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MARISA PUGLIESE

Docente a contratto
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto
Docente a contratto
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa

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Pubblicazioni

2023 - Neuropsychological Outcomes of Children Treated for Brain Tumors [Articolo su rivista]
Pancaldi, Alessia; Pugliese, Marisa; Migliozzi, Camilla; Blom, Johanna; Cellini, Monica; Iughetti, Lorenzo
abstract

Central nervous system (CNS) neoplasms are the most common solid tumors diagnosed in children. CNS tumors represent the leading cause of cancer death and cancer-related morbidity for children less than 20 years of age, although there has been a moderate increase in survival rates over the past several decades. The average survival at 5 years now nearly reaches 75%, and for some, non-malignant histology approximates 97% at 20 years from diagnosis. Neurological, cognitive, and neuropsychological deficits are the most disabling long-term effects of brain tumors in children. Childhood is a time of extreme brain sensitivity and the time of life in which most brain development occurs. Thus, the long-term toxicities that children treated for CNS tumors experience can affect multiple developmental domains and day-to-day functioning, ultimately leading to a poor quality of survival (QoS). We reviewed literature focusing on the risk factors for cognitive and neuropsychological impairment in pediatric patients treated for brain tumors with the aim of better understanding who is at major risk and what the best strategies for monitoring these patients are.

2022 - Neonatal seizures treatment based on conventional multichannel EEG monitoring: an overview of therapeutic options [Articolo su rivista]
Guidotti, Isotta; Lugli, Licia; Ori, Luca; Roversi, Maria Federica; Casa Muttini, Elisa Della; Bedetti, Luca; Pugliese, Marisa; Cavalleri, Francesca; Stefanelli, Francesca; Ferrari, Fabrizio; Berardi, Alberto
abstract

Introduction: Seizures are the main neurological emergency during the neonatal period and are mostly acute and focal. The prognosis mainly depends on the underlying etiology. Conventional multichannel video-electroencephalographic (cEEG) monitoring is the gold standard for diagnosis, but treatment remains a challenge. Areas covered: : This review, based on PubMed search over the last 4 decades, focuses on the current treatment options for neonatal seizures based on cEEG monitoring. There is still no consensus on seizure therapy, owing to poor scientific evidence. Traditionally, the first-line treatments are phenobarbital and phenytoin, followed by midazolam and lidocaine, but their efficacy is limited. Therefore, current evidence strongly suggests the use of alternative antiseizure medications. Randomized controlled trials of new drugs are ongoing. Expert opinion: : Therapy for neonatal seizures should be prompt and tailored, based on semeiology, mirror of the underlying cause, and cEEG features. Further research should focus on antiseizure medications that directly act on the etiopathogenetic mechanism responsible for seizures and are therefore more effective in seizure control.

2022 - Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes [Articolo su rivista]
Lugli, L.; Guidotti, I.; Pugliese, M.; Roversi, M. F.; Bedetti, L.; Della Casa Muttini, E.; Cavalleri, F.; Todeschini, A.; Genovese, M.; Ori, L.; Amato, M.; Miselli, F.; Lucaccioni, L.; Bertoncelli, N.; Candia, F.; Maura, T.; Iughetti, L.; Ferrari, F.; Berardi, A.
abstract

