Stefano Nobile - Academia.edu (original) (raw)

Papers by Stefano Nobile

Research paper thumbnail of Efficacy of a new technique – INtubate-RECruit-SURfactant-Extubate – “IN-REC-SUR-E” – in preterm neonates with respiratory distress syndrome: study protocol for a randomized controlled trial

Trials, 2016

Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is n... more Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69 %. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria. In this study, 206 spontaneously breathing infants born at 24(+0)-27(+6) weeks' gestation and failing nCPAP during the first 24 h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3 days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30 min after surfactant administration or when they meet the nCPAP failure criteria after extubation. From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following hypothesis: a lung recruitment maneuver performed with a step-by-step Continuous Distending Pressure increase during High-Frequency Oscillatory Ventilation (and not with a sustained inflation) could have a positive effects in terms of improved surfactant distribution and consequent its major efficacy in preterm newborns with respiratory distress syndrome. This represents our challenge. ClinicalTrials.gov identifier: NCT02482766 . Registered on 1 June 2015.

Research paper thumbnail of Role of immunosuppressive and biologic therapy in pediatric IBD

Research paper thumbnail of Some Recent Advances of Ultrasonic Diagnostic Methods Applied to Materials and Structures (Including Biological Ones)

Research paper thumbnail of Pulmonary surfactant in newborn infants

Research paper thumbnail of Electronic clinical challenges and images in GI. Abdominal tuberculosis

Research paper thumbnail of Surfactant protein B and A concentrations are increased in neonatal pneumonia

Pediatric research, 2015

Term newborns with pneumonia show a reduced pulmonary compliance due to multiple and ill-defined ... more Term newborns with pneumonia show a reduced pulmonary compliance due to multiple and ill-defined factors. Surfactant proteins' (SPs) changes could have a role in the reduced compliance but the matter is still unsettled. The aim of this study was to clarify the meaning of SPs changes during pneumonia in term newborns. In 28 term ventilated newborns, 13 with pneumonia and 15 with no lung disease, we measured SP-B, SP-A, disaturated-phosphatidylcholine (DSPC), and total phospholipids (PL) concentrations in tracheal aspirates at intubation and close to extubation. We also measured DSPC kinetics using (U-(13)C-PA)dipalmitoyl-phosphatidylcholine. At baseline, SP-B, expressed as % of PL, was significantly different between the groups, being 3.5-fold higher in pneumonia than controls. Conversely, SP-A did not vary between the groups. At extubation, SP-B and SP-A concentrations had decreased significantly in newborns with pneumonia, while there was no significant change in controls. DSPC...

Research paper thumbnail of Surfactant protein B and A concentrations are increased in neonatal pneumonia

Pediatric Research, 2015

Term newborns with pneumonia show a reduced pulmonary compliance due to multiple and ill-defined ... more Term newborns with pneumonia show a reduced pulmonary compliance due to multiple and ill-defined factors. Surfactant proteins' (SPs) changes could have a role in the reduced compliance but the matter is still unsettled. The aim of this study was to clarify the meaning of SPs changes during pneumonia in term newborns. In 28 term ventilated newborns, 13 with pneumonia and 15 with no lung disease, we measured SP-B, SP-A, disaturated-phosphatidylcholine (DSPC), and total phospholipids (PL) concentrations in tracheal aspirates at intubation and close to extubation. We also measured DSPC kinetics using (U-(13)C-PA)dipalmitoyl-phosphatidylcholine. At baseline, SP-B, expressed as % of PL, was significantly different between the groups, being 3.5-fold higher in pneumonia than controls. Conversely, SP-A did not vary between the groups. At extubation, SP-B and SP-A concentrations had decreased significantly in newborns with pneumonia, while there was no significant change in controls. DSPC t1/2 was significantly shorter in the pneumonia group (11.8 (5.5-19.8) h vs. 26.6 (19.3-63.6) h, P = 0.011). In term newborns with pneumonia, SP-B increases with respect to PL, and DSPC is turned over at a faster rate. Disease's resolution is associated with the restoration of the normal ratio between SP-B and PL.

