Stefania Sgrò | Sapienza University of Roma (original) (raw)

Papers by Stefania Sgrò

Brain Sciences, 2021

Congenital diaphragmatic hernia (CDH) is a severe pediatric disorder with herniation of abdominal... more Congenital diaphragmatic hernia (CDH) is a severe pediatric disorder with herniation of abdominal viscera into the thoracic cavity. Since neurodevelopmental impairment constitutes a common outcome, we performed morphometric magnetic resonance imaging (MRI) analysis on CDH infants to investigate cortical parameters such as cortical thickness (CT) and local gyrification index (LGI). By assessing CT and LGI distributions and their correlations with variables which might have an impact on oxygen delivery (total lung volume, TLV), we aimed to detect how altered perfusion affects cortical development in CDH. A group of CDH patients received both prenatal (i.e., fetal stage) and postnatal MRI. From postnatal high-resolution T2-weighted images, mean CT and LGI distributions of 16 CDH were computed and statistically compared to those of 13 controls. Moreover, TLV measures obtained from fetal MRI were further correlated to LGI. Compared to controls, CDH infants exhibited areas of hypogiria wi...

Pediatric Anesthesia, 2020

Epidural anesthesia is a widely-used technique for anesthesia and analgesia in infants and childr... more Epidural anesthesia is a widely-used technique for anesthesia and analgesia in infants and children.1 Epidurals, as well as other regional blocks, are a useful component of a multimodal approach to anesthesia and analgesia, in order to reduce the risk of opioid-related side effects such as postoperative apnoea, especially in preterms.2 Epidural catheter breakage is a very rare but alarming complication, the correct management of which is uncertain.

Pediatric Cardiology, 2019

Frontiers in Pediatrics, 2019

Aim of the study: In selected surgical neonates and infants, the rapidity of induction and intuba... more Aim of the study: In selected surgical neonates and infants, the rapidity of induction and intubation may represent an important factor for their safety. Propofol is an anesthetic characterized by a rapid onset and fast recovery time that may reduce time of anesthetic induction and improve post-anesthetic outcome. The aim of this study was to evaluate the safety and efficacy of anesthesia induction in full-term neonates and young infants after propofol bolus administration. Methods: A retrospective case-control study including infants below 6 months of age, undergoing general anesthesia between 2011 and 2013, was carried out. Patients that received intravenous propofol bolus to induce anesthesia were compared to patients who received inhaled sevoflurane. Time to reach successful orotracheal intubation (OTI) was measured in seconds. The quality of OTI was defined as "excellent," "good," and "poor," based on established classification and was reported. Hemodynamic parameters as systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), heart rate (HR), and oxygen saturation (SaO2) were collected before OTI (t0), at OTI (t1), and at spontaneous breathing recovery (t2). Main adverse effects were recorded for both groups. Results are median (IQ range) or prevalence; p < 0.05 was considered significant. Results: 160 infants were enrolled in the study, 80 received propofol and 80 inhaled sevoflurane. Major surgery (involving organs in the thoracic, abdominal, or pelvic cavities) was performed in 64 and 54% of patients in the propofol and sevoflurane group, respectively (p = 0.07). Patients in the propofol group showed a shorter time for OTI [11.5 (4.0-65) vs. 360.0 (228.0-720.0) seconds, (p < 0.0001)]. No difference was found in the quality of OTI between the two groups. No significant complications were recorded in either group. Conclusions: Propofol is a safe and effective anesthetic in neonates and infants permitting rapid induction of anesthesia and rapid intubation, without negative impact on the quality of intubation and haemodynamic compromise.