Background: Neonatal encephalopathy due to perinatal asphyxia is one of the leading causes of neonatal death and morbidity worldwide. The neurodevelopmental outcomes of asphyxiated neonates have considerably improved after therapeutic hypothermia (TH). The current challenge is to identify all newborns with encephalopathy at risk of cerebral lesions and subsequent disability within 6 h of life and who may be within the window period for treatment with TH. This study evaluated the neurodevelopmental outcomes in surviving asphyxiated neonates who did and did not receive TH, based on clinical and polygraphic electroencephalographic (p-EEG) criteria. Methods: The study included 139 asphyxiated newborns divided into two groups: 82 who received TH and 57 who were not cooled. TH was administered to asphyxiated newborns (gestational age ≥ 35 weeks, birth weight ≥ 1800 g) with encephalopathy of any grade and moderate-to-severe p-EEG abnormalities or seizures. Neurodevelopmental outcomes between the groups at 24 months of life and the risk factors for severe outcomes were assessed. Results: Severe neurodevelopmental impairment occurred in 10 (7.2%) out of the 139 enrolled neonates. Nine out of the 82 cooled neonates (11.0%) had severe neurodevelopmental impairment. All but one neonate (98.2%) who did not receive TH had normal outcomes. The multivariate logistic regression analysis showed that abnormal p-EEG patterns (OR: 27.6; IC: 2.8–267.6) and general movements (OR: 3.2; IC: 1.0–10.0) were significantly associated with severe neurodevelopmental impairment (area under ROC curve: 92.7%). Conclusion: The combination of clinical and p-EEG evaluations in hypoxic–ischemic encephalopathy contributed to a more accurate selection of patients treated with therapeutic hypothermia. When administered to infants with moderate to severe p-EEG abnormalities, TH prevents approximately 90% of severe neurodevelopmental impairment after any grade of hypoxic–ischemic encephalopathy.

2022 - Sudden Unexpected Postnatal Collapse and Therapeutic Hypothermia: What’s Going On? [Articolo su rivista]
Bedetti, L.; Lugli, L.; Garetti, E.; Guidotti, I.; Roversi, M. F.; Della Casa, E.; Miselli, F.; Bariola, M. C.; Di Caprio, A.; Pugliese, M.; Ferrari, F.; Berardi, A.
abstract

Sudden unexpected postnatal collapse (SUPC) is a rare event, potentially associated with catastrophic consequences. Since the beginning of the 2000s, therapeutic hypothermia (TH) has been proposed as a treatment for asphyxiated neonates after SUPC. However, only a few studies have reported the outcome of SUPC after TH. The current study presents the long-term neurodevelopmental outcome of four cases of SUPC treated with TH in a single Italian center. Furthermore, we reviewed the previous literature concerning 49 cases of SUPC treated with TH. Among 53 total cases (of whom four occurred in our center), 15 (28.3%) died before discharge from the NICU. A neurodevelopmental follow-up was available only for 21 (55.3%) out of the 38 surviving cases, and seven infants developed neurodevelopmental sequelae. TH should be considered in neonates with asphyxia after SUPC. However, SUPC is a rare event, and there is a lack of comparative clinical data to establish the risk/benefit of TH after SUPC with different degrees of asphyxia. Analysis of large cohorts of newborns with SUPC, whether treated with TH or untreated, are needed in order to better identify infants who should undergo TH.

2021 - Health-related quality of life and metabolic control in young patients with type 1 diabetes and in their parents before and after the COVID-19 lockdown [Abstract in Rivista]
Predieri, B.; Bruzzi, P.; Candia, F.; Caccamo, P.; Sandoni, M.; Stefanelli, F.; Pugliese, M.; Lucaccioni, L.; Madeo, S. F.; Iughetti, L.
abstract

Introduction: Since the beginning of the COVID-19 pandemic, concerns for consequences in patients with type 1 diabetes (T1D) were raised. Objectives: To compare the diabetes-specific health-related quality of life (D-HRQOL) of youths with T1D and their parents before and after the COVID-19-related lockdown. Methods: The Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 DM) was used to evaluate the D-HRQOL. Patients who filled the D-HRQOL before lockdown (Dec-19–Feb-20; T0) were recruited in the study and filled the same survey immediately after the lockdown was stopped (Jun-20; T1) during a routine outpatient or telemedicine visit. Results: Sixty-two patients (median age: 12.6 [5.25-17.8] yrs; T1D duration 4.23 [0.45- 16.4] yrs) with T1D and their parents (60 mothers, 10 fathers) were enrolled. Patients' scales scores did not significantly change from T0 to T1. Mothers significantly increased their Diabetes symptoms scale score (median 67.0 vs. 70.4; p=0.007). Data were also analyzed according to visit type (outpatient vs. telemedicine), glucose monitoring (SBGM vs. isCGM vs. rtCGM), and insulin therapy (MDI vs. CSII), but D-HRQOL data were longitudinally comparable and no difference was found between groups. During lockdown no DKA, severe hypoglycemic events, and SARS-CoV-2 were recorded. Despite the significant decrease of exercise (median 3.25 vs. 0.50 h/week; p<0.0001), median glycemic control (HbA1c 58.5 vs. 57.9 mmol/mol) and total daily insulin dose (0.86 vs. 0.82 IU/kg/day) were unchanged. At T1, the lower the HbA1c, the better patients' Diabetes symptoms (R=-0.41, p<0.001), Worry (R=-0.27, p=0.032) scales, and total scores (R=-0.33, p=0.009). Similar results were found in parents. Conclusions: During COVID-19 pandemic-related lockdown the D-HRQOL did not change in children and adolescents with T1D and their parents. Our data may be possibly related to staying at home, making diabetes managements easier and also allowing the maintenance of good glycemic control without acute complications.