Research paper thumbnail of Are Infants with Bronchopulmonary Dysplasia Prone to Gastroesophageal Reflux? A Prospective Observational Study with Esophageal pH-Impedance Monitoring

The Journal of Pediatrics, 2015

Objective To perform an observational cohort study with esophageal pH-multichannel intraluminal i... more Objective To perform an observational cohort study with esophageal pH-multichannel intraluminal impedance (pH-MII) monitoring in symptomatic preterm infants with and without bronchopulmonary dysplasia (BPD).

Research paper thumbnail of The importance of oxygen control reaffirmed: experience of ROP reduction at a single tertiary care center

Journal of pediatric ophthalmology and strabismus

To report the impact of the adoption of a low oxygen saturation policy on retinopathy of prematur... more To report the impact of the adoption of a low oxygen saturation policy on retinopathy of prematurity (ROP) incidence at a single tertiary care center. ROP incidence, procedures for ROP, and neonatal outcome among very low birth weight infants were compared before and after the adoption of a low saturation policy, which took place in 2004. The Mann– Whitney test was performed to look for differences. The incidence of severe ROP significantly decreased from 5.3% of live very low birth weight infants between 1999 and 2004 to 1% of live very low birth weight infants between 2005 and 2012 (P = .003). The use of laser therapy for severe ROP between the same periods significantly decreased from 6.4% of live very low birth weight infants between 1999 and 2004 to 0.6% of live very low birth weight infants between 2005 and 2012 (P = .002). There was also a significant reduction of death or bronchopulmonary dysplasia from 33.8% between 1999 and 2004 to 24.2% between 2005 and 2012 (P = .02). Tr...

Research paper thumbnail of Probiotics in GI Diseases

Frontiers of Gastrointestinal Research, 2009

Founded 1975 by L. van der Reis, San Francisco, Calif.

Research paper thumbnail of A novel mutation of the insulin receptor gene in a preterm infant with Donohue syndrome and heart failure

Journal of Pediatric Endocrinology and Metabolism, 2000

Donohue syndrome (DS) is a rare autosomal recessive condition caused by mutations in the gene enc... more Donohue syndrome (DS) is a rare autosomal recessive condition caused by mutations in the gene encoding the insulin receptor. It is characterised by severe metabolic and endocrine derangement, prenatal and postnatal linear growth impairment, soft tissue overgrowth, and poor development of adipose tissue and muscle. Causes of death, which is often within the first year of life, include intercurrent infection and, in some cases, heart failure. Management is currently based on case reports and very small case series only, and no formal guidelines or recommendations exist. We describe a preterm infant who had typical features of DS but who later developed hypertrophic cardiomyopathy with heart failure leading to death at 10 weeks old. Molecular genetic analysis revealed compound heterozygosity for the previously reported p.Arg890X nonsense mutation and the novel p.Tyr818Cys missense mutation in the INSR gene. Tyrosine 818 falls in an exquisitely conserved residue of the alphabeta fibronectin domain of the insulin receptor, whose structure and function are much less well understood than other parts of the receptor. We discuss management options for DS, including the therapeutic dilemma around whether recombinant human insulin-like growth factor 1, one of the few available treatments for the syndrome, may exacerbate hypertrophic cardiomyopathy and cardiac failure.

Research paper thumbnail of Herpes Zoster Infection Followed by Henoch-Schönlein Purpura in a Girl Receiving Infliximab for Ulcerative Colitis

JCR: Journal of Clinical Rheumatology, 2009

... Leonardo Felici, MD. Department of Pediatrics. Ospedale San Salvatore. Pesaro, Italy. ... REF... more ... Leonardo Felici, MD. Department of Pediatrics. Ospedale San Salvatore. Pesaro, Italy. ... REFERENCES. 1. Lee A, Kasama R, Evangelisto A, et al. Henoch-Schönlein purpura after etanercept therapy for psoriasis. J Clin Rheumatol. 2006;12:249-251. ... 2. Duffy TN, Genta M, Moll ...

