Kangaroo mother care: four years of experience in very low birth weight and preterm infants.

Abstract AIM: Kangaroo Mother Care (KMC) is a method of providing care for preterm infants through skin-to-skin contact with the mother and, preferably, exclusive breastfeeding. The growing interest in KMC at the Neonatology Unit of Pisa has provided the occasion for a retrospective analysis of the last four years, comparing the clinical effects of the kangaroo method vs. those obtained with conventional care (CNC) with respect to indicators of the general health of the infants (indices of growth, and duration of breastfeeding and hospitalization). METHODS: A total of 213 infants, aged <37 gestational weeks and weighing ≤1500 g were enrolled for the study; these were divided into two groups for the purpose of comparison (91 in KMC vs. 71 in CNC). RESULTS: The indices of growth and the duration of the infants in hospital were not significantly different in the two groups. Nevertheless, it is worth noting how KMC is more efficacious in the very tiny VLBW infants, and that the means of the growth parameters in the KMC infants are greater than those referring to the CNC subjects, body temperatures taken at the beginning and end of a KMC session are higher, and that the mother-child relationship facilitates better sucking-feeding. CONCLUSION: While KMC is equivalent to CNC in terms of safety, thermal protection, morbidity and auxologic development, it appears to promote humanisation of infant care and mother-child bond more quickly

Low testosterone levels in pre-term newborns born small for gestational age

Previous studies showed that small for gestational age (SGA) newborns have an increased prevalence of hypospadias and other congenital defects of external genitalia. We observed that in the first days of life, SGA male pre-term newborns have reduced testosterone levels compared with adequate for gestational age pre-term newborns, independently from the presence of abnormalities of the external genitalia. (J. Endocrinol. Invest. 33: 215-217, 2010) (C) 2010, Editrice Kurti

Education in neonatology by simulation: between reality and declaration of intent

An unexpected event is not rare in Neonatology and can be dramatic: the operators must act with the right skills and abilities in the shortest time. Often it is a team effort and each member must be trained adequately. According to the "Swiss cheese" model by J. Reason, an accident is never the consequence of a single error, but the very final result of a chain of misunderstandings, irregularities or negligence (cheese holes): several holes allow the final medical error. Therefore, we should avoid those holes in our work. The clinical risk is always around the corner. The legal issues are becoming more and more relevant and lead to a defensive medicine, which is definitely not the best practice. For this reason, raising the safety standards is mandatory. With this purpose, after a decade of experience in "traditional" training courses, we started testing a new strategy of continuous education in Neonatology by means of high-fidelity simulation. Since 2008, we have arranged and managed a Center for Neonatal Simulation and Advanced Training in the Neonatology Unit of the University Hospital of Pisa. We have already delivered courses to pediatricians, neonatologists, anesthesiologists, gynecologists, emergency doctors, midwives and nurses, using an advanced Laerdal SimNewB simulator to teach diagnostic and therapeutic skills or communication strategies. The model has been proposed to the Italian Society of Neonatology and it has been decided to create a Task Force to discuss our model and encourage to use it in other Italian areas

Disorders of Sexual Development.

A difficulty to recognize at birth a male from a female newborn due to the presence of \u201cambiguous genitalia\u201d is a rare event, but abnormalities of the external genitalia that need further investigation may occur in about 1 in 4000 birth. Terms as intersex, hermaphroditism or pseudohermaphroditism have been considered unacceptable by affected individuals and support groups. Thus, a new nomenclature has been proposed. According to karyotype, DSD are divided in disorders with normal or abnormal sex chromosomes. DSD with karyotype abnormalities include diseases in which the number of sex chromosome is impaired. In 46, XX DSD three different groups of disorders may be described: a) disorders of ovarian development, b) disorders of androgen excess, including congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD), which is the commonest cause of ambiguous genitalia of the newborn and c) other conditions affecting sex development (some syndromic associations that can cause developmental genital abnormalities in 46,XX girls). 46,XY DSD are divided into: (1) disorders of gonadal development, (2) disorders of testosterone byosinthesis, metabolism or action, (3) other conditions. Initial management of DSD depends on establishing an early diagnosis, which is just as important as in other chronic medical conditions leading to life-long consequences. However, reaching a certain diagnosis may be difficult in many cases. To this purpose, discussion between a multidisciplinary medical team and the parents must be open, and parents\u2019 participation in decision-making should be encouraged