2021 - QUALITÀ DI VITA E CONTROLLO METABOLICO NEI BAMBINI ED ADOLESCENTI CON DIABETE DI TIPO 1 E NEI LORO GENITORI PRIMA E DOPO IL LOCKDOWN PER COVID-19. [Abstract in Atti di Convegno]
Predieri, Barbara; Bruzzi, Patrizia; Candia, Francesco; Caccamo, Paola; Sandoni, Marcello; Stefanelli, Francesca; Pugliese, Marisa; Lucaccioni, Laura; Madeo, Simona F.; Iughetti, Lorenzo
abstract

2021 - Si può “Valere” di più: un progetto italiano studia i disturbi alimentari negli adolescenti con diabete tipo 1. Dati preliminari [Abstract in Atti di Convegno]
Troncone, Alda; Iafusco, Dario; Curto, Stefano; Piscopo, Alessia; Zanfardino, Angela; Cascella, Crescenzo; Affuso, Gaetana; Chianese, Antonietta; Lera, Liccardo; Patrizia Bracciolini, Giulia; Grosso, Caterina; Bertelli, Giulia; Cherubini, Valentino; Piccinno, Elvira; Delvecchio, Maurizio; Ortolani, Federica; Vendemiale, Marcella; Rutigliano, Alessandra; Zecchino, Clara; Zucchini, Stefano; Maltoni, Giulio; Scarponi, Dorella; Fraternale, Lucia; Susanna Coccioli, Maria; Brugnola, Vito; Gallo, Francesco; Ripoli, Carlo; Rossella Ricciardi, Maria; Pascarella, Filomena; Perrotti, Arcangelo; Golino, Anna; Stamati, Filomena; Caruso Nicoletti, Manuela; Lo Presti, Donatella; Saggio, Annalisa; Citriniti, Felice; Sperlì, Domenico; De Marco, Rosaria; Daniela Borselli, Maria; Lazzaro, Nicola; Toni, Sonia; Balbo, Verena; D’Annunzio, Giuseppe; Minuto, Nicola; Parodi, Alice; Caloiero, Mimma; Aloe, Monica; Corsini, Maria; Lombardo, Fortunato; Pecoraro, Danila; Bonfanti, Riccardo; Pozzi, Clara; Iughetti, Lorenzo; Predieri, Barbara; Pugliese, Marisa; Rabbone, Ivana; Pignatiello, Ciro; Galderisi, Alfonso; Santoro, Giacomo; De Berardinis, Fiorella; Iovane, Brunella; Dioni, Silvia; Carmela Lia, Maria; Tutino, Rita; Cianfarani, Stefano; Schiaffini, Riccardo; Patrizia Patera, Ippolita; Cristina Matteoli, Maria; Carducci, Chiara; Rutigliano, Irene; Franca Minenna, Adelaide; Trada, Michela; Tinti, Davide; Montarulo, Cinzia; Cardinale, Giuliana; de Leo, Sofia; Arnaldi, Claudia; Longo, Barbara
abstract

2020 - Glycemic Control Improvement in Italian Children and Adolescents With Type 1 Diabetes Followed Through Telemedicine During Lockdown Due to the COVID-19 Pandemic [Articolo su rivista]
Predieri, B.; Leo, F.; Candia, F.; Lucaccioni, L.; Madeo, S. F.; Pugliese, M.; Vivaccia, V.; Bruzzi, P.; Iughetti, L.
abstract