The Journal of Maternal-Fetal & Neonatal Medicine, 2017

Abstract Background: Despite the optimization of neonatal assistance, severe retinopathy of prema... more Abstract Background: Despite the optimization of neonatal assistance, severe retinopathy of prematurity (ROP, stage III–IV) remains a common condition among preterm infants. Laser photocoagulation usually requires general anesthesia and intubation, but extubation can be difficult and these infants often affected by chronic lung disease. We retrospectively evaluated the clinical charts of 13 neonates that were sedated with propofol in association with fentanyl for the laser treatment of ROP. This protocol was introduced in our unit to avoid intubation and minimize side effects of anesthesia and ventilation. Methods: Propofol 5% followed by a bolus of fentanyl was administered as sedation during laser therapy to 13 preterm infants, affected by ROP stage III–IV. Propofol was initially infused as a slow bolus of 2–4 mg/kg and then continuously during the entire procedure, at 4 mg/kg/hour, increasing the dosage to 6 mg/kg/hour if sedation was not achieved. A laryngeal mask was placed and patients were ventilated with a flow-inflating resuscitation bag. Results: Thirteen neonates were treated allowing to perform surgery without intubation. Only 4/13 (30.8%) of infants required minimal respiratory support during and/or after surgery. Heart rate after the intervention was higher than that at the beginning while remaining in the range of normal values. Blood pressures before, during and after surgery were similar. No episodes of bradycardia nor hypotension were recorded. Laser treatment was always successful. Conclusion: The good level of anesthesia and analgesia achieved sustains the efficacy of sedation with propofol during laser photocoagulation to avoid intubation and mechanical ventilation during and after the procedure.

European Journal of Pediatric Surgery Reports, 2018

Lung hypoplasia and pulmonary hypertension (PH) in association with congenital diaphragmatic hern... more Lung hypoplasia and pulmonary hypertension (PH) in association with congenital diaphragmatic hernia (CDH) may cause fatal respiratory failure. Lung transplantation (Ltx) may represent an option for CDH-related end-stage pulmonary failure. The aim of this study is to report a patient with CDH who underwent Ltx or combined heart-lung transplantation (H-Ltx). Our patient was born at 33 weeks of gestation, with a prenatally diagnosed isolated left CDH. Twenty-four hours after birth, she underwent surgical repair of a type D defect (according to the CDH Study Group staging system). Postoperative course was unexpectedly uneventful, and she was discharged home at 58 days of life. Echocardiography before discharge was unremarkable. Periodic follow-up revealed gastroesophageal reflux (GER) and initial scoliosis. At the age of 10, she was readmitted for severe PH. Lung function progressively deteriorated, and at the age of 14, she underwent H-Ltx due to end-stage respiratory failure. After di...

Pediatric Surgery International, 2012

The best anesthesia for newborns/infants necessitating colorectal surgery remains questionable. E... more The best anesthesia for newborns/infants necessitating colorectal surgery remains questionable. Endovenous and locoregional anesthesiological approaches were compared to determine the influence on stress response. Patients with anorectal malformations or Hirschsprung&amp;#39;s disease were randomized to inhalatory/epidural anesthesia (IPA) or inhalatory/endovenous anesthesia (IEA). Heart rate, blood pressure, oxygen saturation, serum concentrations of dehydroepiandrosterone, cortisol, and glucose were recorded 24 h before operation (T0), after tracheal intubation (T1), 120 min after skin incision (T2), 60 min (T3) and 24 h after operation (T4). Seventeen patients were enrolled in the study, 8 receiving IPA, and 9 IEA. Heart rate, blood pressure, oxygen saturation remained stable and normal, without statistical differences between the two groups, during the study period. Similar cortisol and glucose levels showed no statistical differences between groups. Dehydroepiandrosterone values were significantly higher in IEA during anesthesia (T1-T3) compared with IPA (T1: 494.0 vs. 266.5, p &amp;lt; 0.05; T2: 444.0 vs. 201.0, p &amp;lt; 0.05; T3: 385.0 vs. 305.0, p &amp;lt; 0.05). This study suggests that epidural and endovenous anesthesia are both effective in intra- and postoperative period. This preliminary report suggests that IPA is more efficient compared to IEA in controlling stress reaction related to surgery. Further larger studies are needed to confirm these findings.

