Developmental language disorder: Early predictors, age for the diagnosis, and diagnostic tools. A scoping review

Background. Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children. Methods. We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies. Results. Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy. Conclusions. Monitoring risk situations and employing caregivers\u2019 reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions

Impact of Chronic Lung Disease on Very Low Birth Weight infants: a collaborative study of the Italian Group of Neonatal Pneumology

Objective. To evaluate the incidence and risk factors for chronic lung disease in a population of very low birth weight infants. Methods. In a prospective multicentric trial all very low birth weight infants (< 1500 g) accepted in 36 Italian Neonatal Intensive care units were studied from February 89 to January 99. For each patient were recorded maternal history, perinatal events, respiratory disease, infections, patent ductus arteriosus, retinopathy of prematurity, intraventricular haemorrhage and final outcome. Logistic regression analysis was performed in a multivariate assessment of risk factors for chronic lung disease. Results. In the study were included 1634 patients: 1387 infants survived beyond 36 weeks and 6.9% of them still oxygen dependent. The incidence of chronic lung disease was higher among babies with a gestational age of < 28 weeks and weight \ub2 1000 g. The multivariate analysis showed that low birth weight, respiratory distress syndrome, persistent ductus arteriosus and sepsis were the main risk factors. Conclusions. In our study the incidence of chronic lung disease was relatively lo

2004-2015 - 12 anni di screening uditivo neonatale universale. Il significato della continuit\ue0 assistenziale e l\u2019importanza del follow-up.

Scopo dello studio: Valutazione dei risultati dello screening uditivo neonatale universale ottenuti nel corso di 12 anni presso l\u2019ospedale di Treviso utilizzando una metodologia di screening basata sulla registrazione rispettivamente delle Transient Otoacoustic Emissions (TOAEs) al Nido e delle TOAEs e dell\u2019Automatic Auditory Brainstem Responses (aABR) presso la Terapia Intensiva Neonatale (TIN). Metodi: sono stati esaminati i risultati dello screening uditivo neonatale universale effettuato presso l\u2019ospedale \u201cS.M. di Ca\u2019 Foncello\u201d di Treviso a partire da gennaio 2004 e fino al 31 ottobre 2015. Sono stati valutati: la copertura garantita dallo screening uditivo neonatale, i risultati dello screening di primo e secondo livello, l\u2019incidenza dell\u2019ipoacusia, la strategia riabilitativa e il follow-up. Sono stati analizzati separatamente i risultati corrispondenti a due periodi di studio, caratterizzati da due differenti protocolli di screening applicati al NIDO: nel periodo 2004-2012 venivano segnalati come \u201cFAIL\u201d solo i bambini in cui le TOAEs erano assenti bilateralmente, mentre a partire dal 2013 vengono segnalati come \u201cFAIL\u201d tutti i bambini le cui TOAEs risultano assenti almeno in un orecchio. Risultati: In quasi 12 anni di screening uditivo neonatale universale, sono stati esaminati 30332 neonati, corrispondente ad una copertura dei neonati superiore al 98%. Di questi, oltre il 90% \ue8 stato sottoposto a screening uditivo mediante il rilievo delle TOAEs presso il NIDO e circa il 9% mediante TOAEs e AABR presso la TIN. Tra i bambini esaminati al NIDO, hanno superato lo screening neonatale di primo livello il 95,2% dei bambini, mentre sono risultati \u201cFAIL\u201d il 4,8%. Per quanto riguarda i bambini ricoverati in TIN sottoposti a screening di primo livello, il tasso di \u201cFAIL\u201d \ue8 stato dell\u201919.5%.I falsi positivi sono stati 0,96%. Sono stati cos\uec identificati 42 bambini ipoacusici, confermando un tasso di prevalenza dell\u2019ipoacusia di 1,38/1000 neonati (1/649). Discussione: Lo screening uditivo neonatale universale attivo presso l\u2019ospedale di Treviso a partire da gennaio 2004 si colloca, con una copertura dell\u2019oltre 98% dei neonati, ben al di sopra della percentuale del 95% raccomandata dagli studi pi\uf9 accreditati presenti in letteratura. Il tasso di prevalenza dell\u2019ipoacusia congenita di 1,38/1000 risulta in linea con i dati di precedenti esperienze di screening. E\u2019 importante sottolineare che quasi la met\ue0 dei bambini ipoacusici accertati provenivano dal Nido, e in soli 3 di loro era individuabile un fattore di rischio per ipoacusia. Inoltre, considerando i due periodi presi in esame, la modifica del criterio di \u201cPass-Fail\u201d presso il Nido ha permesso di individuare i bambini affetti da ipoacusia monolaterale con conseguente attuazione di una strategia di follow-up. Conclusioni: lo screening uditivo neonatale universale rimane il cardine della strategia di identificazione precoce delle ipoacusie infantili congenite e dell\u2019avvio tempestivo della riabilitazione. L\u2019estensione dello screening a tutti i neonati, ha permesso di fatto di raddoppiare, rispetto al decennio precedente quando lo screening era basato sul registro di rischio, il numero di bambini identificati e trattati precocemente con conseguente miglioramento della storia naturale dell\u2019ipoacusia

