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590: Long term neurodevelopmental outcome in twin twin transfusion syndrome (TTTS) from a single institution in the USA
Poster Session IV
ajog.org
CONCLUSION: Neonatal respiratory morbidities requiring ventilator support are more severe after indicated PTB compared to spontaneous PTB. The role of the underlying etiology of PTB on adverse neonatal outcomes needs further exploration.
590 Long term neurodevelopmental outcome in twin twin transfusion syndrome (TTTS) from a single institution in the USA
Rana Jawish1, Foong-Yen Lim1, Ahmed Lababidi1, Mohamed Zaid1, William Polzin2, Mounira Habli1
1 Cincinnati Children’s Hospital Medical Center, Center For Fetal Cellular And Molecular Therapy, Cincinnati, OH, 2Cincinnati Children’s Hospital Medical Center, Cincinnati Fetal Center, Cincinnati, OH
OBJECTIVE: Our objective is to evaluate the long term neuro-
developmental impairment (NDI) using Ages and Stages Questionnaire (ASQ) in TTTS from a single institution. STUDY DESIGN: A prospective study on 97 TTTS patients treated with laser (SFLP, n¼70) or amnioreduction (n¼3) or observation (OBS, n¼24) from 2009-2013. ASQ is a parent-completed childmonitoring system that has been validated against the Bayley Scales of Infant Development as a screening tool for abnormal development. ASQ contains 5 domains (communication, gross motor skills, fine motor skills, problem solving skills, and personal social skills). Each domain has 6 questions. Domain scores are compared with established screening cut off points according to guidelines. Primary outcome was NDI as assessed by ASQ. Secondary outcomes were: maternal demographics, Quintero stage, fetal death, survival at birth and gestational age (GA) at evaluation and delivery. Data was stratified based on infant age at time of survey (18 month and 24 month ) and treatment and Ttest or chi-square was used as needed. RESULTS: 400 ASQ mailed to patients, 24% (n¼97) replied. 55% (n¼ 53) were screened at 18 month (6 weeks), 28% (n¼27) at 24 months (6 weeks), 9% (n¼9) at 36 month (6 weeks) and 2% (n¼2) at 54 months. The rate of fetal death was 6% (n¼6), 10% (n¼10) cerebral palsy as reported by patients, 36% (n¼33) moderate to severe speech delay and 4% (n¼4) visual impairment. At 18 month as compared to OBS group (76% were Quintero stage I), patients treated with laser (85% were Quintero stage III or IV) had a significant reduction in fine motor scores (Table). Among groups, there were no other significant variables. CONCLUSION: Laser treated TTTS patients had significantly more severe disease and were found to have significant reduction in fine motor skills scores as compared to TTTS patients not having laser. This is most likely related to severity of disease and not treatment.
591 Hepcidin, an iron regulatory hormone of innate immunity, is differentially expressed in premature fetuses with early onset neonatal sepsis (EONS)
Sammy Tabbah1, Catalin Buhimschi1, Katherine Rodewald Millen1, Christopher Pierson2, Stephen Thung1, Taryn Summerfield1, Vineet Bhandari3, Philip Samuels1, Irina Buhimschi4
1 The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Columbus, OH, 2Nationwide Children’s Hospital, Department of Pathology and Laboratory Medicine, Columbus, OH, 3Yale University School of Medicine, Department of Pediatrics, New Haven, CT, 4 Nationwide Children’s Hospital, Center for Perinatal Research, Columbus, OH
OBJECTIVE: Hepcidin impacts iron metabolism by binding ferroportin. This process leads to ferroportin degradation, intracellular iron sequestration and reduction of circulating iron. At the expense of reduced iron bioavailability to vital organs, this functional hypoferremia is a key regulatory process in fighting infection. We explored the hepcidin-ferroportin interaction in neonates with EONS. STUDY DESIGN: 92 paired cord blood-maternal blood samples were studied in the following groups: “Yes” EONS (n¼42, GA 291wk) and “No” EONS (n¼52, GA 261wk). EONS was defined by clinical and hematologic criteria. Hepcidin and IL-6 levels were assessed by ELISA. Data were corrected for GA at birth. Presence and level of expression of hepcidin and ferroportin were evaluated in human placental and neonatal liver autopsy specimens (n¼8) by IHC. We used RT-PCR to identify hepcidin and ferroportin expression changes in the placenta.