Research paper thumbnail of M2050 Lack of Association Between Markers On 5p13.1 and 10q21.1 Loci and IBD in Italian Population

Gastroenterology, 2008

... Pages A-458, April 2008, Authors:Orazio Palmieri; Anna Latiano; Maria R. Valvano; Elisabetta ... more ... Pages A-458, April 2008, Authors:Orazio Palmieri; Anna Latiano; Maria R. Valvano; Elisabetta Colombo; Renata D'Incà; Salvatore Cucchiara; Massimo Castro; Bruno Dallapiccola; Vito Annese; Alessandro Ferraris; R. Berni Canani; Concetta Sferlazzas; Graziella Guariso; Paolo ...

Research paper thumbnail of Mucosal healing in pediatric Crohn’s disease after anti-TNF therapy

European Journal of Gastroenterology & Hepatology, 2014

Purpose The anti-tumor necrosis factor (TNF) agents infliximab (IFX) and adalimumab (ADA) have be... more Purpose The anti-tumor necrosis factor (TNF) agents infliximab (IFX) and adalimumab (ADA) have been recently introduced to treat severe inflammatory bowel disease (IBD) that is unresponsive to other drugs. Several studies have confirmed the safety and efficacy of these agents for adult IBD patients, whereas there is less data on pediatric IBD. Mucosal healing, associated with fewer complications and surgeries, is considered the goal of treatment by some authors. The objective of this study was to evaluate the safety and efficacy (in terms of endoscopic, clinical, and laboratoristic response) of IFX and ADA in a cohort of pediatric patients with Crohn's disease (CD).

Research paper thumbnail of Intestinal stomas: A 4-year experience in a neonatal intensive care unit

Digestive and Liver Disease, 2013

Research paper thumbnail of The pathogenetical role of intestinal permeability in type 1 diabetes

Digestive and Liver Disease, 2006

Research paper thumbnail of Coeliac disease in Libya

Digestive and Liver Disease, 2006

Research paper thumbnail of PP33 Adalimumab Does Not Influence Pituitary Adenoma in a Child With Active Refractory Crohn's Disease

Digestive and Liver Disease, 2009

Research paper thumbnail of Schonlein–Henoch purpura and Herpes zoster infection after infliximab therapy for ulcerative colitis

Digestive and Liver Disease, 2007

Research paper thumbnail of P221 - Lack of association of previously identified disease loci 10q12, 11p15, and 20q13 in IBD

Journal of Crohn's and Colitis, 2009

Research paper thumbnail of Efficacy of a new technique – INtubate-RECruit-SURfactant-Extubate – “IN-REC-SUR-E” – in preterm neonates with respiratory distress syndrome: study protocol for a randomized controlled trial

Trials, 2016

Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is n... more Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69 %. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria. In this study, 206 spontaneously breathing infants born at 24(+0)-27(+6) weeks' gestation and failing nCPAP during the first 24 h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3 days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30 min after surfactant administration or when they meet the nCPAP failure criteria after extubation. From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following hypothesis: a lung recruitment maneuver performed with a step-by-step Continuous Distending Pressure increase during High-Frequency Oscillatory Ventilation (and not with a sustained inflation) could have a positive effects in terms of improved surfactant distribution and consequent its major efficacy in preterm newborns with respiratory distress syndrome. This represents our challenge. ClinicalTrials.gov identifier: NCT02482766 . Registered on 1 June 2015.

Research paper thumbnail of Role of immunosuppressive and biologic therapy in pediatric IBD

Research paper thumbnail of Some Recent Advances of Ultrasonic Diagnostic Methods Applied to Materials and Structures (Including Biological Ones)

Research paper thumbnail of Pulmonary surfactant in newborn infants

Research paper thumbnail of Electronic clinical challenges and images in GI. Abdominal tuberculosis

Research paper thumbnail of Surfactant protein B and A concentrations are increased in neonatal pneumonia

Pediatric research, 2015

Term newborns with pneumonia show a reduced pulmonary compliance due to multiple and ill-defined ... more Term newborns with pneumonia show a reduced pulmonary compliance due to multiple and ill-defined factors. Surfactant proteins' (SPs) changes could have a role in the reduced compliance but the matter is still unsettled. The aim of this study was to clarify the meaning of SPs changes during pneumonia in term newborns. In 28 term ventilated newborns, 13 with pneumonia and 15 with no lung disease, we measured SP-B, SP-A, disaturated-phosphatidylcholine (DSPC), and total phospholipids (PL) concentrations in tracheal aspirates at intubation and close to extubation. We also measured DSPC kinetics using (U-(13)C-PA)dipalmitoyl-phosphatidylcholine. At baseline, SP-B, expressed as % of PL, was significantly different between the groups, being 3.5-fold higher in pneumonia than controls. Conversely, SP-A did not vary between the groups. At extubation, SP-B and SP-A concentrations had decreased significantly in newborns with pneumonia, while there was no significant change in controls. DSPC...

Research paper thumbnail of Surfactant protein B and A concentrations are increased in neonatal pneumonia

Pediatric Research, 2015

Term newborns with pneumonia show a reduced pulmonary compliance due to multiple and ill-defined ... more Term newborns with pneumonia show a reduced pulmonary compliance due to multiple and ill-defined factors. Surfactant proteins' (SPs) changes could have a role in the reduced compliance but the matter is still unsettled. The aim of this study was to clarify the meaning of SPs changes during pneumonia in term newborns. In 28 term ventilated newborns, 13 with pneumonia and 15 with no lung disease, we measured SP-B, SP-A, disaturated-phosphatidylcholine (DSPC), and total phospholipids (PL) concentrations in tracheal aspirates at intubation and close to extubation. We also measured DSPC kinetics using (U-(13)C-PA)dipalmitoyl-phosphatidylcholine. At baseline, SP-B, expressed as % of PL, was significantly different between the groups, being 3.5-fold higher in pneumonia than controls. Conversely, SP-A did not vary between the groups. At extubation, SP-B and SP-A concentrations had decreased significantly in newborns with pneumonia, while there was no significant change in controls. DSPC t1/2 was significantly shorter in the pneumonia group (11.8 (5.5-19.8) h vs. 26.6 (19.3-63.6) h, P = 0.011). In term newborns with pneumonia, SP-B increases with respect to PL, and DSPC is turned over at a faster rate. Disease's resolution is associated with the restoration of the normal ratio between SP-B and PL.

Research paper thumbnail of Are Infants with Bronchopulmonary Dysplasia Prone to Gastroesophageal Reflux? A Prospective Observational Study with Esophageal pH-Impedance Monitoring

The Journal of Pediatrics, 2015

Objective To perform an observational cohort study with esophageal pH-multichannel intraluminal i... more Objective To perform an observational cohort study with esophageal pH-multichannel intraluminal impedance (pH-MII) monitoring in symptomatic preterm infants with and without bronchopulmonary dysplasia (BPD).

Research paper thumbnail of The importance of oxygen control reaffirmed: experience of ROP reduction at a single tertiary care center

Journal of pediatric ophthalmology and strabismus

To report the impact of the adoption of a low oxygen saturation policy on retinopathy of prematur... more To report the impact of the adoption of a low oxygen saturation policy on retinopathy of prematurity (ROP) incidence at a single tertiary care center. ROP incidence, procedures for ROP, and neonatal outcome among very low birth weight infants were compared before and after the adoption of a low saturation policy, which took place in 2004. The Mann– Whitney test was performed to look for differences. The incidence of severe ROP significantly decreased from 5.3% of live very low birth weight infants between 1999 and 2004 to 1% of live very low birth weight infants between 2005 and 2012 (P = .003). The use of laser therapy for severe ROP between the same periods significantly decreased from 6.4% of live very low birth weight infants between 1999 and 2004 to 0.6% of live very low birth weight infants between 2005 and 2012 (P = .002). There was also a significant reduction of death or bronchopulmonary dysplasia from 33.8% between 1999 and 2004 to 24.2% between 2005 and 2012 (P = .02). Tr...

Research paper thumbnail of Probiotics in GI Diseases

Frontiers of Gastrointestinal Research, 2009

Founded 1975 by L. van der Reis, San Francisco, Calif.

