La patologia polmonare cronica nel neonato pretermine

La patologia polmonare cronica nel neonato pretermin

Photoprevention or phototherapy in newborn infants born prematurely?

The authors studied the effects of different kinds of phototherapy in 186 newborns with a gestational age less than 33 weeks and weighing less than 2500 g. A control group of 60 infants was compared with a group of 31 infants submitted to photoprophylaxis, a group of 54 infants treated with day light, and a group of 41 infants treated with day light + special blue light. As far as the serum bilirubin variations in the first week, the maximum levels attained and the number of exchange transfusions are concerned, phototherapy always proved effective in reducing potentially neurotoxic serum bilirubin concentrations. Among the infants subjected to treatment, those treated with the day light showed a significant smaller decrease of serum bilirubin compared to those treated with the day light + special blue light, even if levels above 15 mg/dl were found in a similar percentage. Only 3.2% of the babies treated with photoprophylaxis showed serum bilirubin values above 15 mg/dl. The authors conclude that prophylaxis seems to be preferable to other phototherapeutic schedules used in the treatment of hyperbilirubinemia in low gestational age infants

Miastenia grave in gravidanza: ripercussioni materne e neonatali.

Miastenia grave in gravidanza: ripercussioni materne e neonatali

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys