Irene Papa - Academia.edu (original) (raw)

Papers by Irene Papa

Research paper thumbnail of Neonatal Cytomegalovirus Blood Load and Risk of Sequelae in Symptomatic and Asymptomatic Congenitally Infected Newborns

OBJECTIVE.Human cytomegalovirus (CMV) is a ubiquitous human-specific DNA virus and is the main ca... more OBJECTIVE.Human cytomegalovirus (CMV) is a ubiquitous human-specific DNA virus and is the main cause of congenital virus infection in developed countries leading to psychomotor impairment and deafness. Diagnostic techniques for CMV detection have greatly improved during recent years with the advent of sophisti- cated serological and virological methods. The aim of the present study was to assess the diagnostic and

Research paper thumbnail of Infection Neonatal Aortic Arch Thrombosis as a Result of Congenital Cytomegalovirus

Thrombotic disease is rare in neonates. The main risk factors at this age are perinatal asphyxia,... more Thrombotic disease is rare in neonates. The main risk factors at this age are perinatal asphyxia, maternal diabetes, sepsis, polycythemia, dehydration, a low cardiac output, and in primis the catheterization of central lines. Another important risk factor is inherited thrombophilia. Arterial thrombosis is even more rare than venous thrombosis and less related to most of the risk factors listed above; it occurs more frequently in the iliac, femoral, and cerebral arteries but very rarely in the aorta. Most of the described cases of aortic thrombosis are associated with the catheterization of an umbilical artery and involve the descending tract and the renal arteries; very few relate to the ascending tract and the aortic arch. The possible role of virus-induced primary vascular endothelium damage in the etiopathogenesis of neonatal arterial thrombosis has been previously hypothesized. Herpesviruses, particularly human cytomegalovirus (HCMV), can infect endothelial cells and directly damage intact vascular endothelium, altering its thromboresistant surface as a result of procoagulant activity mediated by specific viral surface phospholipids, necessary for the coagulation enzyme complex assembly that leads to thrombin generation. We describe a case of congenital aortic arch thrombosis. The clinical, laboratory, and virologic pictures; the anatomopathologic findings (fully compatible with viral infection); the detection of HCMV in various tissues (including the aorta); and the absence of other causes of aortic thrombosis make it possible to attribute the case to a severe congenital HCMV infection with multiple organ involvement, after the primary infection of the mother. The hemostatic system disorders and hemodynamic disturbances related to viral cardiac damage explain the clinical features of the case and indicate that congenital HCMV infection should be included among the causes of neonatal aortic thrombosis. Pediatrics 2001;108(6). URL: http://www. pediatrics.org/cgi/content/full/108/6/e114; human cytomegalovirus, congenital infection, aortic thrombosis, myocarditis, polymerase chain reaction.

Research paper thumbnail of Universal antenatal screening for group B streptococcus in Emilia-Romagna

Journal of Medical Screening, 2011

Background Group B streptococcus (GBS) is a leading cause of severe infections in newborns. Intra... more Background Group B streptococcus (GBS) is a leading cause of severe infections in newborns. Intrapartum antibiotic chemoprophylaxis (IAP) reduces the rate of early-onset disease. The aim of this study is to determine the degree of clinicians' compliance with the suggested protocol for GBS prevention in Emilia-Romagna (Italy). Methods Characteristics of each delivery were prospectively recorded in the period between October 2005 to December 2005. Standardized pro-forma were used to collect data. Results Among 5118 babies, 7.2% (369) were preterm and 92.3% were born at term (4749). Antenatal screening was performed in 86.6% of women who delivered at term, of which 18.1% were GBS culture-positive. Information regarding culture site was available in 93.2% of women screened and recto-vaginal cultures were documented in 42.7%. IAP was administered to 28.7% of 3937 women at term who had either spontaneous delivery or emergency caesarean section. In this cohort, 15.9% were diagnosed GBS culture-positive, of which 92.6% received IAP. Prophylaxis was also administered to 8.4% (331) of women for no apparent reason. Compared with tertiary level hospitals, women delivering in primary/secondary hospitals were more likely to be both GBS screened (P , 0.0001; OR 3.04; CI 2.33 -3.97) and to receive prophylaxis !4 hours before delivery (P ¼ 0.0025; OR 1.57; CI 1.17 -2.12). Conclusions GBS screening was performed in .85% of women and . 90% of culture-positive women received prophylaxis. However, there is a need to educate clinicians about protocol adherence, as most cultures were suboptimal and cases of unnecessary IAP were administered. The screening was more effective in hospitals with fewer deliveries.

