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Cappellari, Ambra (2014) Nascita pretermine nella Regione Veneto: outcome a breve e lungo termine in uno studio di coorte area based. [Tesi di dottorato]

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Abstract (inglese)

Preterm birth, defined as the birth of a baby of less than 37 weeks gestational age, has a number of consequences at social, ethical, economic and health care level. These consequences affect both hospital health care programs, local programs and prevention plans. The rapid and remarkable innovation of assistance methods and of equipment in the Neonatal Intensive Care Unit has allowed a gradual increase of survival rates of extremely low weight and low gestational age premature infants. Several studies have demonstrated that premature and extremely premature infants show severe short, medium and long-term clinical outcomes, in particular neurological and neurosensorial outcomes. However, long-term follow-ups of infants cohorts selected by area-based surveillance are not available.
The aim of this study is to analyse the clinical outcomes of preterm infants in the Veneto Region by means of a follow-up assessment of short, medium and long-term health outcomes according to gestational age, in particular for extremely low weight and extremely low gestational age premature infants.
The study has been divided into different phases. In the first preliminary phase a stratification sampling of population has been carried out on the basis of the gestational age of all infants born in the Veneto Region from 2003 to 2009. For this phase the current flow of the Certificate of Delivery Care (CEDAP) has been used. This flow has been mandatory since 2001 and records all newborns of the Region, it contains information on the infant (gender, weight, length, head circumference, gestational age, major resuscitation care in case of assisted intubation and ventilation and medical cardiac resuscitation, minor resuscitation care in case of aspiration and cardiac massage, infant’s admission in neonatal intensive care unit, possible malformations and possible cause of infant mortality), on the delivery (single or multiple, natural or cesarean, possible type of pain relief and type of anesthetic, maternal complications), on pregnancy (number of tests and ultrasound scans, prenatal diagnosis, course of pregnancy: physiological or pathological, threatened abortion, threatened preterm labour, infectious diseases, infections of the genitourinary tract, diabetes and gestosis) and on the mother and the father (age, education, job, marital status, exposure to risk factors such as smoke).
Stratification sampling has been carried out according to the gestational week (GW) from 20 GW to 42 GW. In particular, all newborns ≤ 28 gestational weeks in the above mentioned period have been considered. Patients cohorts have thus been arranged and the cohorts of infants born in 2005 and from 2007 to 2009 have been studied. In the next phase, starting from current statistics, patients’ natural history has been reconstructed, when possible, by means of death certificates (ISTAT) in order to assess survival, hospital discharge records for recoveries, intercurrent acute pathologies and chronic pathologies, information flow on the rehabilitation activity ex art. 26 L 833/1978 of the Veneto Region in order to assess the admission to rehabilitative services and the flow Rare Diseases Registry.
In particular, the “chronic” patients have been identified, defined as subjects with at least 2 hospitalizations within 12 months, both characterized by the same pathology code of hospital discharge records.
Eventually the results have been analysed: mortality, survival rate, patients affected by chronic pathologies, patients affected by rare diseases and patients who have undergone rehabilitation cycles. The patients not included in the categories described above will be sampled and assessed in follow-up after this study according to the following protocol: qualitative assessment of spontaneous motor function, qualitative assessment by means of classification systems (ABC, Gross Motor Function Measure, and, for the most severe cases, Besta scale and QUEST scale), cognitive assessment (Griffiths, WIPPSI, WISC-IV), neurosensorial assessment by means of the analysis of the Multimodal Evoked Potentials (PEV, BAEPs, SEP), assessment of neuroimaging (standard protocol and 3D brain NMRI with DTI and resting state for tractographic assessment).
During the analysed period from 2003 to 2009 in the Veneto Region 322.598 neonates have been recorded, approximately 46.000 neonates/year. 91,71% of these were born at term (>37 GW), 7,63% were born premature (<37 GW). If we consider preterm neonates, 2,13% were born before 32 GW and 0,55% are ≤ 28 GW. The recorded premature neonates ≤ 28 GW, who are 0,55% of the total amount, are approximately 1785, on average 255/year. Birth mortality total rate in neonates between 2003 and 2009 is 2,9 x 1000 in single deliveries and 8,7 x 1000 in multiple deliveries; the rate grows along with the decrease of gestational age, in particular rates of 8,3 at 36 GW for single deliveries vs 1,1 for multiple deliveries are recorded, 17,8 for single deliveries (35 GW) vs 6,0 for multiple deliveries and 117,6 for single deliveries vs 57,7 for multiple deliveries in neonates born before 28 GW.
Premature babies <28 GW increased from 201 in 2003 (0,48% of neonates in 2003) to 301 in 2009 (0,63% of neonates in 2009).
Multiple deliveries of neonates < 28 GW are 24% (20% twins, 3% multiple twins) in comparison to 1,2 % of babies born at term (2,7% twins and 0,1% multiple twins) and 3% in comparison to the total amount of deliveries.
The percentage of extremely low weight and gestational age neonates and their survival are thus growing rapidly in the Veneto Region. This is due to the growing innovation of care methods and of equipment in the Neonatal Intensive Care Units: even babies born at 20 GW are resuscitated and survive (1 baby born in 2007 recorded, 1 at 19 GW and 1 at 20 GW; in 2008 7 babies born at 21 GW, only two neonatal deaths). Our analysis shows that apparently some factors are implied in preterm birth: one factor is the mother’s age, in particular the percentage of neonates <28 GW decreases from 1,2% for mothers <24 years old to 0,8% between 25 and 29 years and 1,5% if >40 years old (relative risk RR is of 2,3). Another factor is the mother’s ethnic group: among African women and Eastern European women the percentage of preterm neonates is twice as high as among Italian women.
If we analyse the women who have delivered preterm babies, 55% are primiparas (RR 1.2), 30% report a spontaneous abortion in their anamnesis before the delivery (RR 1.8), 4% report a stillbirth before the delivery (RR 3.1) and 12% report a voluntary interruption of pregnancy (RR 2.1). 7% are smokers (RR 1.1) and 2,6% undergo medically assisted procreation or MAP (RR 2.03).
With regard to MAP, 1.8% babies are born every year; 11% of the neonates ≤28 GW were born by means of MAP vs 1% of babies born at term by means of MAP.
If we now analyse the results of neonates born < 28 GW in 2005 and 2007-2009 cohorts, in 2005 the babies who died during the first year of life are 65 (29%); the survivors are 160 (71%).
11 survivors out of the total amount are chronic patients (6.8%); 9 have been rehabilitated (5.6%); 1 affected with a rare disease has been registered (0.6%). Although they were not mentioned in the considered sources, 105 show diagnosis of complications at birth and/or during the first year of life (66%). The percentage of premature babies with severe outcomes is thus 79%. 37 are not mentioned in any source and have had no complications (23%).
From 2007 to 2009 dead babies during the first year of life are 250 (31%); survivors are 545 (69%). 61 patients out of the total amount are chronic patients (11%), 1 of them is affected by a rare disease and registered in the Rare Disease Registry, 13 have been rehabilitated (2.3%) and 3 (0.5%) report rare diseases diagnosis on the hospital discharge record; 63 are rehabilitated (12%), 15 out of these are chronic; 11 are affected by rare diseases (2.7%), only two of which are registered in the Rare Disease Registry.
Although they were not mentioned in the considered sources, 360 report diagnosis of complications at birth and/or during the first year of life (66%). The percentage of premature babies with severe outcomes is approximately 91%. 72 are not mentioned in any source and have had no complications (13%).
The percentage of neonates with severe prematurity is rising remarkably in the Veneto Region due to the growth of the survival rate of babies born between 22 and 28 GW. By means of preliminary analyses, several factors related to the mother’s history, to the reproductive history and to the pregnancy course, as well as to the neonate, can apparently determine a preterm birth. In light of these preliminary data, considering the above mentioned survival and disability rates, it is particularly important to know the babies’ natural history and to verify the short and long-term clinical outcomes in terms of impact on the health care and rehabilitation planning.