Thermal management with and without servo-controlled system in preterm infants immediately after birth: a multicentre, randomised controlled study

Background: The thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed. Objective: To compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth. Study design and setting: Multicentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals. Participants: Infants with estimated birth weight <1500 g and/or gestational age <30+6 weeks. Intervention: Thermal management with or without a thermal servo-controlled system during stabilisation in the delivery room. Primary outcome: Proportion of normothermia at NICU admission (axillary temperature 36.5\ub0C-37.5\ub0C). Results: At NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36\ub0C-36.4\ub0C) (risk ratio 1.48, 95% CI 1.09 to 2.01). Conclusions: In very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge. Trial registration number: NCT0384420

Developmental care, neonatal behavior and postnatal maternal depressive symptomatology predict internalizing problems at 18 months for very preterm children

OBJECTIVE: To provide a prospective developmental model for behavioral outcomes in preterm infants in relation to developmental care (DC) practices and postnatal maternal depression. STUDY DESIGN: A longitudinal, multicenter, follow-up study conducted in 25 Italian tertiary neonatal intensive care units (NICUs). Participants were 162 healthy very preterm infants and their mothers. The level of quality of DC was assessed for each hospital. Infant's neurobehavioral profile was evaluated twice: at discharge (T1) and at 18 months for behavioral problems (T3). Maternal depressive symptomatology was measured at T1 and at 6 months (T2). RESULTS: Low-quality DC in NICUs was associated with lower levels of infant neurobehavioral adaptability and higher levels of maternal depressive symptoms. Maternal depressive symptomatology in conjunction with higher infant dysregulation predicted more internalizing problems at 18 months of age. CONCLUSION: DC interventions and postnatal maternal depression, as well as infant behavior have an impact on short- and long-term infant outcomes

Post-discharge nutrition of the very low-birthweight infant: Interim results of the multicentric GAMMA study

This report presents the interim results up to 12 mo corrected age (c.a.) of a multicentric, prospective, controlled study on very low-birthweight infants, randomized at 40 wk post-conception in two different groups of formula feeding: 80 Kcal/dL (group A) vs 70 Kcal/dL (group B) up to 55 wk of postconceptional age. Subsequently, all the babies were fed with a follow-on formula, with the introduction of solid foods at 6 mo c.a. Weight, length, head circumference and neurological conditions with psychomotor development (evaluated by the Griffiths' Developmental Scale) were measured at regular intervals and all of these parameters were satisfactory in both groups. For growth, in group A there was a greater increase in weight in boys at 55 wk and at 6 mo c.a., and small for gestational age (SGA) babies had a greater increase in length at 1 y of age, while head circumference caught up on growth from week 40 to week 55. Measured by the Griffiths' Developmental Scale, the SGA group fed 80 Kcal/dL had a better score at 6 mo; similarly boys fed 80 Kcal/dL had a better score at 6 and at 9 mo. Conclusion: Nutrition of very low birthweight infants post-discharge could have an influence on physical growth and on neurodevelopmental outcome. This interim report needs to be confirmed at the end of the study

Post-discharge nutrition of the very low-birthweight infant: Interim results of the multicentric GAMMA study

This report presents the interim results up to 12 mo corrected age (c.a.) of a multicentric, prospective, controlled study on very low-birthweight infants, randomized at 40 wk post-conception in two different groups of formula feeding: 80 Kcal/dL (group A) vs 70 Kcal/dL (group B) up to 55 wk of postconceptional age. Subsequently, all the babies were fed with a follow-on formula, with the introduction of solid foods at 6 mo c.a. Weight, length, head circumference and neurological conditions with psychomotor development (evaluated by the Griffiths' Developmental Scale) were measured at regular intervals and all of these parameters were satisfactory in both groups. For growth, in group A there was a greater increase in weight in boys at 55 wk and at 6 mo c.a., and small for gestational age (SGA) babies had a greater increase in length at 1 y of age, while head circumference caught up on growth from week 40 to week 55. Measured by the Griffiths' Developmental Scale, the SGA group fed 80 Kcal/dL had a better score at 6 mo; similarly boys fed 80 Kcal/dL had a better score at 6 and at 9 mo. Conclusion: Nutrition of very low birthweight infants post-discharge could have an influence on physical growth and on neurodevelopmental outcome. This interim report needs to be confirmed at the end of the study