Research paper thumbnail of A novel mutation of the insulin receptor gene in a preterm infant with Donohue syndrome and heart failure

Journal of Pediatric Endocrinology and Metabolism, 2000

Donohue syndrome (DS) is a rare autosomal recessive condition caused by mutations in the gene enc... more Donohue syndrome (DS) is a rare autosomal recessive condition caused by mutations in the gene encoding the insulin receptor. It is characterised by severe metabolic and endocrine derangement, prenatal and postnatal linear growth impairment, soft tissue overgrowth, and poor development of adipose tissue and muscle. Causes of death, which is often within the first year of life, include intercurrent infection and, in some cases, heart failure. Management is currently based on case reports and very small case series only, and no formal guidelines or recommendations exist. We describe a preterm infant who had typical features of DS but who later developed hypertrophic cardiomyopathy with heart failure leading to death at 10 weeks old. Molecular genetic analysis revealed compound heterozygosity for the previously reported p.Arg890X nonsense mutation and the novel p.Tyr818Cys missense mutation in the INSR gene. Tyrosine 818 falls in an exquisitely conserved residue of the alphabeta fibronectin domain of the insulin receptor, whose structure and function are much less well understood than other parts of the receptor. We discuss management options for DS, including the therapeutic dilemma around whether recombinant human insulin-like growth factor 1, one of the few available treatments for the syndrome, may exacerbate hypertrophic cardiomyopathy and cardiac failure.

Research paper thumbnail of Herpes Zoster Infection Followed by Henoch-Schönlein Purpura in a Girl Receiving Infliximab for Ulcerative Colitis

JCR: Journal of Clinical Rheumatology, 2009

... Leonardo Felici, MD. Department of Pediatrics. Ospedale San Salvatore. Pesaro, Italy. ... REF... more ... Leonardo Felici, MD. Department of Pediatrics. Ospedale San Salvatore. Pesaro, Italy. ... REFERENCES. 1. Lee A, Kasama R, Evangelisto A, et al. Henoch-Schönlein purpura after etanercept therapy for psoriasis. J Clin Rheumatol. 2006;12:249-251. ... 2. Duffy TN, Genta M, Moll ...

Research paper thumbnail of M2050 Lack of Association Between Markers On 5p13.1 and 10q21.1 Loci and IBD in Italian Population

Gastroenterology, 2008

... Pages A-458, April 2008, Authors:Orazio Palmieri; Anna Latiano; Maria R. Valvano; Elisabetta ... more ... Pages A-458, April 2008, Authors:Orazio Palmieri; Anna Latiano; Maria R. Valvano; Elisabetta Colombo; Renata D'Incà; Salvatore Cucchiara; Massimo Castro; Bruno Dallapiccola; Vito Annese; Alessandro Ferraris; R. Berni Canani; Concetta Sferlazzas; Graziella Guariso; Paolo ...

Research paper thumbnail of Mucosal healing in pediatric Crohn’s disease after anti-TNF therapy

European Journal of Gastroenterology & Hepatology, 2014

Purpose The anti-tumor necrosis factor (TNF) agents infliximab (IFX) and adalimumab (ADA) have be... more Purpose The anti-tumor necrosis factor (TNF) agents infliximab (IFX) and adalimumab (ADA) have been recently introduced to treat severe inflammatory bowel disease (IBD) that is unresponsive to other drugs. Several studies have confirmed the safety and efficacy of these agents for adult IBD patients, whereas there is less data on pediatric IBD. Mucosal healing, associated with fewer complications and surgeries, is considered the goal of treatment by some authors. The objective of this study was to evaluate the safety and efficacy (in terms of endoscopic, clinical, and laboratoristic response) of IFX and ADA in a cohort of pediatric patients with Crohn's disease (CD).

Research paper thumbnail of Intestinal stomas: A 4-year experience in a neonatal intensive care unit

Digestive and Liver Disease, 2013

Research paper thumbnail of The pathogenetical role of intestinal permeability in type 1 diabetes

Digestive and Liver Disease, 2006

Research paper thumbnail of Coeliac disease in Libya

Digestive and Liver Disease, 2006

Research paper thumbnail of PP33 Adalimumab Does Not Influence Pituitary Adenoma in a Child With Active Refractory Crohn's Disease

Digestive and Liver Disease, 2009

Research paper thumbnail of Schonlein–Henoch purpura and Herpes zoster infection after infliximab therapy for ulcerative colitis

Digestive and Liver Disease, 2007

Research paper thumbnail of P221 - Lack of association of previously identified disease loci 10q12, 11p15, and 20q13 in IBD

Journal of Crohn's and Colitis, 2009