Normally, delivery takes place between the 37th and the 42nd week of gestation. By that time, the fetus is fully formed and developed enough to be able to adapt to extra-uterine life. However, in some cases delivery may occur before the 37th week of gestation. In that case, the neonate is considered preterm, with the degree of development of their organs being dependent on the gestational age.

Maturation and functionality of the lungs is critical for survival. Based on the degree of prematurity, lungs can be partially or even completely immature, and thus unable to ensure an adequate respiratory function.

For decades, Chiesi has been committed to neonatology, working alongside the medical community to improve the level of care for preterm babies. Thanks to this important relationship, Chiesi has become a global partner for neonatologists, bringing its life-saving drugs to more than 80 countries worldwide, and working towards the sharing of best clinical practices.

APNOEA OF PREMATURITY

The incomplete development of the respiratory system and the areas of the brain that regulate respiration is a common issue in preterm infants, with severity increasing in babies with a low birthweight. This condition results in episodes of spontaneous apnoea, which is usually defined as a cessation of breathing lasting more than 20 seconds. Clinically, this interruption may be accompanied by a slower heart rate and/or a reduction of the quantity of oxygen in the blood. Finally, pale or cyanotic skin tone can occur in an infant experiencing an apnoeic episode, together with a reduction in muscle tone. Lower gestational age is associated with a higher risk of apnoeic episodes, which generally begin between 2 and 3 days of life.

Milder episodes can be resolved by tactile stimulation of the neonate, while more severe episodes need pharmacological intervention with stimulant drugs, such as caffeine.

Adenosine is a neurotransmitter that modulates neuronal activity and reduce the breathing effort. Caffeine directly opposes this effect by blocking the interaction of adenosine with its cellular receptors, thus resulting in an enhanced breathing rate.

RDS (Respiratory Distress Syndrome)

Neonatal respiratory distress syndrome is a typical condition in preterm infants. Rather than identifying a single pathology, RDS is usually used to identify a complex clinical picture whose symptoms are due to an under-development of the respiratory system. Severity and incidence of this pathology are directly linked with the degree of prematurity, with infants born before the 28th week of gestation being at greater risk.

Respiratory failure in preterm infants with RDS is due to a shortage in the pool of pulmonary surfactant, which helps to create a biofilm covering the inner walls of the alveoli. The physiological role of surfactant is to allow the lungs to expand and avoid collapse (atelectasis) during the expiratory phases. Lack of surfactant results in difficulty in breathing, with low oxygenation, increased breathing effort and the need for respiratory support.

The pool of available surfactant in a preterm infant is usually extremely limited compared to that of a term neonate and further decreases as a result of RDS. When necessary, the administration of exogenous surfactant can alleviate the symptoms of this syndrome by supplementing the endogenous pool of surfactant, thereby enabling the biofilm to be replenished.

CARDIOVASCULAR DISEASES

Cardiovascular diseases (CVD) are the number one cause of death globally: more people die annually from CVDs than from any other cause.

CVD refers to any disease that affects the cardiovascular system, principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease. The causes of CVD are diverse but atherosclerosis and/or hypertension are the most common. In addition, with ageing come a number of physiological and morphological changes that alter cardiovascular function and lead to an increased risk of CVD, even in healthy asymptomatic individuals.

In the fight for the prevention of CVDs, the strongest effort focusses on the treatment of hypertension, as it is one of the biggest cardiovascular risk factors. As a matter of fact, it substantially increases the probability of cardio-, cerebral- , and reno-vascular adverse events. Moreover, the possible association with other prominent risk factors, such as hypercholesterolemia, smoking and diabetes, brings about a further significant increase in probability. Therefore, the therapeutic choice must be based on individual global cardiovascular risk calculation, taking into account age, gender, past occurrence of cardiovascular events and presence of other associated risk factors.

PRIMARY CARE

RHEUMATIC AND MUSCULOSKELETAL DISEASES

RHEUMATOID ARTHRITIS

Rheumatoid arthritis is an autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated.

The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (turgescence) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium. The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis (fusion) of the joints.

ANKYLOSING SPONDYLITIS

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton, with variable involvement of peripheral joints and non-articular structures. AS is a member of the group of the spondyloarthropathies. It mainly affects joints in the spine and the sacroiliac joint in the pelvis,  and can cause eventual fusion of the spine. Complete fusion results in a complete rigidity of the spine, a condition known as "bamboo spine". It usually begins in the second or third decade of life and has male preponderance.

The aetiology of AS is unknown, but a combination of genetic and environmental factors work together to produce the clinical disease.

The outcome in patients with AS is generally good compared to that in patients with a disease such as rheumatoid arthritis.

OSTEOARTHRITIS

Osteoarthritis, is the most common form of arthritis and affects millions of people around the world and occurs when the protective cartilage on the ends of bones wears down over time.

While osteoarthritis can damage any joint in the human body, the disorder most commonly affects joints in the hands, neck, lower back, knees and hips.

Osteoarthritis gradually worsens with time, and no cure exists. However, osteoarthritis current treatments can slow the progression of the disease, relieve pain and improve joint function.