Research paper thumbnail of Group B Streptococcal Infections in a Northern Region of Italy

PEDIATRICS, 2007

http://pediatrics.aappublications.org/content/120/3/e487.full.html located on the World Wide Web at:

Research paper thumbnail of HLA DR13 and HCV Vertical Infection

Pediatric Research, 2002

Risk factors affecting vertical hepatitis C virus (HCV) transmission are not completely known, if... more Risk factors affecting vertical hepatitis C virus (HCV) transmission are not completely known, if we exclude maternal HIV coinfection. We hypothesized that immunogenetic factors related to maternal or neonatal HLA profiles may affect HCV vertical transmission. HLA typing (microcytotoxicity assay on blood samples) was performed in 18 infants affected by vertically transmitted HCV infection and in 17 serum-reverted infants. (Serum-reversion is defined as antibody negative by 1 year of age and persistently HCV-RNA negative.) Moreover, HLA typing was performed in 20 mothers. Logistic regression analysis showed a significant negative association between children's HLA-DR13 antigens and risk of HCV vertical transmission (p Ͻ 0.01). This association persisted in a model including the maternal HIV status: HLA DR13 and maternal HIV coinfection showed a separate, opposite effect on vertical HCV infection (p Ͻ 0.01 and p Ͻ 0.001, respectively). The relative risk estimate for the ratio of not-infected to infected children in the presence of DR13 was 8.4 (95% confidence bounds, 1.1-60.8). Breastfeeding did not affect the risk of vertical HCV transmission. Maternal HLA profile did not relate to vertical infection. The present study reveals a significant association between HLA-DR13 and the likelihood of seroreversion in infants born to HCV-infected mothers. The findings of the present study could help in better understanding the pathogenesis of vertical HCV infection and in better identifying the cases at higher risk, which would be useful for the development of prevention strategies. It is possible that DR13 modulates the immune response to viruses, enhancing their clearance and, thus, in the case of HCV, exerting a protective role against the development of vertical infection. (Pediatr Res 51: 746-749, 2002) Abbreviations HCV, hepatitis C virus RT-PCR, reverse transcriptase-PCR

Research paper thumbnail of Group B Streptococcus Early-Onset Disease in Emilia-Romagna: Review After Introduction of a Screening-Based Approach

The Pediatric Infectious Disease Journal, 2010

Background: Group B streptococcus (GBS) is a leading cause of neonatal bacterial infections. Earl... more Background: Group B streptococcus (GBS) is a leading cause of neonatal bacterial infections. Earlyonset infections have decreased in recent years but, despite considerable efforts poured into prevention, cases continue to occur. Objectives: To analyze trends and identify determining factors for the persistence of the GBS infections. To evaluate the impact of antenatal screening and intrapartum chemo-prophylaxis on the clinical presentation of the infection. Methods: A prospective cohort, population-based study has been ongoing in Emilia-Romagna (Italy) since 2003. Invasive GBS infections, observed between 2003 and 2008 in infants aged <7 days were analysed. Results: Sixty-one early-infections were observed among 214,120 live births. Fourteen infants (23.0%) were born preterm. Among 47 infants who were delivered at term, 28 were born to mothers who had no risk factors and 7 were born to mothers who had none other than GBS colonization. Forty-one women at term had been screened prenatally; among them, only 10 were documented as GBS culturepositive. Disease severity was highest in infants at lower gestational ages, but most meningitis cases were observed in term infants born to mothers who were GBS culture-negative at screening. Nine newborns had culture-proven infection despite having received intrapartum antibiotics. They were born to mothers with ≥1 obstetrical risk factors and 5 mothers have been treated during labor with macrolides. Conclusion: Most infections presented in infants whose mothers had been screened GBS culturenegative. Missed opportunities for prevention contributed more than prophylaxis failures to the earlyonset disease burden.

