMV infection during pregnancy, inadequate antenatal care, maternal HIV infection or immunosuppression, birthweight and/or head circumference.

Background Preterm birth alters nephrogenesis and reduces the total nephron number. Intrauterine growth restriction (IUGR) seems to worsen nephron loss, but only a few studies have investigated its role in neonatal kidney impairment. We investigated whether IUGR, defined as reduced estimated fetal growth and/or placental flow alterations and low birth weight z-score, increases the risk of developing acute kidney injury (AKI) in very preterm infants. Methods We performed a retrospective study including infants born with a birth weight (BW) ≤ 1500 g and/or gestational age (GA) ≤ 32 weeks admitted to our center between January 2016 and December 2021. Neonatal AKI was defined according to the neonatal KDIGO classification based on the decline of urine output and/or creatinine elevation. We used multivariable linear regressions to verify the association between AKI and GA, BW z-score, IUGR definition, and hemodynamically significant patent ductus arteriosus (PDA). Results We included 282 infants in the analysis, with a median (IQR) GA = 29.4 (27.4, 31.3) weeks, BW = 1150 (870, 1360) g, and BW z-score = − 0.57 (− 1.64, 0.25). AKI was diagnosed in 36 (13%) patients, and 58 (21%) had PDA. AKI was significantly associated with BW z-score (beta (std. error) = − 0.08 (0.03), p = 0.008) and severe IUGR (beta (std. error) = 0.21 (0.08), p = 0.009), after adjusting for GA and PDA. Conclusions Our data suggest that low BW z-score and IUGR could represent adjunctive risk factors for kidney impairment in preterm babies. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

Article: Prenatal use of indomethacin for preterm labor and renal function among very low birth weight infants - Minerva Obstetrics and Gynecology 2023 Feb 14 - Minerva Medica - Journals

We describe a case of neonatal SARS-CoV-2 infection, in an infant diagnosed 3 days after birth, and manifesting with silent hypoxemia, requiring respiratory support.