Landolfo, Francesca (2010) High risk premature neonates. [Tesi di dottorato] (Unpublished)

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Survival of premature babies has considerably improved during the recent twenty years. A significant improvement in survival occurred in the second half of the 90s, this progress is mainly due to the introduction of artificial surfactant, which allows us to overcome the characteristic respiratory distress syndrome of premature infants especially in those greater or equal to 25 weeks of gestation. Unfortunately, especially neurological morbidity of these premature infants, has not improved as the same rate as survival. If in the 80s the onset of severe disability was 12%, at the moment it’s about 10%. Severe disabilities are those that prevent normal school attendance, such as severe forms of cerebral palsy, blindness, deafness, and slow development. The increasing proportion of premature infants who survive increases the prevalence of these disabilities. The most significant factors associated with the development of these disabilities are chronic lung disease, intraventricular hemorrhage or periventricular leukomalacia, use of steroid and male sex. The rate of neurological morbidity remained more or less unchanged compared with the past, and is inversely correlated with gestational age and birthweight: the less are gestational age and birth-weight the higher the probability of neurological disorders. The preterm infant is particularly fragile, exposed to various pathogenic insults, in which small environmental perturbations can cause significant changes in the organism. In fact between 24 and 40 weeks of gestation, the Central Nervous System (CNS) has a rapid growth, high differentiation, high plasticity and a strong sensitivity to any kind of stress. Furthermore, the premature is frequently exposed to numerous diseases and alterations of various apparatus:Cardiovascular: hypotension, patent ductus arteriosus;Respiratory: apnea of prematurity, respiratory distress syndrome, bronchopulmonary dysplasia; Apparatus Gastrointestinal: necrotizing enterocolitis; Central nervous system: periventricular leukomalacia, intraventricular hemorrhage, subarachnoid hemorrhage, hydrocephalus, retinopathy of prematurity. Preterm infants have also been reported to be at higher risk than term infants for sudden infant death syndrome (SIDS). Reasons for this higher risk are not clear. Infants who subsequently died of SIDS had fewer spontaneous arousals. In addition they had more central apnoeas in the prone position which suggests that they have poorer respiratory control in that position. The aim of this study is to detailed different aspects of the premature infant at high risk, starting from an epidemiological study conducted in the NICU of Federico II of Naples, investigating both the respiratory and gastrointestinal physiopathology and studying new automated methods for the rapid identification of late sepsis.

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