Luigi Gagliardi - Academia.edu (original) (raw)

Papers by Luigi Gagliardi

The Journal of Maternal-Fetal & Neonatal Medicine, 2015

Organizational features of neonatal intensive care influence the care of sick neonates. We estima... more Organizational features of neonatal intensive care influence the care of sick neonates. We estimated the acuity-adjusted nurse-to-patient ratio (NPR) in a national sample of Italian NICUs and factors influencing it. Twelve monthly cross-sectional surveys were prospectively carried out in 63 NICUs. Number and acuity of infants, and number of nurses were recorded. Infants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; acuity was assessed by Rogowki&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 2013 and British Association for Perinatal Medicine 2001 classifications. We collected 702 reports regarding 11 082 infants. Non-intensive infants represented about 75% of NICU residents. Very preterm infants (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1501 g birth weight or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30 weeks gestation) represented 10.8% of admissions, but 44% of all infants surveyed. Average acuity-adjusted NPR was 0.31 (interquartile range 0.28-0.38); NPR depended on case-mix (proportion of intensive infants), size of the unit (larger units had a lower NPR) and was higher during morning shifts (+18%). Clustering on hospitals, reflecting shared components within each hospital, explained 47% of the variability of NPR. The majority of infants cared for in NICUs are not intensive. NPR is influenced by acuity of infants, size of units, shifts, but is largely due to other unobserved hospital-related organizational features.

Medical Engineering & Physics, 2016

We developed a device for an objective measurement of non-nutritive sucking (NNS). NNS is newborn... more We developed a device for an objective measurement of non-nutritive sucking (NNS). NNS is newborns&amp;amp;amp;amp;amp;#39; spontaneous action that is a predictor of their neural system development and can be adopted as an intervention to train oral feeding skills in preterms. Two miniaturized digital pressure sensors were embedded into a commercial pacifier and the two signals were simultaneously acquired using the Inter-Integrated circuit (I²C) interface. This solution traced a complete pressures profile of the sucking pattern in order to better understand the functional aspects of the two NNS phases, the suction and the expression. Experimental tests with nine newborns confirmed that the sensorized pacifier is an adequate tool for measuring NNS burst-pause patterns. The identified parameters related to the suction/expression rhythmicity could be used as indicators of the NNS ability. This device might be used both for exploring the possible diagnostic data contained in NNS pattern and for monitoring the sucking skills of premature infants.

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La Pediatria medica e chirurgica: Medical and surgical pediatrics

Journal of Applied Physiology

The Hering-Breuer reflex (HBR) plays an important role in the regulation of respiratory timing in... more The Hering-Breuer reflex (HBR) plays an important role in the regulation of respiratory timing in infancy. Some investigators have noted that HBR is stronger when the respiratory rate (RR) is faster. However, this finding may be due to a spurious correlation, since one of the variables (expiratory time) used to calculate both HBR and RR is the same. We investigated this hypothesis with Monte Carlo (simulation) studies by using uncorrelated random numbers to calculate RR and HBR and found a strong spurious correlation (r = 0.7) between HBR and RR, i.e., subjects with higher RR had a stronger HBR. These results were confirmed algebraically, and the formula for the expected value of the correlation coefficient [E(r)] was derived. E(r) was always >0; it was 0.707 when no prolongation of inspiration occurred and was larger in the presence of a prolongation; when HBR strength was 100%, E(r) = 0.89, and when it was 200%, E(r) = 0.94. The expected value of the slope of the regression lin...

Archives of Disease in Childhood

pregnancy. Assessment of adrenal function should be preserved for newborns with clinical suspicio... more pregnancy. Assessment of adrenal function should be preserved for newborns with clinical suspicion of adrenal dysfunction or with risk factors as prematurity or placenta bed pathology.

Acta paediatrica (Oslo, Norway : 1992), Jan 12, 2015

I recently read an Acta Paediatrica paper by Andrews et al (1), whose unambiguous title was The n... more I recently read an Acta Paediatrica paper by Andrews et al (1), whose unambiguous title was The nonimpact of gestational age on neurodevelopmental outcome for ventilated survivors born at 23-28 weeks of gestation. Provocative as it may be, it raised a key point by suggesting that the importance of gestational age (GA) is exaggerated. Briefly, the article reported data from a single institution that showed that the frequency of neurological impairment at two-years-of-age in neonatal intensive care unit (NICU) survivors was not associated with GA, even in those born at a very low GA of 23 to 28 weeks. Thus, GA should not be the main variable on which to gauge probabilities and make decisions about resuscitation and withdrawing therapies. This article is protected by copyright. All rights reserved.

Acta paediatrica (Oslo, Norway : 1992), 2014

Journal of Pregnancy and Child Health, 2014

Journal of Perinatal Medicine, 2000

The Edinburgh Postnatal Depression Scale (EPDS) is a widely used instrument for screening for pos... more The Edinburgh Postnatal Depression Scale (EPDS) is a widely used instrument for screening for postpartum depression, but it might also detect anxiety symptoms. To investigate the factor structure of the EPDS administered immediately after delivery and to understand which factors predict a high EPDS score 3 months later. A cohort of 594 Italian mothers delivering a healthy baby at Versilia Hospital completed the EPDS at two points in time: 2 days after delivery (T0) and 3 months later (T1) by telephone interview. EPDS scores were higher at T0 than at T1. Overall, 15.7% of women at 2 days postpartum and 7.6% at 3 months later reported a score &amp;amp;amp;amp;amp;gt;9. The factor analysis of EPDS at T0 indicated a three-factor structure: &amp;amp;amp;amp;amp;quot;depression&amp;amp;amp;amp;amp;quot; (items 7-10), &amp;amp;amp;amp;amp;quot;anxiety&amp;amp;amp;amp;amp;quot; (items 3-6) and &amp;amp;amp;amp;amp;quot;anhedonia&amp;amp;amp;amp;amp;quot; (items 1-2). Anxious symptoms were quantitatively more important than depressive ones (mean 3.9 vs. 1.2) but tended to spontaneously ameliorate at T1, whereas total EPDS score at T1 was better predicted by depressive symptoms at T0 (discriminative ability 0.75 vs. 0.68). This study suggests that EPDS subscales immediately after delivery help understand the spectrum of maternal postpartum psychological problems. Anxious symptoms immediately after delivery are frequent but transient, linked probably to maternity blues or atypical depression, whereas the presence of depressive symptomatology at T0 suggests higher risk of later depressive disorders.