Background/Objective: To minimize the wide spread of coronavirus disease (COVID-19) pandemic, Italy was placed in an almost complete lockdown state that forced people to “stay at home”. Aim of this study was to evaluate the effects of lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) followed through telemedicine. Subjects/Methods: This observational study involved patients with T1D using the real-time continuous glucose monitoring (CGM) Dexcom G6®. Ambulatory glucose profile data from the 3-months before schools closure (November 26, 2019–February 23, 2020; T0) and from the 3-months of consecutive lockdown (February 24–May 18, 2020; T1) were compared. Results: Sixty-two children and adolescents (11.1 ± 4.37 years, 50% males) with T1D (median time disease 3.67 years) were enrolled in the study. Insulin total daily dose was unchanged, while time spent on physical activities was decreased (p<0.0001). Despite the lack of statistical significance, median value of the glucose management indicator decreased from 7.4% to 7.25%. Glucose standard deviation (p<0.0001) and coefficient of variation (p=0.001) improved across the study. Median time in range increased from 60.5% to 63.5% (p=0.008), time above range decreased from 37.3% to 34.1% (p=0.048), and time below range decreased from 1.85% to 1.45% (p=0.001). Conclusions: Overall, in our children and adolescents with T1D glycemic control improved during lockdown. Despite patients were confined to their homes and limited to exercise, our data suggest that the use of real-time CGM, the continuous parental management, and the telemedicine can display beneficial effects on T1D care.

2020 - Health-Related Quality of Life and Metabolic Control in Immigrant and Italian Children and Adolescents with Type 1 Diabetes and in their Parents [Articolo su rivista]
Predieri, Barbara; Bruzzi, Patrizia; Bigi, Elena; Boncompagni, Alessandra; Bocchi, Federica; Cenciarelli, Valentina; Madeo, Simona F; Poluzzi, Silvia; Pugliese, Marisa; Toffoli, Carlotta; Lucaccioni, Laura; Iughetti, Lorenzo
abstract

Objective: To determine if the diabetes-specific health-related quality of life (D-HRQOL) of young people with type 1 diabetes (T1D) and their parents is influenced by migrant status. Subjects and methods: One hundred and twenty-five patients (12.4±3.55 years, males 53.6%) with T1D and their parents (102 mothers, 37 fathers) were enrolled and categorized into: Group A (both foreign parents) and Group B (both native Italian parents). The Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 DM) was used to evaluate the D-HRQOL. Data on diabetic ketoacidosis (DKA) at T1D onset, insulin therapy, and glycosylate hemoglobin (HbA1c) were also collected. Results: Group A (n=40), compared to Group B (n=85), had higher frequency of DKA at T1D onset (p<0.001) and a lower use of sensor augmented insulin pump (p=0.015). HbA1c values were higher in Group A than in Group B (p<0.001). Patients' "Diabetes symptoms" (p=0.004), "Treatment barriers" (p=0.001), and "Worry" (p=0.009) scales scores were lower in Group A than in Group B. Mothers of Group A had lower scores in "Diabetes symptoms" (p=0.030), "Treatment barriers" (p<0.001), "Treatment adherence" (p=0.018), "Communication" (p=0.009) scales, and total score (p=0.011) compared to the Group B ones. High PedsQL™ 3.0 DM was significantly associated with being Italian, being pre-pubertal, and having lower HbA1c mean levels. Conclusions: Being a migrant confers disadvantages in terms of D-HRQOL and metabolic control in children and adolescents with T1D. Specific educational interventions should be considered in the clinical care of patients with migration background, to improve D-HRQOL and health status.

