La nascita pretermine determina un’alterazione dei normali processi di maturazione dei vari organi ed apparati che durante la gravidanza fisiologica si completano durante le 38-40 settimane di vita intrauterina. Queste alterazioni sono alla base della mortalità e morbilità perinatale che condiziona la prognosi a breve termine di questa popolazione, ma possono determinare anche sequele a medio e lungo termine. E’ stato ampiamente documentato che la nefrogenesi si completa a 36 settimane di vita intrauterina e pertanto la nascita pretermine altera il decorso fisiologico di tale processo; a questa condizione di immaturità si sovrappongono i fattori patogeni che possono determinare danno renale acuto in epoca neonatale, a cui i pretermine sono in larga misura esposti. Queste condizioni conducono ad un rischio di alterazioni della funzione renale di entità variabile in età infantile ed adulta. Nel presente studio è stata studiata la funzione renale in 29 bambini di 2-4 anni di età, precedentemente sottoposti a valutazione della funzione renale alla nascita durante il ricovero in Terapia Intensiva Neonatale. I dati raccolti hanno mostrato la presenza di alterazioni maggiori (sindrome nefrosica, riduzione di eGFR) in un ridotto numero di soggetti e alterazioni minori ed isolate (proteinuria di lieve entità, riduzione del riassorbimento tubulare del fosforo, pressione arteriosa tra il 90° e il 99° percentile per sesso ed altezza). L’età di 2-4 anni, alla luce dei risultati ottenuti, può rappresentare un momento utile per effettuare una valutazione di screening di funzione renale in una popolazione a rischio come i pretermine, con lo scopo di individuare i soggetti che richiedano una presa in carico specialistica ed un follow-up a lungo termine. / Preterm birth may be associated to an impairment of the development that is completed after 40 weeks of gestation in term newborn. These alterations may lead to perinatal mortality and morbidity that are higher in preterm than in term newborn, and they may also determine short and long term sequelae. It was reported by several authors that nephrogenesis is completed at 36 weeks of gestation; for this reason preterm birth interrupts the physiological course of process; moreover, preterm newborns are exposed to several risk factors for acute kidney injury. These conditions are responsible of an increased risk of renal impairment in children and adults born prematurely. The aim of this study was to investigate renal function in 29 children 2-4 years old born prematurely and previously investigated for renal function in the perinatal period. We observed in the study group both major renal disorders (nephrotic syndrome and decreased eGFR)in a few infants, and mild impairment (mild proteinuria, decreased TRP, systolic blood pressure higher than 90° centile). Our results suggest that infants born prematurely could be screened for renal function in prescholar age to detect subjects requiring a long term follow up for renal function.

Background. Neonatal immune system is not fully developed at birth; newborns have an adequate leukocytes and lymphocytes count at birth but these cells lack of function. Objective. To assess the functional activity of T-cells at birth and at 30 days of life and the influence of the main perinatal factors in a population of preterm infants. Design. A prospective longitudinal study was carried out in a population of 59 preterms. Fifteen healthy adults were included as a control group. Blood samples were collected at birth and at 30 days of life to evaluate CD4+ T cell activity using the Immuknow® assay. Results. CD4+ T cell activity at birth and at 30 days of life were significantly lower compared with adult controls (p < .001). Twins showed lower activity compared to singletons (p= .005). Infants born to vaginal delivery had higher CD4+ T cell activity compared to those born to c-section (p=0.031); infants born after pPROM showed a higher activity at birth (p= .002). Low levels of CD4+ T cells activation at birth were associated with necrotizing enterocolitis development in the first week of life (p=.049). Conclusions. Preterm infants show a lack in CD4+ T cells activation at birth. Perinatal factors such as intrauterine inflammation, mode of delivery, zygosity can influence the levels of adaptative immune activity at birth and can contribute to expose these infants to serious complications such as NEC.

In this paper, we present an integrated framework for structuring and evaluating sequential greenhouse gas abatement policies under uncertainty. The analysis integrates information concerning the magnitude, timing, and impacts of climate change with data on the likely effectiveness and cost of possible response options, using reduced-scale representations of the global climate system drawn from the MIT Integrated Global System Model. To illustrate the method, we explore emissions control policies of the form considered under the United Nations Framework Convention on Climate Change. / Includes bibliographical references (p. 27-28). / Abstract in HTML and technical report in HTML and PDF available on the Massachusetts Institute of Technology Joint Program on the Science and Policy of Global Change website (http://mit.edu/globalchange/www/)

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Introduction Postnatal human cytomegalovirus (CMV) infection is usually asymptomatic in term babies, while preterm infants are more susceptible to symptomatic CMV infection. Breastfeeding plays a dominant role in the epidemiology of transmission of postnatal CMV infection, but the risk factors of symptomatic CMV infection in preterm infants are unknown. Patients and Methods Between December 2003 and August 2006, eighty Very Low Birth Weight (VLBW) preterm infants (gestational age ≤ 32 weeks and birth weight < 1500 g), admitted to the Neonatal Intensive Care Unit of St Orsola-Malpighi General Hospital, Bologna were recruited. All of them were breastfed for at least one month. During the first week of life, serological test for CMV was performed on maternal blood. Furthermore, urinary CMV culture was performed in all the infants in order to exclude a congenital CMV infection. Urine samples from each infant were collected and processed for CMV culture once a week. Once every 15 days a blood sample was taken from each infant to evaluate the complete blood count, the hepatic function and the C reactive protein. In addition, samples of fresh breast milk were processed weekly for CMV culture. A genetic analysis of virus variant was performed in the urine of the infected infants and in their mother’s milk to confirm the origin of infection. Results We evaluated 80 VLBW infants and their 68 mothers. Fifty-three mothers (78%) were positive for CMV IgG antibodies, and 15 (22%) were seronegative. In the seronegative group, CMV was never isolated in breast milk, and none of the 18 infants developed viruria; in the seropositive group, CMV was isolated in 21 out of 53 (40%) mother’s milk. CMV was detected in the urine samples of 9 out of 26 (35%) preterm infants, who were born from 21 virolactia positive mothers. Six of these infants had clinically asymptomatic CMV infection, while 3 showed a sepsis-like illness with bradycardia, tachypnea and repeated desaturations. Eight out of nine infants showed abnormal hematologic values. The detection of neutropenia was strictly related to CMV infection (8/9 infected infants vs 17/53 non infected infants, P<.005), such as the detection of an increase in conjugated bilirubin (3/9 infected infants vs 2/53 non infected infants, P<.05). The degree of neutropenia was not different between the two groups (infected/non infected). The use of hemoderivatives (plasma and/or IgM–enriched immunoglobulin) in order to treat a suspected/certain infection in newborn with GE< 28 ws was seen as protective against CMV infection (1/4 infected infants vs 18/20 non infected infants [GE<28 ws]; P<.05). Furthermore, bronchopulmonary dysplasia (defined both as oxygen-dependency at 30 days of life and 36 ws of postmenstrual age) correlated with symptomatic infection (3/3 symptomatic vs 0/6 asymptomatic: P<.05). Conclusion Our data suggest that CMV infection transmitted to preterm newborn through human milk is always asymptomatic when newborns are clinically stable. Otherwise, the infection can worsen a preexisting disease such as bronchopulmonary dysplasia. Human milk offers many nutritional and psychological advantages to preterm newborns: according to our data, there’s no reason to contraindicate it neither to pasteurize the milk of all the mothers of preterm infants who are CMV seropositive.