Abstract (italiano)

La nascita pretermine, definita come nascita che avviene prima di 37 settimane complete di gravidanza, comporta una serie di implicazioni sociali, etiche, economiche e sanitarie che impattano sui programmi assistenziali ospedalieri e territoriali e sui programmi preventivi di salute. La rapida e cospicua innovazione dell’assistenza e delle strumentazioni nelle Unità di Terapia Intensiva Neonatale ha prodotto negli ultimi anni un progressivo aumento della sopravvivenza dei gravi prematuri di basso peso e di bassa età gestazionale. Numerosi studi hanno dimostrato che i bambini nati prematuri ed estremamente prematuri presentano severi esiti clinici a breve e medio termine, in particolare neurologici e neurosensoriali. Non sono tuttavia disponibili follow-up a lungo termine di coorti di bambini selezionate da sorveglianze area-based.
Lo scopo di questo studio è analizzare gli esiti clinici dei nati prematuri in Regione Veneto, valutando in follow-up gli esiti di salute a breve, medio e lungo termine per età gestazionale, in particolare per i gravi prematuri di basso peso e di bassa età gestazionale.
Lo studio è stato suddiviso in diverse fasi. In una prima fase preliminare è stata condotta una stratificazione per età gestazionale della popolazione di tutti i nati in Regione Veneto nel periodo 2003-2009. Per questa fase è stato utilizzato il flusso corrente del Certificato di Assistenza al Parto (CEDAP). Tale flusso è mandatorio dal 2001 e registra tutti i nati della Regione, contiene informazioni relative al nato (sesso, peso, lunghezza, circonferenza cranica, età gestazionale, necessità di rianimazione maggiori se intubazione e ventilazione assistita e rianimazione cardiologica con farmaci, necessità di rianimazione minore se aspirazione e massaggio, necessità di ricovero del nato in reparto di cure intensive neonatali, eventuale presenza di malformazione ed eventuale causa di nati-mortalità), al parto (genere del parto: semplice o plurimo, modalità parto se spontaneo o cesareo, eventuale tipo di controllo del dolore e tipo di anestesia, complicanze materne legate al parto), alla gravidanza (numero di accertamenti eseguiti in gravidanza, numero di ecografie, indagini prenatali, decorso gravidanza se fisiologico o patologico, se patologico il tipo di condizione morbosa insorta durante la gravidanza: minacce di aborto, minaccia di parto prematuro, malattie infettive, infezioni tratto genito-urinario, diabete e gestosi) e informazioni riguardanti il padre e la madre (tra cui età, scolarità, professione, parità, stato civile, esposizione a fattori di rischio quali il fumo). La stratificazione è stata fatta per settimana gestazionale dalla 20 sg alla 42 sg. In particolare sono stati considerati tutti i nati < 28 settimane gestazionali nel periodo sovra descritto. Sono state pertanto create delle coorti di pazienti e sono state analizzate le coorti dei nati nel 2005 e nel triennio 2007-2009.
Nella fase successiva, a partire dalle statistiche correnti, sono state ricostruite le storie naturali di ciascun paziente, quando possibile, utilizzando le schede di morte (ISTAT) per valutare la sopravvivenza, le schede di dimissione ospedaliera (SDO) per le ospedalizzazioni, le patologie acute intercorrenti e patologie croniche, flusso informativo sull’attività di riabilitazione dei centri ex art.26 L 833/1978 per valutare l’accesso a servizi riabilitativi e il flusso Registro Malattie Rare.
In particolare sono stati identificati i soggetti “cronici” definiti come i soggetti con almeno 2 ospedalizzazioni nell’arco di 12 mesi caratterizzate entrambe dallo stesso codice di patologia SDO.
,Alla fine sono stati analizzati gli esiti: mortalità, sopravvivenza, soggetti affetti da patologie croniche, soggetti affetti da malattie rare e soggetti che hanno necessitato di cicli di riabilitazione. I soggetti non inclusi nella categorie sovradescritte verranno in un tempo successivo a questo studio campionati e valutati in follow up secondo il protocollo seguente: valutazione qualitativa della motricità spontanea, valutazione quantitativa mediante l’utilizzo di scale di valutazione (ABC, Gross Motor Function Measure, e, per i casi con esiti più gravi, Scala Besta e scala QUEST), valutazione cognitiva (Griffiths, WIPPSI, WISC-IV), valutazione neurosensoriale mediante studio del Potenziali Evocati Multimodali (PEV, BAEPs, SEP), valutazione di neuroimaging (RMN cerebrale con protocollo standard e 3D con DTI e resting state per la valutazione trattografica)
