Arribas-Sánchez, C. (Cristina)
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- Human bone marrow-derived mesenchymal stromal cells reduce the severity of experimental necrotizing enterocolitis in a concentration-dependent manner(MDPI, 2023) Manzoni, F. (Francesca); Amodeo, I. (Ilaria); Gulden, S. (Silvia); Lonati, C. (Caterina); Mosca, F. (Fabio); Provitera, L. (Livia); Maggioni, M. (Marco); Tomaselli, A. (Andrea); Cerasani, J. (Jacopo); Cavallaro, G. (Giacomo); Pesenti, N. (Nicola); Raffaeli, G. (Genny); Crippa, S. (Stefania); Bernardo, M.E. (Maria Ester); Arribas-Sánchez, C. (Cristina); Amelio, G.S. (Giacomo Simeone); Oldoni, S. (Samanta); Menis, C. (Camilla); Tripodi, M. (Matteo); Cortesi, V. (Valeria); Santi, L. (Ludovica); Algieri, F. (Francesca); Garrido-Martínez-de-Salazar, F. (Felipe); Cervellini, G. (Gaia): Necrotizing enterocolitis (NEC) is a devastating gut disease in preterm neonates. In NEC animal models, mesenchymal stromal cells (MSCs) administration has reduced the incidence and severity of NEC. We developed and characterized a novel mouse model of NEC to evaluate the effect of human bone marrow-derived MSCs (hBM-MSCs) in tissue regeneration and epithelial gut repair. NEC was induced in C57BL/6 mouse pups at postnatal days (PND) 3–6 by (A) gavage feeding term infant formula, (B) hypoxia/hypothermia, and (C) lipopolysaccharide. Intraperitoneal injections of PBS or two hBM-MSCs doses (0.5 × 106 or 1 × 106 ) were given on PND2. At PND 6, we harvested intestine samples from all groups. The NEC group showed an incidence of NEC of 50% compared with controls (p < 0.001). Severity of bowel damage was reduced by hBM-MSCs compared to the PBS-treated NEC group in a concentration-dependent manner, with hBM-MSCs (1 × 106 ) inducing a NEC incidence reduction of up to 0% (p < 0.001). We showed that hBM-MSCs enhanced intestinal cell survival, preserving intestinal barrier integrity and decreasing mucosal inflammation and apoptosis. In conclusion, we established a novel NEC animal model and demonstrated that hBM-MSCs administration reduced the NEC incidence and severity in a concentration-dependent manner, enhancing intestinal barrier integrity.
- Bloqueo del nervio ciático poplíteo ecoguiado en urgencias en un paciente pediátrico con dolor severo producido por una picadura de escorpión(Elsevier, 2023) Ruano, G.M. (G. Miguel); Álvarez-Avello, J.M. (J.M.); Leal-Quiñones, F. (F.); Arribas-Sánchez, C. (Cristina)Presentamos el caso de un paciente pediátrico que acudió a urgencias con dolor severo en la extremidad inferior derecha causado por la picadura de un escorpión. Ante la ausencia de respuesta a los analgésicos administrados se optó por realizar un bloqueo poplíteo ecoguiado, lo que consiguió una analgesia completa y permitió el manejo ambulatorio del paciente, sin referir efectos adversos. Las familias de escorpiones presentes en nuestro país no suponen un riesgo vital para el ser humano, pero su picadura produce una reacción local con dolor autolimitado a unas 24-48 h que puede ser severo. El manejo prioritario es realizar una correcta analgesia. Las técnicas anestésicas regionales son de utilidad para el control del dolor agudo y pueden representar una colaboración eficaz entre los servicios de anestesiología y urgencias.
- Age-dependent nasal immune responses in non-hospitalized bronchiolitis children(Frontiers, 2022-12-06) López, V. (Victoria); Solís, B. (Beatriz); Rodriguez, J. (Javier); García-Vao, C. (Carlos); Andrés, B. (Belén) de; Rodríguez, M. (Mercedes); Roa, S. (Sergio); Díaz, J. (Juncal); Gaspar, M.L. (María Luisa); Cortegano, I. (Isabel); Zaballos, A. (Ángel); Arrabal, A. (Alejandro); Arribas-Sánchez, C. (Cristina); Fernández, S. (Sandra); Rosa, B. (Belén) de la; Hernangómez, S. (Susana); Garrido-Martínez-de-Salazar, F. (Felipe)Bronchiolitis in children is associated with significant rates of morbidity and mortality. Many studies have been performed using samples from hospitalized bronchiolitis patients, but little is known about the immunological responses from infants suffering from mild/moderate bronchiolitis that do not require hospitalization. We have studied a collection of nasal lavage fluid (NLF) samples from outpatient bronchiolitis children as a novel strategy to unravel local humoral and cellular responses, which are not fully characterized. The children were age-stratified in three groups, two of them (GI under 2-months, GII between 2-4 months) presenting a first episode of bronchiolitis, and GIII (between 4 months and 2 years) with recurrent respiratory infections. Here we show that elevated levels of pro-inflammatory cytokines (IL1β, IL6, TNFα, IL18, IL23), regulatory cytokines (IL10, IL17A) and IFNγ were found in the three bronchiolitis cohorts. However, little or no change was observed for IL33 and MCP1, at difference to previous results from bronchiolitis hospitalized patients. Furthermore, our results show a tendency to IL1β, IL6, IL18 and TNFα increased levels in children with mild pattern of symptom severity and in those in which non RSV respiratory virus were detected compared to RSV+ samples. By contrast, no such differences were found based on gender distribution. Bronchiolitis NLFs contained more IgM, IgG1, IgG3 IgG4 and IgA than NLF from their age-matched healthy controls. NLF from bronchiolitis children predominantly contained neutrophils, and also low frequency of monocytes and few CD4+ and CD8+ T cells. NLF from infants older than 4-months contained more intermediate monocytes and B cell subsets, including naïve and memory cells. BCR repertoire analysis of NLF samples showed a biased VH1 usage in IgM repertoires, with low levels of somatic hypermutation. Strikingly, algorithmic studies of the mutation profiles, denoted antigenic selection on IgA-NLF repertoires. Our results support the use of NLF samples to analyze immune responses and may have therapeutic implications.
