Ramenghi (Gaslini): “Every year 5,000 newborns must be resuscitated”

“In Italy, around 5,000 newborn babies need to be resuscitated every year. Of these, 600 develop severe post-asphyxial encephalopathy, at least about 300 have arterial stroke. Out of 100 children who develop cerebral palsy (an average of about 2 per thousand births) at least one fifth is due to post-asphyxial encephalopathy. And it is precisely perinatal asphyxia, reduction of blood flow to the tissues or reduction of oxygen in the blood of the newborn before and during birth, perhaps the main and most mysterious enemy on which we must work. Research must help us identify the possible genetic causes of this serious condition ”. So at Adnkronos Salute Luca Ramenghi, extraordinary professor of Pediatrics at the University of Genoa and director of Neonatal Pathology and of the Mother-Child Department of the Irccs Gaslini pediatric hospital in Genoa who is also the founder of Eu-Brain. “A non-profit association – explains Ramenghi – that was born with a dual purpose: to spread the perinatal neurological culture, or to spread what is known today about the various neurological problems that a child can encounter, both in the mother’s belly and in a was born, and raise funds to increase research in perinatal neurology, a field with enormous margins for discovery. The more people, parents, will be aware of it, the greater the efforts can be made to achieve great results, to add to those already obtained “Perinatal asphyxia and arterial stroke worry Ramenghi, because” each of these conditions – he argues – can potentially lead to a motor neurological outcome and to the cognitive and / or behavioral sphere that remains for life. Hence the need to study it. the effects in society. Thanks to the Melinda and Bill Gates Foundation, the Global Burden of Disease was born, which measures the social impact of these pathologies later in life “. “In this period – says Ramenghi – we are also concentrating our efforts on a research project funded by Eu-brain and the Gaslini Institute called Ripensa (Italian perinatal registry for post-asphyxial encephalopathy) which aims to study asphyxiation at best, also creating a register that does not yet exist in Italy. Objectives of the study – Ramenghi, who is also a member of the board of the European Society of Perinatal Medicine, points out – to identify the possible genetic causes of asphyxiation to try to understand why some newborns during labor cope well with the stress of uterine contractions, while others , two / three out of a thousand, are born with the need to be resuscitated and then some of them (1-1.5 / 1000) also develop a post-asphyxial encephalopathy with long-term outcomes “. Furthermore, although Italy is among the countries in the world where people are born better, with very low neonatal mortality rates (2.1 per thousand live births compared to 2.9 in Germany; 2.6 in Denmark; 2.7 in Netherlands and 2.9 in England, Eurostat data 2018), “in our country 6.7 births per hundred are pre-term” and premature babies are at greater risk of neurological outcomes than those born at full term of pregnancy. born in 2020, “about 25-28 thousand came to light before the canonical 37 weeks – underlines Ramenghi -. Of these 2500 were born under 31 weeks and weighing less than 1500 grams, the smaller ones and those who risk more than the others. But 25-28 thousand premature births under 37 weeks are really a lot because pre-term births are not without consequences “. When a baby is born pre-term it presents an immaturity of the organs. “It is easy to understand how to cope with the immaturity of the lungs – recalls the pediatrician – it is no coincidence that newborns are attached to the ventilator and thus helped to breathe. Instead, it is less easy to imagine what implies the immaturity of the brain which is easily exposed to developing not only brain lesions (intraventricular hemorrhages and inflammation of the white matter) due to its intrinsic immaturity but which often does not even allow adequate development outside the womb. . This is why I wanted Eu-brain, to allow the premature baby’s brain to grow at its best in the hostile extrauterine environment and to better understand the causes that give birth to many births at full term of pregnancy with great difficulty and need to be resuscitated but which can lead to neurological outcomes at a distance, as happens with asphyxia “. The reasons that push doctors to favor a pre-term birth are different.” If a fetus is growing little and badly and therefore suffers inside the uterus – Ramenghi affirms – you have to decide to give it birth earlier. It is a good reason to save the well-being of the fetus and the future baby. But at the basis of a premature birth there are so many conditions such as preeclampsia that with the worsening of maternal arterial hypertension accompanies the presence of an excess of protein in the urine that develops after 20 weeks of gestation and, not infrequently, mother nature takes care of itself to protect mother and fetus and, therefore, a labor starts spontaneously before the term “, concludes Ramenghi.