Nel periodo considerato 2003-2009 in Regione Veneto sono stati registrati 322.598 nati, in media circa 46.000 nati/anno. Di questi 91,71% sono nati a termine (>37 sg), 7,63% nascono prematuri (<37 sg). Se consideriamo i nati pretermine, 2,13% sono nati prima delle 32 sg e 0,55% sono <28 sg. I nati prematuri <28 sg registrati, che rappresentano lo 0,55%, sono 1785 circa, in media 255/anno. Il quoziente di natimortalità totale dei nati dal 2003 al 2009 è 2,9 x 1000 per i parti singoli e 8,7 x 1000 per i parti plurimi; tale quoziente aumenta con il decrescere dell’età gestazionale in particolare si registrano quozienti di 8,3 alla 36 sg per i parti singoli vs 1,1 per i parti plurimi , 17,8 per i parti singoli (35 sg) vs 6,0 per i parti plurimi e 117,6 per
i parti singoli vs 57,7 per i parti plurimi nei nati prima delle 28 sg.
I nati prematuri <28 sg sono passati da 201 nel 2003 (0,48% dei nati nel 2003) a 301 nel 2009 (0,63% dei nati nel 2009).
I parti plurimi dei neonati < 28 sg sono il 24% (20% gemellari e 3% plurigemellari) rispetto al 1,2 % dei nati a termine (2,7% gemellari e 0,1% trigemellari) e il 3% rispetto al totale del parti.
La percentuale di nati con prematurità grave e la loro sopravvivenza sono dunque in grande aumento nella Regione Veneto. Questo fenomeno è dovuto alla crescente innovazione dell’assistenza e delle strumentazioni nelle Unità di Terapia Intensiva Neonatale: vengono rianimati e sopravvivono anche nati dalle 20 sg (registrati 1 nati nel 2007 uno alla 19 sg e 1 alla 20 sg; nel 2008 7 nati alla 21 sg di cui solo due decessi alla nascita). Dalle nostre analisi alcuni fattori sembrano implicati nella nascita pretermine: l’età della madre è uno di questi in particolare la percentuale dei nati <28 sg passa da 1,2% per madri <24 aa allo 0,8% tra i 25 e i 29 anni e 1,5% se >40 aa (rischio relativo RR di 2,3). Un altro fattore è la cittadinanza materna: le donne africane e le donne dell’Europa dell’Est hanno una percentuale di nati pretermine doppia rispetto alle donne italiane. Se analizziamo le donne che hanno partorito dei neonati prematuri, il 55% sono primipare (RR 1,2), il 30% segnala in anamnesi un aborto spontaneo precedente al parto (RR pari a 1,8), il 4% un nato morto precedente al parto (RR 3,1) e il 12% una interruzione volontaria di gravidanza precedente (RR 2,1). Il 7% fuma (RR 1,1) e il 2,6% ricorre a una Procreazione Medicalmente Assistita o PMA (RR 2.03).
Per quanto riguarda la PMA i nati sono 1,8% all’anno; 11% dei nati <28 sg sono nati da PMA vs 1% dei nati a termine da PMA.
Se analizziamo ora gli esiti dei nati < 28 sg nelle coorti 2005 e 2007-2009, nel 2005 i morti entro il primo anno di vita sono 65 (29%); i sopravissuti sono 160 (71%).
Dei sopravissuti 11 sono pazienti cronici (6,8%); 9 sono stati riabilitati (5,6%); 1 affetto da malattia rara certificato (0,6%). 105 pur non essendo presenti nelle fonti considerate presentano diagnosi di complicazione alla nascita e/o dentro l’anno (66%). La percentuale di nati prematuri con esiti maggiori è pertanto di 79%. 37 non sono presenti in alcuna fonte né hanno avuto delle complicazioni (23%).
Nel triennio 2007-2009 i morti entro il primo anno di vita sono 250 (31%); i sopravissuti sono 545 (69%). Dei sopravissuti 61 sono pazienti cronici (11%) di cui 1 con malattia rare e certificato verificato nel flusso malattie rare, 13 riabilitati (2,3%) e 3 (0,5%) presentano diagnosi di malattie rare alla SDO; 63 sono riabilitati (12%) di questi 13 sono cronici ; 15 affetti da malattia rara (2,7%) di cui solo due con certificato di patologia rara.
360 pur non essendo presenti nelle fonti considerate presentano diagnosi di complicazione alla nascita e/o dentro l’anno (66%). La percentuale di nati prematuri con esiti maggiori è circa 91%. 72 non sono presenti in alcuna fonte né hanno avuto delle complicazioni (13%).
La percentuale di nati con prematurità grave è in grande aumento nella Regione Veneto per l’incremento della sopravvivenza dei nati tra le 22 e le 28 sg da analisi preliminari sembra che numerosi fattori relativi alla storia materna, alla storia riproduttiva e al decorso della gravidanza nonché fattori relativi al neonato possano determinare una nascita pretermine. Alla luce di questi dati preliminari, risulta particolarmente rilevante, soprattutto per le ricadute programmatorie dei servizi di assistenza e di riabilitazione, conoscere la storia naturale di questi bambini e verificarne gli esiti in termini di disabilità complesse che ne possono derivare viste le percentuali di sopravvivenza e di disabilità sovra riportate.