Pediatric Anesthesia, 2014

In infants, post-thoracotomy analgesia traditionally consists of systemic opiates, while regional... more In infants, post-thoracotomy analgesia traditionally consists of systemic opiates, while regional techniques have gained more favor in recent years. We compare the two techniques for thoracotomy in infants. All consecutive patients below 6 months of age who underwent thoracotomy for congenital pulmonary malformations in the study period were retrospectively divided according to the chosen postoperative analgesia: Group S systemic opiates, Group R continuous regional (epidural or extrapleural paravertebral) block. We studied the following outcomes: need for NICU and mechanical ventilation, pain score, requirement for additional analgesics, heart rate 1 h postsurgery, time to pass first stool and to full feed, complications, and duration of hospitalization. Forty consecutive patients were included, 19 in Group S and 21 in Group R. Median age at surgery was 89 days (40-110) and 90 days (46-117), respectively. Five of 19 patients in Group S vs none in Group R required postoperative intensive care (P = 0.017). Patients in Group R had significantly lower postoperative heart rate (145 [138-150] vs. 160 [152-169] b·min(-1) , P = 0.007), earlier passage of first stools (24 h [12-24] vs. 36 h [24-48] P = 0.004), and earlier time to full feed (36 h [24-48] vs. 84 h [60-120] P = 0.0001) than those in Group S. The only observed complication was one catheter dislocation. In infants undergoing thoracotomy, loco-regional analgesia is effective and associated with a reduced intensity of postoperative care and earlier full feeding than systemic analgesia; it should therefore be considered a better option.

Journal of Pediatric Surgery, 2014

Near infrared spectroscopy (NIRS) gradually became the gold standard to guide anesthetic conducti... more Near infrared spectroscopy (NIRS) gradually became the gold standard to guide anesthetic conduction during cardiac surgery, and nowadays, it is commonly utilized to monitor cerebral oxygenation during invasive procedures. Preterm babies also benefit from this non-invasive monitoring to prevent neurological sequelae. However, few data are available on NIRS perioperative changes in newborn operated on for major non-cardiac malformations. Aim of the present study is to evaluate the usefulness of NIRS assessment during and after esophageal atresia (EA) correction and its correlation with clinical behavior. Patients and Methods All patients treated for EA from May 2011 were prospectively enrolled in the study. All infants underwent to "open" correction of EA and cerebral and splanchnic NIRS was applied up to 48 hours after surgery. Body temperature, blood pressure, pH, paSO2, paCO2, urine output, were recorded during NIRS registration. Mann-Whitney test and 1way ANOVA (Kruskal-Wallis and Dunn's multiple comparison tests) was used as appropriate Results Seventeen patients were enrolled into the study and 13 were available for the analysis. Four patients were excluded because poor NIRS registration. Cerebral and renal NIRS values significantly decreased at 24 hours post-operatively (p<0.05). Interestingly, all parameters studied as possible confounders in NIRS remained stable during the study period. Urine output significantly decreased Conclusion Our data confirmed that perioperative monitoring of tissue oxigenation during neonatal

Somatic symptoms represent a multi-determined phenomenon that need to be addressed in both clinic... more Somatic symptoms represent a multi-determined phenomenon that need to be addressed in both clinical and non-clinical settings in light of their impact on child emotional and psychosocial functioning. According to a developmental perspective, children with insecure attachment are more likely to experience somatic symptoms and to perceive greater symptom severity. The present study was designed to increase our understanding of the relationship between parental attachment and somatic symptoms by testing the mediational role of anxiety, peer attachment and depressive symptoms in a non-clinical sample of 332 Italian children (49.4% males) aged 8 to 11 years (Mage= 9.26; SD= 0.89) A serial multiple mediation model was used to verify the study's hypothesis. Somatic symptoms correlated with attachment, anxiety and depressive symptoms. Anxiety, peer attachment and depression mediated the association between parental attachment and somatic symptoms. This association remained significant a...