- Current pain management practices for preterm infants with necrotizing enterocolitis: a European survey(Nature Publishing Group, 2023) Simons, S.H.P. (Sinno H. P.); Meesters, N.J. (Naomi J.); Allegaert, K. (Karel); Vermeulen, M.J. (Marijn J.); Ten-Barge, J.A. (Judith A.); Cavallaro, G. (Giacomo); Raffaeli, G. (Genny); Bosch, G.E. (Gerbrich E.) van den; Arribas-Sánchez, C. (Cristina); Garrido-Martínez-de-Salazar, F. (Felipe)Background: Necrotizing enterocolitis (NEC) is a highly painful intestinal complication in preterm infants that requires adequate pain management to prevent short- and long-term effects of neonatal pain. There is a lack of international guidelines for pain management in NEC patients. Therefore, this study aims to describe current pain management for NEC patients in European neonatal intensive care units (NICUs). Methods: An online survey was designed and conducted to assess current practices in pain management for NEC patients in European NICUs. The survey was distributed via neonatal societies, digital platforms, and professional contacts. Results: Out of the 259 responding unique European NICUs from 36 countries, 61% had a standard protocol for analgesic therapy, 73% assessed pain during NEC, and 92% treated NEC patients with intravenous analgosedatives. There was strong heterogeneity in the used pain scales and initial analgesic therapy, which mainly included acetaminophen (70%), fentanyl (56%), and/or morphine (49%). A third of NICU representatives considered their pain assessment adequate, and half considered their analgesic therapy adequate for NEC patients. Conclusions: Various pain scales and analgesics are used to treat NEC patients in European NICUs. Our results provide the first step towards an international guideline to improve pain management for NEC patients. Impact: This study provides an overview of current pain management practices for infants with necrotizing enterocolitis (NEC) in European neonatal intensive care units. Choice of pain assessment tools, analgosedatives, and dosages vary considerably among NICUs and countries. A third of NICU representatives were satisfied with their current pain assessment practices and half of NICU representatives with their analgesic therapy practices in NEC patients in their NICU. The results of this survey may provide a first step towards developing a European pain management consensus guideline for patients with NEC.
- Description of the exposure of the most-followed spanish instamom's children to social medias(MDPI, 2022) García, P. (Pilar); Cavallaro, G. (Giacomo); González-Caballero, J.L. (Juan Luis); Raffaeli, G. (Genny); Merino, M. (María); Vacaroaia, A. (Alex); Sanmiguel, P. (Patricia); Arribas-Sánchez, C. (Cristina); Iriso, I. (Isabel); Couso, B. (Beatriz); Álvarez, A. (Alexandra); Garrido-Martínez-de-Salazar, F. (Felipe)There is evidence of the risk of overexposure of children on social networks by parents working as influencers. A cross-sectional study of the profiles of the sixteen most-followed Instamoms in Spain was carried out. An analysis of these profiles was performed over a full month (April 2022), three times a week, to describe the representation of influencers’ children in the posts shared by them, as well as their role in the Instamoms’ marketing. A total of 192 evaluations of the profiles were performed in the study period. The average number of children exposed by an Instamom was three, generally preschoolers and schoolchildren. The children appear in a context of the family home and accompanied by their mother. The type of advertising that accompanies the appearance of underage children is usually women or children’s clothing, but also food products, leisure, etc. Appearance of children in the posts had a statistically significant influence on followers measured by the number of likes. Results provided the identification of two Instamom clusters with differentiated behaviors in relation to appearance of children in posts. It is important to involve Social Pediatrics in the protection of the privacy and interests of children given the increase in sharenting. The authors believe that there are concerns about their explicit consent to public exposure from early childhood and about the medium and long-term effect that this may have on their future well-being.
- Variations in antibiotic use and sepsis management in neonatal intensive care units: A European survey(2021) Paniagua, M. (Miren); Allegaert, K. (Karel); Cavallaro, G. (Giacomo); Raffaeli, G. (Genny); Arribas-Sánchez, C. (Cristina); Villamor, E. (Eduardo); Garrido-Martínez-de-Salazar, F. (Felipe)Management of neonatal sepsis and the use of antimicrobials have an important impact on morbidity and mortality. However, there is no recent background on which antibiotic regimens are used in different European neonatal intensive care units (NICUs). Our study aimed to describe the use of antibiotics and other aspects of early- and late-onset sepsis (EOS and LOS, respectively) management by European NICUs. We conducted an online survey among NICUs throughout Europe to collect information about antibiotic stewardship, antibiotic regimens, and general aspects of managing neonatal infections. NICUs from up to 38 European countries responded, with 271 valid responses. Most units had written clinical guidelines for EOS (92.2%) and LOS (81.1%) management. For EOS, ampicillin, penicillin, gentamicin, and amikacin were the most commonly used antibiotics. Analysis of the combinations of EOS regimens showed that the most frequently used was ampicillin plus gentamicin (54.6%). For LOS, the most frequently used antibiotics were vancomycin (52.4%), gentamicin (33.9%), cefotaxime (28%), and meropenem (15.5%). Other aspects of the general management of sepsis have also been analyzed. The management of neonatal sepsis in European NICUs is diverse. There was high self-reported adherence to the local clinical guidelines. There was homogeneity in the combination of antibiotics in EOS but less in LOS.