Research paper thumbnail of Neonatal Cytomegalovirus Blood Load and Risk of Sequelae in Symptomatic and Asymptomatic Congenitally Infected Newborns

OBJECTIVE.Human cytomegalovirus (CMV) is a ubiquitous human-specific DNA virus and is the main ca... more OBJECTIVE.Human cytomegalovirus (CMV) is a ubiquitous human-specific DNA virus and is the main cause of congenital virus infection in developed countries leading to psychomotor impairment and deafness. Diagnostic techniques for CMV detection have greatly improved during recent years with the advent of sophisti- cated serological and virological methods. The aim of the present study was to assess the diagnostic and

Research paper thumbnail of Infection Neonatal Aortic Arch Thrombosis as a Result of Congenital Cytomegalovirus

Thrombotic disease is rare in neonates. The main risk factors at this age are perinatal asphyxia,... more Thrombotic disease is rare in neonates. The main risk factors at this age are perinatal asphyxia, maternal diabetes, sepsis, polycythemia, dehydration, a low cardiac output, and in primis the catheterization of central lines. Another important risk factor is inherited thrombophilia. Arterial thrombosis is even more rare than venous thrombosis and less related to most of the risk factors listed above; it occurs more frequently in the iliac, femoral, and cerebral arteries but very rarely in the aorta. Most of the described cases of aortic thrombosis are associated with the catheterization of an umbilical artery and involve the descending tract and the renal arteries; very few relate to the ascending tract and the aortic arch. The possible role of virus-induced primary vascular endothelium damage in the etiopathogenesis of neonatal arterial thrombosis has been previously hypothesized. Herpesviruses, particularly human cytomegalovirus (HCMV), can infect endothelial cells and directly damage intact vascular endothelium, altering its thromboresistant surface as a result of procoagulant activity mediated by specific viral surface phospholipids, necessary for the coagulation enzyme complex assembly that leads to thrombin generation. We describe a case of congenital aortic arch thrombosis. The clinical, laboratory, and virologic pictures; the anatomopathologic findings (fully compatible with viral infection); the detection of HCMV in various tissues (including the aorta); and the absence of other causes of aortic thrombosis make it possible to attribute the case to a severe congenital HCMV infection with multiple organ involvement, after the primary infection of the mother. The hemostatic system disorders and hemodynamic disturbances related to viral cardiac damage explain the clinical features of the case and indicate that congenital HCMV infection should be included among the causes of neonatal aortic thrombosis. Pediatrics 2001;108(6). URL: http://www. pediatrics.org/cgi/content/full/108/6/e114; human cytomegalovirus, congenital infection, aortic thrombosis, myocarditis, polymerase chain reaction.

Research paper thumbnail of Universal antenatal screening for group B streptococcus in Emilia-Romagna

Journal of Medical Screening, 2011

Background Group B streptococcus (GBS) is a leading cause of severe infections in newborns. Intra... more Background Group B streptococcus (GBS) is a leading cause of severe infections in newborns. Intrapartum antibiotic chemoprophylaxis (IAP) reduces the rate of early-onset disease. The aim of this study is to determine the degree of clinicians' compliance with the suggested protocol for GBS prevention in Emilia-Romagna (Italy). Methods Characteristics of each delivery were prospectively recorded in the period between October 2005 to December 2005. Standardized pro-forma were used to collect data. Results Among 5118 babies, 7.2% (369) were preterm and 92.3% were born at term (4749). Antenatal screening was performed in 86.6% of women who delivered at term, of which 18.1% were GBS culture-positive. Information regarding culture site was available in 93.2% of women screened and recto-vaginal cultures were documented in 42.7%. IAP was administered to 28.7% of 3937 women at term who had either spontaneous delivery or emergency caesarean section. In this cohort, 15.9% were diagnosed GBS culture-positive, of which 92.6% received IAP. Prophylaxis was also administered to 8.4% (331) of women for no apparent reason. Compared with tertiary level hospitals, women delivering in primary/secondary hospitals were more likely to be both GBS screened (P , 0.0001; OR 3.04; CI 2.33 -3.97) and to receive prophylaxis !4 hours before delivery (P ¼ 0.0025; OR 1.57; CI 1.17 -2.12). Conclusions GBS screening was performed in .85% of women and . 90% of culture-positive women received prophylaxis. However, there is a need to educate clinicians about protocol adherence, as most cultures were suboptimal and cases of unnecessary IAP were administered. The screening was more effective in hospitals with fewer deliveries.