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Tipo di EPrint:Tesi di dottorato
Relatore:Facchin, Paola
Data di deposito della tesi:28 Gennaio 2014
Anno di Pubblicazione:30 Gennaio 2014
Parole chiave (italiano / inglese):prematurità prematurity
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/39 Neuropsichiatria infantile
Struttura di riferimento:Dipartimenti > Dipartimento di Salute della Donna e del Bambino
Codice ID:6520
Depositato il:05 Nov 2014 09:50
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March of Dimes, PMNCH, Save the Children, WHO. Born Too Soon: The Global Action Report on Preterm Birth. Eds Howson CP, Kinney MV, Lawn JE. World Health Organization. Geneva, 2012. Cerca con Google

Lumley J. Defining the problem: the epidemiology of preterm birth. BJOG. 2003;110(Suppl 20):3-7. Cerca con Google

Marlow N, Wolke D, Bracewell MA, Samara M; EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med. 2005;352(1):9-19. Cerca con Google

American Academy of Pediatrics Committee on Fetus And Newborn. Levels of neonatal care. Pediatrics. 2012;130(3):587-97. Cerca con Google

Oh W, Raju TN. Not all "term" infants are created equal. JAMA Pediatr. 2013;167(11):1001-2. Cerca con Google

Raju TN, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics. 2006;118(3):1207-14. Cerca con Google

Kugelman A, Colin AA. Late preterm infants: near term but still in a critical developmental time period. Pediatrics. 2013;132(4):741-51. Cerca con Google

Raju TN. Moderately preterm, late preterm and early term infants: research needs. Clin Perinatol. 2013;40(4):791-7. Cerca con Google

Raju TN. Epidemiology of Late Preterm (Near-Term) Births. Clin Perinatol. 2006;33(4):751-63. Cerca con Google

American Academy of Pediatrics and the American College of Obstetricians and Gynecologistis. Guidelines for Perinatal Care. 5th edition. Elk Grove Village (IL); 2005. Cerca con Google

Ofek Shlomai N, Reichman B, Lerner-Geva L, Boyko V, Bar-Oz B; The Collaboration with the Israel Neonatal Network. Population-based study shows improved postnatal growth in preterm very low birth weight infants between 1995 and 2010. Acta Paediatr. 2014. doi: 10.1111/apa.12569. [Epub ahead of print]. Cerca con Google

Menon R. Spontaneous preterm birth, a clinical dilemma: etiologic, pathophysiologic and genetic heterogeneities and racial disparity. Acta Obstet Gynecol Scand. 2008;87(6):590-600. Cerca con Google

Nguyen RH, Wilcox AJ. Terms in reproductive and perinatal epidemiology: I. Reproductive terms. J Epidemiol Community Health. 2005;59(11):916-9. Cerca con Google

Nguyen RH, Wilcox AJ. Terms in reproductive and perinatal epidemiology: 2. Perinatal terms. J Epidemiol Community Health. 2005;59(12):1019-21. Cerca con Google

Borg F, Gravino G, Schembri-Wismayer P, Calleja-Agius J. Prediction of pretermbirth. Minerva Ginecol. 2013;65(3):345-60. Cerca con Google

Dong Y, Chen SJ, Yu JL. A systematic review and meta-analysis of long-term development of early term infants. Neonatology. 2012;102(3):212-21. Cerca con Google

Menon R, Torloni MR, Voltolini C, Torricelli M, Merialdi M, Betrán AP, Widmer M, Allen T, Davydova I, Khodjaeva Z, Thorsen P, Kacerovsky M, Tambor V, Massinen T, Nace J, Arora C. Biomarkers of spontaneous preterm birth: an overview of the literature in the last four decades. Reprod Sci. 2011;18(11):1046-70. Cerca con Google

Nazari M, Zainiyah SY, Lye MS, Zalilah MS, Heidarzadeh M. Comparison of maternal characteristics in low birth weight and normal birth weight infants. East Mediterr Health J. 2013;19(9):775-81. Cerca con Google

Schaaf JM, Liem SM, Mol BW, Abu-Hanna A, Ravelli AC. Ethnic and racial disparities in the risk of preterm birth: a systematic review and meta-analysis. Am J Perinatol. 2013;30(6):433-50. Cerca con Google

Mortensen LH, Helweg-Larsen K, Andersen AM. Socioeconomic differences in perinatal health and disease. Scand J Public Health. 2011;39(7 Suppl):110-4. Cerca con Google

Culhane JF, Goldenberg RL. Racial disparities in preterm birth. Semin Perinatol. 2011;35(4):234-9. Cerca con Google

Hauck FR, Tanabe KO, Moon RY. Racial and ethnic disparities in infant mortality. Semin Perinatol. 2011;35(4):209-20. Cerca con Google

Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med. 2010;39(3):263-72. Cerca con Google

Räisänen S, Gissler M, Saari J, Kramer M, Heinonen S. Contribution of risk factors to extremely, very and moderately preterm births - register-based analysis of 1,390,742 singleton births. PLoS One. 2013;8(4):e60660. Cerca con Google

Räisänen S, Gissler M, Sankilampi U, Saari J, Kramer MR, Heinonen S. Contribution of socioeconomic status to the risk of small for gestational age infants--a population-based study of 1,390,165 singleton live births in Finland. Int J Equity Health. 2013;12:28. Cerca con Google

Vinnars MT, Nasiell J, Holmström G, Norman M, Westgren M, Papadogiannakis N. Association between placental pathology and neonatal outcome in preeclampsia: a large cohort study. Hypertens Pregnancy. 2013:4. [Epub ahead of print]. Cerca con Google

Kaufmann P, Black S, Huppertz B. Endovascular trophoblast invasion: implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biol Reprod. 2003;69(1):1-7. Cerca con Google

Kovo M, Schreiber L, Bar J. Placental vascular pathology as a mechanism of disease in pregnancy complications. Thromb Res. 2013;131 Suppl 1:S18-21. Cerca con Google

Di Renzo GC, Roura LC. European Association of Perinatal Medicine Study Group on Preterm Birth. Guidelines for the management of spontaneous preterm labor. J Perinat Med. 2006;34(5):359-366. Cerca con Google

Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Preterm Birth: Causes, Consequences, and Prevention. Institute of Medicine (US); Behrman RE, Butler AS, editors. Washington (DC): National Academies Press (US);2007. Cerca con Google

Ronconi A, Corchia C, Bellù R, gagliardi L, Mosca F, Zanini R, Donati S. Esiti dei neonati di basso peso nelle Terapie Intensive Neonatali partecipanti all’Italian National Network nel 2008. Roma: Istituto Superiore di Sanità; 2011(Rapporti ISTISAN 11/44). Cerca con Google

Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75-84. Cerca con Google

Zeitlin J, Draper ES, Kollée L, Milligan D, Boerch K, Agostino R, Gortner L, Van Reempts P, Chabernaud JL, Gadzinowski J, Bréart G, Papiernik E; MOSAIC research group. Differences in rates and short-term outcomes of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort. Pediatrics 2008;121(4):e936-44. Cerca con Google

EURO-PERISTAT Project, with SCPE, EUROCAT, EURONEOSTAT. European Perinatal Health Report. Data from 2004. Euro-Peristat; 2008 Vai! Cerca con Google

Ministero della Salute, Dipartimento della Qualità, Direzione Generale del Sistema Informativo, Ufficio di Direzione Statistica. Certificato di assistenza al parto (CeDAP)- Analisi dell’evento nascita- Anno 2008. Ministero della Salute 2011. Cerca con Google

Facchin P, Barbieri S, Bua M, Cappellari A, Cesaretto R, De Lorenzi M, Fedetto R, Ferrante A, Gelasio O, Guarnieri E, Manea S, Mazzucato M, Menegazzo F, Minichiello C, Rampazzo M, Ranzato C, Rosa Rizzotto M, Salmaso L, Tagliapietra M, Toto E, Vianello A, Visonà Dalla Pozza L, Zanatta C, Zinato L. Rapporto Tecnico del Registro Nascita del Veneto (Anno 2011). Regione Veneto, 2012. Cerca con Google

Vivere Onlus. Manifesto dei Diritti del bambino Nato Pretermine, approvato dal Senato in data 21 dicembre 2010. Cerca con Google

Iams JD, Romero R, Culhane JF, Goldenberg RL. Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet. 2008;371(9607):164-75. Cerca con Google

Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, Bauer CR, Donovan EF, Korones SB, Laptook AR, Lemons JA, Oh W, Papile LA, Shankaran S, Stevenson DK, Tyson JE, Poole WK; NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007;196(2):147.e1-8. Cerca con Google

Herber-Jonat S, Streiftau S, Knauss E, Voigt F, Flemmer AW, Hummler HD, Schulze A, Bode H. Long-term outcome at age 7-10 years after extreme prematurity - a prospective, two centre cohort study of children born before 25 completed weeks of gestation (1999-2003). Matern Fetal Neonatal Med. 2014. [Epub ahead of print]. Cerca con Google

Ochiai M, Kinjo T, Takahata Y, Iwayama M, Abe T, Ihara K, Ohga S, Fukushima K, Kato K, Taguchi T, Hara T. Survival and Neurodevelopmental Outcome of Preterm Infants Born at 22-24 Weeks of Gestational Age. Neonatology. 2013;105(2):79-84 Cerca con Google

Buhimschi IA, Nayeri UA, Laky CA, Razeq SA, Dulay AT, Buhimschi CS. Advances in medical diagnosis of intra-amniotic infection. Expert Opin Med Diagn. 2013;7(1):5-16. Cerca con Google

Bolisetty S, Dhawan A, Abdel-Latif M, Bajuk B, Stack J, Lui K; New South Wales and Australian Capital Territory Neonatal Intensive Care Units’ Data Collection. Intraventricular hemorrhage and neurodevelopmental outcomes in extreme preterm infants. Pediatrics. 2014;133(1):55-62. Cerca con Google

Fabbri G, Panico M, Dallolio L, Suzzi R, Ciccia M, Sandri F, Farruggia P. Outbreak of ampicillin/piperacillin-resistant Klebsiella pneumoniae in a neonatal intensive care unit (NICU): investigation and control measures. Int J Environ Res Public Health. 2013;10(3):808-15. . Cerca con Google