S294 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015
ajog.org
CONCLUSION: Neonatal respiratory morbidities requiring ventilator support are more severe after indicated PTB compared to spontaneous PTB. The role of the underlying etiology of PTB on adverse neonatal outcomes needs further exploration.
590 Long term neurodevelopmental outcome in twin twin transfusion syndrome (TTTS) from a single institution in the USA
Rana Jawish1, Foong-Yen Lim1, Ahmed Lababidi1, Mohamed Zaid1, William Polzin2, Mounira Habli1
1 Cincinnati Children’s Hospital Medical Center, Center For Fetal Cellular And Molecular Therapy, Cincinnati, OH, 2Cincinnati Children’s Hospital Medical Center, Cincinnati Fetal Center, Cincinnati, OH
OBJECTIVE: Our objective is to evaluate the long term neuro-
developmental impairment (NDI) using Ages and Stages Questionnaire (ASQ) in TTTS from a single institution. STUDY DESIGN: A prospective study on 97 TTTS patients treated with laser (SFLP, n¼70) or amnioreduction (n¼3) or observation (OBS, n¼24) from 2009-2013. ASQ is a parent-completed childmonitoring system that has been validated against the Bayley Scales of Infant Development as a screening tool for abnormal development. ASQ contains 5 domains (communication, gross motor skills, fine motor skills, problem solving skills, and personal social skills). Each domain has 6 questions. Domain scores are compared with established screening cut off points according to guidelines. Primary outcome was NDI as assessed by ASQ. Secondary outcomes were: maternal demographics, Quintero stage, fetal death, survival at birth and gestational age (GA) at evaluation and delivery. Data was stratified based on infant age at time of survey (18 month and 24 month ) and treatment and Ttest or chi-square was used as needed. RESULTS: 400 ASQ mailed to patients, 24% (n¼97) replied. 55% (n¼ 53) were screened at 18 month (6 weeks), 28% (n¼27) at 24 months (6 weeks), 9% (n¼9) at 36 month (6 weeks) and 2% (n¼2) at 54 months. The rate of fetal death was 6% (n¼6), 10% (n¼10) cerebral palsy as reported by patients, 36% (n¼33) moderate to severe speech delay and 4% (n¼4) visual impairment. At 18 month as compared to OBS group (76% were Quintero stage I), patients treated with laser (85% were Quintero stage III or IV) had a significant reduction in fine motor scores (Table). Among groups, there were no other significant variables. CONCLUSION: Laser treated TTTS patients had significantly more severe disease and were found to have significant reduction in fine motor skills scores as compared to TTTS patients not having laser. This is most likely related to severity of disease and not treatment.
591 Hepcidin, an iron regulatory hormone of innate immunity, is differentially expressed in premature fetuses with early onset neonatal sepsis (EONS)
Sammy Tabbah1, Catalin Buhimschi1, Katherine Rodewald Millen1, Christopher Pierson2, Stephen Thung1, Taryn Summerfield1, Vineet Bhandari3, Philip Samuels1, Irina Buhimschi4
1 The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Columbus, OH, 2Nationwide Children’s Hospital, Department of Pathology and Laboratory Medicine, Columbus, OH, 3Yale University School of Medicine, Department of Pediatrics, New Haven, CT, 4 Nationwide Children’s Hospital, Center for Perinatal Research, Columbus, OH
OBJECTIVE: Hepcidin impacts iron metabolism by binding ferroportin. This process leads to ferroportin degradation, intracellular iron sequestration and reduction of circulating iron. At the expense of reduced iron bioavailability to vital organs, this functional hypoferremia is a key regulatory process in fighting infection. We explored the hepcidin-ferroportin interaction in neonates with EONS. STUDY DESIGN: 92 paired cord blood-maternal blood samples were studied in the following groups: “Yes” EONS (n¼42, GA 291wk) and “No” EONS (n¼52, GA 261wk). EONS was defined by clinical and hematologic criteria. Hepcidin and IL-6 levels were assessed by ELISA. Data were corrected for GA at birth. Presence and level of expression of hepcidin and ferroportin were evaluated in human placental and neonatal liver autopsy specimens (n¼8) by IHC. We used RT-PCR to identify hepcidin and ferroportin expression changes in the placenta.
S294 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2015