International Journal of Epidemiology, 2011

Lowe et al., commenting on our paper 1 on the possible biased association between paracetamol (an... more Lowe et al., commenting on our paper 1 on the possible biased association between paracetamol (and antibiotics) early in childhood and subsequent asthma, add another piece of evidence against causation. In our paper, we advocated 'to condition on (stratify for or adjust for) infection in order to block the possible confounded association between paracetamol/antibiotics use in the first 2 years of life and asthma at school age' and indicated that 'information about the indication for antibiotics and paracetamol prescription are not easy to collect'. In their recent cohort study, Lowe et al. 2 cleverly did so, by documenting prospectively indications for and frequency of paracetamol use. In order to evaluate if the indication for use of paracetamol affected the association with the outcomes under study (among which current asthma at 6-7 years), they restricted the analysis to children who took the drug for non-respiratory tract infections: no association was demonstrated.

Archives of Disease in Childhood, 1990

Archives of Disease in Childhood, 2012

Objective Postnatal depression may interfere with breast feeding. This study tested the ability o... more Objective Postnatal depression may interfere with breast feeding. This study tested the ability of the Edinburgh Postnatal Depression Scale (EPDS) to predict later breast feeding problems, hypothesising that risk of unsuccessful breast feeding increased with increasing EPDS scores, even at low values. Design The authors administered the EPDS on days 2-3 after delivery to 592 mothers of a healthy baby. Feeding method was recorded at 12-14 weeks. Results Median EPDS score was 5 (IQR 2 -8); 15.7% of women scored >9. At 12-14 weeks, 50.7% of infants received full breast feeding, 21.0% mixed breast feeding and 28.4% bottle feeding. Mothers with higher EPDS scores were more likely to bottle feed at 3 months; the odds of bottle feeding increased with EPDS result, even at low scores (OR 1.06, 95% CI 1.01 to 1.11). Conclusions Higher EPDS scores immediately after delivery were associated with later breast feeding failure.

Archives of Disease in Childhood, 1997

The correlation between respiratory rate and body mass in the first three years of life was exami... more The correlation between respiratory rate and body mass in the first three years of life was examined in 635 infants and children, aged between 15 days and 3.5 years. Assessments were made during quiet sleep and when awake and calm. Their body weight (2.8-20.5 kg) was measured at the same time.

American Journal of Epidemiology, 2011

Acta Paediatrica, 1982

... Principi, N., Villa, AD, Assael, BM, Gagliardi, L., Ghezzi, P., Chiccoli, C., Viganò, A. and ... more ... Principi, N., Villa, AD, Assael, BM, Gagliardi, L., Ghezzi, P., Chiccoli, C., Viganò, A. and Salmona, M. (1982), URINARY EXCRETION OF N-ACETYL-β-D-GLUCOSAMINIDASE (NAG) BY CHILDREN WITH UPPER OR LOWER ... Copyright © 1999–2011 John Wiley &amp; Sons, Inc. ...

Acta Paediatrica, 2013

ABSTRACT The diagnosis of hypotension and its subsequent management are controversial areas in th... more ABSTRACT The diagnosis of hypotension and its subsequent management are controversial areas in the care of the very preterm newborn infant. There is an increasing interest in the field, and the number of papers devoted to the subject is increasing. Some Randomized Clinical Trials (RCT), testing old drugs but new approaches, are under way. The hypotension story highlights some of the issues underlying the way we practice medicine today, including the inherent tension between the empirical (evidence-based) and the theoretical (pathophysiology-based) basis of medicine, and the role of RCTs in expanding our understanding. © 2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

Frontiers in Bioscience, Feb 1, 2009

S100B is a neurotrophic protein detectable in biological fluids and in human milk. Since there ar... more S100B is a neurotrophic protein detectable in biological fluids and in human milk. Since there are several maternal-neonatal conditions requiring the administration of animal milks the aim of the present study was to quantify S100B in milk from different mammalian species and to compare protein's concentration among human and mammalian milks. We assessed S100B concentrations in donkey (n=12), goat (n=15) sheep (n=15), commercially available cow (n=8) and human (n=15) milk samples. S100B measurements were performed using an immunoluminometric assay. S100B concentration in human milk (10.41 ± 4.2 microg/L) was higher (P<0.001) than mammalian milks. Of note, S100B concentration in cow milk (3.13 ±0.56 microg/L) was higher (P<0.01) than that showed in donkey (1.17 ± 0.26 microg/L), sheep (0.25 ±0.11 microg/L) and goat (0.26 ± 0.11 microg/L). S100B in donkey milk was higher (P<0.01) than sheep and goat samples whilst protein's concentration did not differ between goat and sheep. The present study suggests the opportunity of S100B addition to animal milk intended for infant feeding.

European Respiratory Journal, Sep 1, 2012

Number: 933 Publication Number: P4652 Abstract Group: 7.6. Paediatric Respiratory Epidemiology