Ranger M, Chau CM, Garg A, Woodward TS, Beg MF, Bjornson B, Poskitt K, Fitzpatrick K, Synnes AR, Miller SP, Grunau RE. Neonatal pain-related stress predicts cortical thickness at age 7 years in children born very preterm. PLoS One. 2013; 8(10):e76702. Cerca con Google

Filippa M, Devouche E, Arioni C, Imberty M, Gratier M.Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Acta Paediatr. 2013;102(10):1017-20 Cerca con Google

Duerden EG, Card D, Lax ID, Donner EJ, Taylor MJ. Alterations in frontostriatal pathways in children born very preterm. Dev Med Child Neurol. 2013;55(10):952-8. Cerca con Google

Comaru T, Miura E. Postural support improves distress and pain during diaper change in preterm infants. J Perinatol. 2009;29(7):504-7. Cerca con Google

Vaivre-Douret L, Golse B. Comparative effects of 2 positional supports on neurobehavioral and postural development in preterm neonates. J Perinat Neonatal Nurs. 2007;21(4):323-30 Cerca con Google

Diniz KT, Cabral-Filho JE, Miranda RM, Souza Lima GM, Vasconcelos Dde A. Effect of the kangaroo position on the electromyographic activity of preterm children: a follow-up study. BMC Pediatr. 2013;16:13:79. Cerca con Google

Bhutta ZA, Giuliani F, Haroon A, Knight HE, Albernaz E, Batra M, Bhat B, Bertino E, McCormick K, Ochieng R, Rajan V, Ruyan P, Cheikh Ismail L, Paul V; International Fetal and Newborn Growth Consortium for the 21st Century. Standardisation of neonatal clinical practice. BJOG. 2013;120 Suppl 2:56-63. Cerca con Google

Linee Guida per i Punti Nascita 2010-2012. Accordo Stato-Regioni. Pubblicato sulla Gazzetta Ufficiale il 18.01.2011. Cerca con Google

Carta dei Diritti del bambino nato prematuro contenuto in Vai! Cerca con Google

Guinsburg R, Branco de Almeida MF, Dos Santos Rodrigues Sadeck L, Marba ST, Suppo de Souza Rugolo LM, Luz JH, de Andrade Lopes JM, Martinez FE, Procianoy RS; Brazilian Network on Neonatal Research Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists. J Perinatol. 2012;32(12):913-9. Cerca con Google

International Neonatal Network, Scottish Neonatal Consultants, Nurses Collaborative Study Group. Risk adjusted and population based studies of the outcome for high risk infants in Scotland and Australia. Arch Dis Child Fetal Neonatal Ed. 2000;82(2):F118-23. Cerca con Google

Bellù R, Gagliardi L, Tagliabue P, Corchia C, Vendettuoli V, Mosca F, Zanini R; Italian Neonatal Network. Survey of neonatal respiratory care and surfactant administration in very preterm infants in the Italian Neonatal Network. Acta Biomed. 2013;84(S1):7-11. Cerca con Google

Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, Verter J, Temprosa M, Wright LL, Ehrenkranz RA, Fanaroff AA, Stark A, Carlo W, Tyson JE, Donovan EF, Shankaran S, Stevenson DK. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics. 2001;107(1):e1. Cerca con Google

Burattini I, Bellagamba MP, Spagnoli C, D'Ascenzo R, Mazzoni N, Peretti A, Cogo PE, Carnielli VP; Marche Neonatal Network. Targeting 2.5 versus 4 g/kg/day of amino acids for extremely low birth weight infants: a randomized clinical trial. J Pediatr. 2013;163(5):1278-82. Cerca con Google

Manzoni P, Stolfi I, Pedicino R, Vagnarelli F, Mosca F, Pugni L, Bollani L, Pozzi M, Gomez K, Tzialla C, Borghesi A, Decembrino L, Mostert M, Latino MA, Priolo C, Galletto P, Gallo E, Rizzollo S, Tavella E, Luparia M, Corona G, Barberi I, Tridapalli E, Faldella G, Vetrano G, Memo L, Saia OS, Bordignon L, Messner H, Cattani S, Della Casa E, Laforgia N, Quercia M, Romeo M, Betta PM, Rinaldi M, Magaldi R, Maule M, Stronati M, Farina D; Italian Task Force for the Study and Prevention of Neonatal Fungal Infections, Italian Society of Neonatology. Human milk feeding prevents retinopathy of prematurity (ROP) in preterm VLBW neonates. Early Hum Dev. 2013;89:S64-8. Cerca con Google

Facchin P, Barbieri S, Bua M, Cappellari A, Cesaretto R, De Lorenzi M, Fedetto R, Ferrante A, Gelasio O, Guarnieri E, Manea S, Mazzucato M, Menegazzo F, Minichiello C, Rampazzo M, Ranzato C, Rosa Rizzotto M, Salmaso L, Tagliapietra M, Toto E, Vianello A, Visonà Dalla Pozza L, Zanatta C, Zinato L. Rapporto Tecnico Coordinamento Regionale delle Malattie Rare e del Registro Regionale delle Malattie Rare del Veneto (Anno 2011). Regione Veneto, 2012. Cerca con Google

Facchin P, Barbieri S, Bua M, Cappellari A, Cesaretto R, De Lorenzi M, Fedetto R, Ferrante A, Gelasio O, Guarnieri E, Manea S, Mazzucato M, Menegazzo F, Minichiello C, Rampazzo M, Ranzato C, Rosa Rizzotto M, Salmaso L, Tagliapietra M, Toto E, Vianello A, Visonà Dalla Pozza L, Zanatta C, Zinato L. Rapporto Tecnico Programma Regionale della Patologia in Età Pediatrica. Il Nuovo Flusso Informativo Regionale sulle Attività Territoriali e sull'Attività Riabilitativa sugli Istituti ex art. 26 L.833/78 (Anno 2011). Regione Veneto, 2012. Cerca con Google