2020 - Neuroprem: The Neuro-developmental outcome of very low birth weight infants in an Italian region [Articolo su rivista]
Lugli, L.; Pugliese, M.; Plessi, C.; Berardi, A.; Guidotti, I.; Ancora, G.; Grandi, S.; Gargano, G.; Braibanti, S.; Sandri, F.; Soffritti, S.; Ballardini, E.; Arena, V.; Stella, M.; Perrone, S.; Moretti, S.; Rizzo, V.; Ferrari, F.
abstract

Introduction: The survival of preterm babies has increased worldwide, but the risk of neuro-developmental disabilities remains high, which is of concern to both the public and professionals. The early identification of children at risk of neuro-developmental disabilities may increase access to intervention, potentially influencing the outcome. Aims: Neuroprem is an area-based prospective cohort study on the neuro-developmental outcome of very low birth weight (VLBW) infants that aims to define severe functional disability at 2 years of age. Methods: Surviving VLBW infants from an Italian network of 7 neonatal intensive care units (NICUs) were assessed for 24 months through the Griffiths Mental Developmental Scales (GMDS-R) or the Bayley Scales of Infant and Toddler Development (BSDI III) and neuro-functional evaluation according to the International Classification of Disability and Health (ICF-CY). The primary outcome measure was severe functional disability at 2 years of age, defined as cerebral palsy, a BSDI III cognitive composite score < 2 standard deviation (SD) or a GMDS-R global quotients score < 2 SD, bilateral blindness or deafness. Results: Among 211 surviving VLBW infants, 153 completed follow-up at 24 months (72.5%). Thirteen patients (8.5%) developed a severe functional disability, of whom 7 presented with cerebral palsy (overall rate of 4.5%). Patients with cerebral palsy were all classified with ICF-CY scores of 3 or 4. BSDI III composite scores and GMDS-R subscales were significantly correlated with ICF-CY scores (p < 0.01). Conclusion: Neuroprem represents an Italian network of NICUs aiming to work together to ensure preterm neuro-developmental assessment. This study updates information on VLBW outcomes in an Italian region, showing a rate of cerebral palsy and major developmental disabilities in line with or even lower than those of similar international studies. Therefore, Neuroprem provides encouraging data on VLBW neurological outcomes and supports the implementation of a preterm follow-up programme from a national network perspective.

2019 - Extra Uterine Growth Restriction (EUGR) in very low birth weight infants: Growth recovery and neurodevelopment by the corrected age of 2 years old [Abstract in Rivista]
Lucaccioni, Laura; Arrigoni, Marta; Elisa Della Casa, ; Natascia, Bertoncelli; Predieri, Barbara; Berardi, Alberto; Pugliese, Marisa; Ferrari, Fabrizio; Iughetti, Lorenzo
abstract

Background: Extra Uterine Growth Restriction (EUGR) represents a serious comorbidity in infants born very low birth weight (VLBW). In fact, failure in postnatal growth and malnutrition at vulnerable ages can interfere with growth recovery and neurodevelopment at older ages. Hypothesis: Aim of the study was to assess whether and how the postnatal early growth patterns of VLBW may affect later growth, spontaneous motility at three months of corrected age (CA) and neurodevelopment at 2 years CA. Study Design: Retrospective single-centre study of 547 infants (255M) born VLBW between 2005 and 2015. Each participant underwent: a) anthropometric assessments of weight (W), length (L) and head circumference (HC) at birth, at discharge from the NICU and at 2 years CA; b) Evaluation of Fidgety movements (F) at three months CA; c) Neurodevelopmental assessment at 2 years CA through the Griffith Mental Development Scales. Results: From the overall population, growth percentiles at discharge were significantly lower than at birth (L p<0.01; W p<0.01; HC p< 0.01). Longitudinal data showed a significant growth restriction between birth (AGA for W:73%; AGA for L:73.2%) and discharge (AGA for W:36%; AGA for L:31.2%). Gestational age, duration of hospitalisation, bronchopulmonary dysplasia and intra ventricular haemorrhage were found to be predictive factors for EUGR at discharge. At 2 years CA, SGA at discharge but not at birth, showed significantly lower stature compared to the AGA ones (p:0.04). Significant correlation was found between F and L (p:0.04; r:0.12) and HC (p<0.02; r:0.2) at discharge, but not at birth. Moreover, a significant difference was found between F and locomotor outcome at two years CA (p<0.01). W and L at discharge, but not at birth, were significantly related to worse locomotor outcome at two years of CA (respectively, p:0.03, r:0.14; p:0.01, r:0.18). In particular, who was found SGA at discharge, both for W and/or L, had the worse motor outcome compared to the AGA ones (respectively, p:0.04 and p:0.01). Conclusions: VLBW growth measurements at discharge, but not at birth, are related to poorer growth and neurodevelopment at later ages, especially in children who become SGA. Lower scores in locomotor assessment at two years CA have been observed in infants with anomalies of F, suggesting how spontaneous motility could predict later neurodevelopmental outcomes. Our findings highlight the necessity of a close clinical follow-up of growth patterns during preterm hospitalization aiming to decrease the incidence of EUGR.