Research paper thumbnail of Group B Streptococcal Infections in a Northern Region of Italy

PEDIATRICS, 2007

http://pediatrics.aappublications.org/content/120/3/e487.full.html located on the World Wide Web at:

Research paper thumbnail of HLA DR13 and HCV Vertical Infection

Pediatric Research, 2002

Risk factors affecting vertical hepatitis C virus (HCV) transmission are not completely known, if... more Risk factors affecting vertical hepatitis C virus (HCV) transmission are not completely known, if we exclude maternal HIV coinfection. We hypothesized that immunogenetic factors related to maternal or neonatal HLA profiles may affect HCV vertical transmission. HLA typing (microcytotoxicity assay on blood samples) was performed in 18 infants affected by vertically transmitted HCV infection and in 17 serum-reverted infants. (Serum-reversion is defined as antibody negative by 1 year of age and persistently HCV-RNA negative.) Moreover, HLA typing was performed in 20 mothers. Logistic regression analysis showed a significant negative association between children's HLA-DR13 antigens and risk of HCV vertical transmission (p Ͻ 0.01). This association persisted in a model including the maternal HIV status: HLA DR13 and maternal HIV coinfection showed a separate, opposite effect on vertical HCV infection (p Ͻ 0.01 and p Ͻ 0.001, respectively). The relative risk estimate for the ratio of not-infected to infected children in the presence of DR13 was 8.4 (95% confidence bounds, 1.1-60.8). Breastfeeding did not affect the risk of vertical HCV transmission. Maternal HLA profile did not relate to vertical infection. The present study reveals a significant association between HLA-DR13 and the likelihood of seroreversion in infants born to HCV-infected mothers. The findings of the present study could help in better understanding the pathogenesis of vertical HCV infection and in better identifying the cases at higher risk, which would be useful for the development of prevention strategies. It is possible that DR13 modulates the immune response to viruses, enhancing their clearance and, thus, in the case of HCV, exerting a protective role against the development of vertical infection. (Pediatr Res 51: 746-749, 2002) Abbreviations HCV, hepatitis C virus RT-PCR, reverse transcriptase-PCR

Research paper thumbnail of Group B Streptococcus Early-Onset Disease in Emilia-Romagna: Review After Introduction of a Screening-Based Approach

The Pediatric Infectious Disease Journal, 2010

Background: Group B streptococcus (GBS) is a leading cause of neonatal bacterial infections. Earl... more Background: Group B streptococcus (GBS) is a leading cause of neonatal bacterial infections. Earlyonset infections have decreased in recent years but, despite considerable efforts poured into prevention, cases continue to occur. Objectives: To analyze trends and identify determining factors for the persistence of the GBS infections. To evaluate the impact of antenatal screening and intrapartum chemo-prophylaxis on the clinical presentation of the infection. Methods: A prospective cohort, population-based study has been ongoing in Emilia-Romagna (Italy) since 2003. Invasive GBS infections, observed between 2003 and 2008 in infants aged <7 days were analysed. Results: Sixty-one early-infections were observed among 214,120 live births. Fourteen infants (23.0%) were born preterm. Among 47 infants who were delivered at term, 28 were born to mothers who had no risk factors and 7 were born to mothers who had none other than GBS colonization. Forty-one women at term had been screened prenatally; among them, only 10 were documented as GBS culturepositive. Disease severity was highest in infants at lower gestational ages, but most meningitis cases were observed in term infants born to mothers who were GBS culture-negative at screening. Nine newborns had culture-proven infection despite having received intrapartum antibiotics. They were born to mothers with ≥1 obstetrical risk factors and 5 mothers have been treated during labor with macrolides. Conclusion: Most infections presented in infants whose mothers had been screened GBS culturenegative. Missed opportunities for prevention contributed more than prophylaxis failures to the earlyonset disease burden.