Ananth CV, Joseph KS, Oyelese Y, Demissie K, Vintzileos AM. Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000. Obstet Gynecol. 2005;105(5):1084-91. Cerca con Google

Muller-Nix C, Forcada-Guex M. Perinatal assessment of infant, parents, and parent-infant relationship: prematurity as an example. Child Adolesc Psychiatr Clin N Am. 2009;18(3):545-57. Cerca con Google

Zysman-Colman Z, Tremblay GM, Bandeali S, Landry JS. Bronchopulmonary dysplasia - trends over three decades. Paediatr Child Health. 2013;18(2):86-90. Cerca con Google

Farkas I, Maróti Z, Katona M, Endreffy E, Monostori P, Máder K, Túri S. Increased heme oxygenase-1 expression in premature infants with respiratory distress syndrome. Eur J Pediatr. 2008;167(12):1379-83. Cerca con Google

Taylor JB, Nyp MF, Norberg M, Dai H, Escobar H, Ellerbeck E, Truog WE. Impact of intercurrent respiratory infections on lung health in infants born &lt;29 weeks with bronchopulmonary dysplasia. J Perinatol. 2013;12 [Epub ahead of print]. Cerca con Google

Koo KY, Kim JE, Lee SM, Namgung R, Park MS, Park KI, Lee C Korean Effect of severe neonatal morbidities on long term outcome in extremely low birthweight infants. J Pediatr. 2010;53(6):694-700. Cerca con Google

Dolfin T, Zamir C, Regev R, Ben Ari J, Wolach B.Effect of surfactant replacement therapy on the outcome of premature infants with respiratory distress syndrome. Isr J Med Sci. 1994;30(4):267-70. Cerca con Google

Hervás D, Reina J, Yañez A, del Valle JM, Figuerola J, Hervás JA. Epidemiology of hospitalization for acute bronchiolitis in children: differences between RSV and non-RSV bronchiolitis. Eur J Clin Microbiol Infect Dis. 2012;31(8):1975-81 Cerca con Google

Heggie AD, Jacobs MR, Butler VT, Baley JE, Boxerbaum B. Frequency and significance of isolation of Ureaplasma urealyticum and Mycoplasma hominis from cerebrospinal fluid and tracheal aspirate specimens from low birth weight infants. J Pediatr. 1994;124(6):956-61. Cerca con Google

Bhutani VK, Wong RJ. Bilirubin neurotoxicity in preterm infants: risk and prevention. J Clin Neonatol. 2013;2(2):61-9. Cerca con Google

Coen RW. Preventing Germinal Matrix Layer Rupture and Intraventricular Hemorrhage. Front Pediatr. 2013;5;1:22. Cerca con Google

Klebermass-Schrehof K, Czaba C, Olischar M, Fuiko R, Waldhoer T, Rona Z, Pollak A, Weninger M. Impact of low-grade intraventricular hemorrhage on long-term neurodevelopmental outcome in preterm infants. Childs Nerv Syst. 2012;28(12):2085-92. Cerca con Google

Romejko-Wolniewicz E, Oleszczuk L, Zaręba-Szczudlik J, Czajkowski K. Dosage regimen of antenatal steroids prior to preterm delivery and effects on maternal and neonatal outcomes. Matern Fetal Neonatal Med. 2013;26(3):237-41. Cerca con Google

Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns. Acta Paediatr. 2004;93(6):779-85 Cerca con Google

Schutzman DL, Porat R, Salvador A, Janeczko M. Neonatal nutrition: a brief review. World J Pediatr. 2008;4(4):248-53. Cerca con Google

Ferri C, Procianoy RS, Silveira RC. Prevalence and Risk Factors for Iron-Deficiency Anemia in Very-Low-Birth-Weight Preterm Infants at 1 Year of Corrected Age. J Trop Pediatr. 2013. [Epub ahead of print]. Cerca con Google

Nalbant D, Bhandary P, Matthews NI, Schmidt RL, Bogusiewicz A, Cress GA, Zimmerman MB, Strauss RG, Mock DM, Widness JA Comparison of multiple red cell volume methods performed concurrently in premature infants following allogeneic transfusion. Pediatr Res. 2013;74(5):592-600. Cerca con Google

Zonnenberg I, de Waal K. The definition of a haemodynamic significant duct in randomized controlled trials: a systematic literature review. Acta Paediatr. 2012;101(3):247-51. Cerca con Google

Oncel MY, Yurttutan S, Erdeve O, Uras N, Altug N, Oguz SS, Canpolat FE, Dilmen U. Oral Paracetamol versus Oral Ibuprofen in the Management of Patent Ductus Arteriosus in Preterm Infants: A Randomized Controlled Trial. J Pediatr. 2013;18.[Epub ahead of print]. Cerca con Google

Blencowe H, Lawn JE, Vazquez T, Fielder A, Gilbert C.Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res. 2013;74(S1):35-49. Cerca con Google

Hakeem AH, Mohamed GB, Othman MF. Retinopathy of prematurity: a study of prevalence and risk factors. Middle East Afr J Ophthalmol. 2012;19(3):289-94. Cerca con Google

Martín FG, Sáenz de Pipaón M, Pérez Rodríguez J, Jiménez JQ. Risk factors for the development of necrotizing enterocolitis: A case-control study. J Neonatal Perinatal Med. 2013;6(4):311-8. Cerca con Google