2019 - Health-Related Quality of Life and Diabetes Control in Immigrant and Italian Children and Adolescents with Type 1 Diabetes and in their Parents [Abstract in Rivista]
Predieri, Barbara; Boncompagni, Alessandra; Patrizia, Bruzzi; Cenciarelli, Valentina; Madeo, Simona F.; Pugliese, Marisa; Toffoli, Carlotta; Federica, Bocchi; Iughetti, Lorenzo
abstract

Background/Objectives: Type 1 diabetes (T1D) is a chronic metabolic disease that requires daily and complex management for both patients and their caregivers, impairing the quality of life. Aim of this cross-sectional observational study was to determine whether metabolic control and health-related quality of life (HRQOL) of T1D subjects and their parents could be influenced by immigration status. Methods: We enrolled 125 children and adolescents with T1D (12.4±3.55 years; males 53.6%; T1D duration 5.61±3.50 years) and their parents (102 mothers and 37 fathers). According to patients’ maternal origin, the study population was categorized into Group A (immigrant) and Group B (Italian). The Italian translation of the PedsQL™ 3.0 Diabetes Module was used to evaluate the HRQOL. Information on presence of diabetic ketoacidosis (DKA) at T1D onset, insulin therapy (MDI/SAP), and glycosylate hemoglobin (HbA1c), were collected at the same time of the questionnaire. Results: Group A, respect to Group B, had significantly higher frequency of DKA at T1D onset (55.0 vs. 22.3%; Chi-square=13.1; p<0.001) and a significant lower use of SAP (5.0 vs. 22.3%; Chi-Square=5.86; p=0.015). HbA1c values were significantly higher in Group A respect to Group B (72.7±17.6 vs. 62.6±12.9 mmol/mol; p<0.001). Patients’ HRQOL scores were significantly lower in Group A than in Group B in the following scales: “Diabetes selfsymptoms” (57.9±14.6 vs. 66.9±12.8; p=0.004), “Treatment barriers” (68.1±23.6 vs. 82.9±13.0; p=0.001), and “Worry” (52.9±26.9 vs. 66.9±23.7; p=0.009). Mothers’ HRQOL scores were significantly lower in Group A than in Group B in the following scales: “Diabetes self-symptoms” (56.7±18.1 vs. 65.8±15.7; p=0.030), “Treatment barriers” (55.9±19.8 vs. 71.3±19.7; p<0.001), “Treatment adherence” (71.2±18.1 vs. 80.6±11.2; p=0.018), “Communication” (58.9±31.4 vs. 75.9±23.3; p=0.009) scales, and total score (57.2±17.1 vs. 68.8±12.6; p=0.011). No differences were found in fathers’ data. The multivariate regression model for child HRQOL scales identified the following significant predictive factors: MDI insulin therapy ('=0.438; p=0.008), Italian ethnicity ('=0.018; p=0.004), HbA1c ('=-0.228; p=0.029) for “Treatment barriers” scale; Italian ethnicity ('=0.584; p=0.046) for “Worry” scale. Conclusions: Our results strongly suggest that immigrant status confers significant disadvantages in terms of T1D treatment, glycemic control, and HRQOL in children and adolescents with T1D. Moreover, parents’ HRQOL data suggest that daily T1D management is usually supervised by mothers rather than fathers. Specific challenges and educational interventions should be considered in clinical care of T1D patients with distinct migration background.