Li D, Rosito G, Slagle T.Probiotics for the prevention of necrotizing enterocolitis in neonates: an 8-year retrospective cohort study. J Clin Pharm Ther. 2013;19 [Epub ahead of print]. Cerca con Google

Chien YH, Tsao PN, Chou HC, Tang JR, Tsou KI Rehospitalization of extremely-low-birth-weight infants in first 2 years of life. Early Hum Dev. 2002;66(1):33-40. Cerca con Google

Wang CJ, Elliott MN, McGlynn EA, Brook RH, Schuster MA. Population-based assessments of ophthalmologic and audiologic follow-up in children with very low birth weight enrolled in Medicaid: a quality-of-care study. Pediatrics. 2008;121(2):e278-85. Cerca con Google

Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med. 2000;343(6):378-84. Cerca con Google

Barnett AL. Motor impairment in extremely preterm or low birthweight children. Dev Med Child Neurol. 2011;53(1):9-10. Cerca con Google

Lee ES, Yeatman JD, Luna B, Feldman HM. Specific language and reading skills in school-aged children and adolescents are associated with prematurity after controlling for IQ. Neuropsychologia. 2011;49(5):906-13. Cerca con Google

Beligere N, Rao R Neurodevelopmental outcome of infants with meconium aspiration syndrome: report of a study and literature review. J Perinatol. 2008 ;28:(S3):S93-101. Cerca con Google

Polam S, Koons A, Anwar M, Shen-Schwarz S, Hegyi T. Effect of chorioamnionitis on neurodevelopmental outcome in preterm infants. Arch Pediatr Adolesc Med. 2005;159(11):1032-5. Cerca con Google

Sharma PK, Sankar MJ, Sapra S, Saxena R, Karthikeyan CV, Deorari A, Agarwal R, Paul V. Growth and neurosensory outcomes of preterm very low birth weight infants at 18 months of corrected age. Indian J Pediatr. 2011;78(12):1485-90. Cerca con Google

Forcada-Guex M, Borghini A, Pierrehumbert B, Ansermet F, Muller-Nix C. Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship. Early Hum Dev. 2011;87(1):21-6. Cerca con Google

Deipolyi AR, Mukherjee P, Gill K, Henry RG, Partridge SC, Veeraraghavan S, Jin H, Lu Y, Miller SP, Ferriero DM, Vigneron DB, Barkovich AJ. Comparing microstructural and macrostructural development of the cerebral cortex in premature newborns: diffusion tensor imaging versus cortical gyration. Neuroimage. 2005;27(3):579-86. Cerca con Google

Thompson DK, Lee KJ, Egan GF, Warfield SK, Doyle LW, Anderson PJ, Inder TE. Regional white matter microstructure in very preterm infants: Predictors and 7 year outcomes. Cortex. 2013; Vai! Cerca con Google

Padilla N, Junqué C, Figueras F, Sanz-Cortes M, Bargalló N, Arranz A, Donaire A, Figueras J, Gratacos E Differential vulnerability of gray matter and white matter to intrauterine growth restriction in preterm infants at 12 months corrected age. Brain Res. 2014;30:1545C:1-11. Cerca con Google

Sun J, Buys N. Early executive function deficit in preterm children and its association with neurodevelopmental disorders in childhood: a literature review. Int J Adolesc Med Health. 2012;24(4):291-9. Cerca con Google

Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013; 29:4(4):e0025. Cerca con Google

Chau V, Synnes A, Grunau RE, Poskitt KJ, Brant R, Miller SP. Abnormal brain maturation in preterm neonates associated with adverse developmental outcomes. Neurology. 2013;81(24):2082-9. Cerca con Google

Bayley N. Bayley scales of infant and Toddler development. In Technical Manual. 3rd ed. San Antonio, TX: Harcourt Assessment; 2006. Cerca con Google

Griffiths R. The abilities of young children. ARICD, Amersham, 1984. O Griffiths R. The Griffiths Mental Developmental Scales (birth to 2 years): the 1996 revision. Cerca con Google

The Uzgiris-Hunt Ordinal Scales of Psychological Development (U-H Scales; Uzgiris & Hunt);1975. Cerca con Google

Leiter, RG. The Leiter International Performance Scale. Chicago: Stoelting. 1980. Cerca con Google

Leiter R.G. The Leiter International Performance Scale. Chicago: Stoelting. 1969. Cerca con Google

Dunn L, Dunn L. Peabody Picture Vocabulary Test - Fourth Edition. Bloomington, MN: Pearson Assessments; 2007. Cerca con Google

Wechsler D. Wechsler Preschool and Primary Scale of Intelligence – Fourth Edition; San Antonio: The Psychological Association ; 2012. Cerca con Google

Wechsler D. WISC-IV Technical and Interpretive Manual. San Antonio: The Psychological Association; 2003. Cerca con Google

Kato T, Yorifuji T, Inoue S, Yamakawa M, Doi H, Kawachi I. Associations of preterm births with child health and development: Japanese population-based study. J Pediatr. 2013;163(6):1578-1584. Cerca con Google

Bhutta AT, Anand KJ. Vulnerability of the developing brain. Neuronal mechanisms. Clin Perinatol. 2002;29(3):357-72. Cerca con Google

Latal B. Prediction of neurodevelopmental outcome after preterm birth. Pediatr Neurol. 2009;40(6):413-9. Cerca con Google

Johnson S. Cognitive and behavioural outcomes following very preterm birth. Semin Fetal Neonatal Med. 2007;12(5):363-73. Cerca con Google

Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis.JAMA. 2002;288(6):728-37 Cerca con Google

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