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A40 Preductal transcutaneous oxygen saturation at birth after elective caesarean section
Selected abstracts / Early Human Development 88S2 (2012) S101–S115
S113
Prognosis is good, with skin lesions improvement especially during the first two years of life and treatment is usually not required.
rapidly measurable, especially in neonates born by VD. A change in current clinical practice is therefore required.
A38 Lactobacillus paracasei ssp. paracasei F-19 and intestinal failure: use in stage 1 of necrotising enterocolitis (NEC)
A40 Preductal transcutaneous oxygen saturation at birth after elective caesarean section V. Dal Cengio1 , D. Trevisanuto1 , M. Parotto1 , N. Rizzo1 , M. Negro2 , V. Zanardo1 . 1 University of Padua, Padua, Italy; 2 University of Bergamo, Bergamo, Italy
N. Zampieri1 , F. Camoglio3 , G. Scire3 , F. Laconi3 , A. Pietrobelli2 . 1 Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Verona, Italy; 2 Pediatric Unit, Verona University Medical School, Verona, Italy; 3 Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Verona, Italy Necrotising enterocolitis (NEC) is one of the most important surgical disease in the first few days after birth in particular in preterm infants. Recently it was proposed the use of probiotics for NEC prevention due to positive effects on modulation of inflammatory response and mucosal barrier function. Aim: Aim of this study was to evaluate the role of Lactobacillus paracasei ssp. paracasei F-19 in Bell’s STAGE 1 in order to prevent the clinical progression to STAGE 2 and STAGE 3. Material and Methods: A prospective study was approved and started in December 2009; patients were infants weighing from 600 g to 1500 g at birth. The intervention group (24 patients) received standard therapy for and probiotic oral supplementation once a day for 10 days (L. paracasei ssp. paracasei F-19, 6×109 CFU/daily) and a control group (27 patients) received only medical standard treatment. Inclusion and exclusion criteria were created. Patients were selected consecutively after parents consent. The primary outcome was the progression to STAGE 2 and STAGE 3. Results: Two subjects in the study group developed STAGE 3 NEC; five patients of the study group developed STAGE 2 NEC; none of these patients died. Ten patients of the control group developed a STAGE 3 NEC and ten patients developed a STAGE 2 NEC. None of these patients died (p < 0.05). Development of STAGE 3 NEC was strictly correlated with gestational age at birth, low 1 min apgar score. Patients with advanced NEC showed longer time of meconium evacuation if compared to the others. Patients treated with probiotics showed a shorter time of meconium evacuation (p < 0.05). Discussion: Oral supplementation of Lactobacillus paracasei reduced the clinical progression of NEC. It was considered that an improvement in intestinal motility might have contributed to this result. The use of Lactobacillus paracasei is safe and effective. We may conclude that the reduction of the progression rate to advanced NEC could suggest the use in preterm infants as a prevention of any surgical procedures. Study with higher number of subjects will confirm our data. A39 Oxygen saturation monitoring at birth: feasibility of the 2010 neonatal resuscitation guidelines V. Dal Cengio1 , N. Rizzo1 , M. Parotto1 , D. Trevisanuto1 , M. Negro2 , V. Zanardo1 . 1 University of Padua, Padua, Italy; 2 University of Bergamo, Bergamo, Italy Background: The 2010 Neonatal Resuscitation Guidelines recommend preductal transcutaneous oxygen saturation (SpO2) monitoring at birth. Objective: To verify the feasibility of SpO2 monitoring at birth by determining the time to get the first SpO2 value using a pulse oximeter. Methods: The study included 100 healthy newborns at term by elective caesarean section (Elective CS, 50 neonates), vaginal delivery (VD, 32 neonates) and emergency caesarean section (Emergency CS, 18 neonates). A Masimo Radical-7 (Masimo, Irvine, CA) pulse oximeter sensor was applied on neonatal right hand noting the minute at which the first oximetry value was provided. For the comparison between the time to get the first oximetry value among the three groups, Chi Square and Fisher Exact Test were used. A p value <0.05 was considered statistically significant. Results: In the total study population, 52% of SpO2 values were obtained within the first minute of life; 28% in the second; 13% in the third; 3% in the fourth; 3% in the fifth; 1% in the sixth. However, the first SpO2 value was more frequently obtained within the first minute of life in newborns by Elective CS (74%) and by Emergency CS (61%) than in those by VD (12.5%), p < 0.05. Conclusions: The first minute after birth is critical for Apgar score and neonatal resuscitation. This study demonstrated that SpO2 is not always
Background: The 2010 Neonatal Resuscitation Guidelines recommend preductal transcutaneous oxygen saturation (SpO2) monitoring at birth. Previous studies have assessed SpO2 showing that SpO2 is lower in newborns by caesarean section (CS) vs. vaginal delivery (VD). This difference has never been investigated in newborns by Elective CS vs. Emergency CS. Objective: To compare SpO2 in newborns by Elective CS vs. Emergency CS. Methods: The study included healthy newborns at term or near term by Elective CS (50 neonates), by Emergency CS (12 neonates) and by VD (17 neonates) as a control group. Infants receiving supplemental oxygen or assisted ventilation were excluded. SpO2 was recorded using a Masimo Radical-7 pulse oximeter probe (Masimo, Irvine, CA) applied to the right hand. The groups were compared with Anova and Fisher test. For the SpO2 comparison, Anova was used. A p value <0.05 was considered statistically significant. Results: The SpO2 gradually improved during the first 10 minutes of life in all groups (p per trend <0,001). The average SpO2 in newborns by VD was significantly higher than in those by CS (p < 0.05 Emergency CS vs. VD at the fifth minute of life). In addition, the SpO2 in newborns by Elective CS was higher than in those by Emergency CS, although the difference was not statistically significant. Conclusions: SpO2 in newborns by VD in the first ten minutes of life is significantly higher than in those born by CS. Prenatal foetal distress may account for lower SpO2 in newborns by Emergency CS vs. Elective CS. A41 Rhesus haemolytic disease (RHD) after the introduction of high-dose intravenous immunoglobulin (IVIg) E. Legnani1 , E. Mariani1 , S. Martini1 , L. Corvaglia1 , G. Faldella1 . 1 University of Bologna, Bologna, Italy Background and Aims: RHD is characterised by haemolysis and hyperbilirubinaemia. New AAP guidelines recommended high-dose IVIg as an alternative of exchange transfusion (EXT). The aim of this study was to compare clinical outcomes of RHD patients before and after the introduction of IVIg. Methods: A chart-review of 88 Coombs-positive RHD patients (1999– 2009) was performed. Patients were divided into two groups, treated before (Group A [GA], n = 35) and after (Group B [GB], n = 53) the introduction of IVIg, respectively. Number of EXT and RBC transfusions, days of permanence of umbilical catheter (UC), duration of hospitalisation and phototherapy, maximum bilirubinaemia, changes in bilirubinaemia over time, and morbidity were compared in the two groups. Results: GB-patients had lower EXT need (13% vs 82% in GA, p = 0.000), UC need (58% vs 97%, p = 0.001) and UC days (mean 2.8/patient vs 4.6, p = 0.001), higher need of RBC transfusions (mean 0.9/patient vs 0.2, p = 0.000), longer hospitalisation (mean 12.1 days/patient vs 6.9, p = 0.000) and longer phototherapy (mean 7.6 days/patient vs 4.5, p = 0.000). No significant difference in maximum bilirubinaemia was found; in GB-patients bilirubinaemia overcame neurological-risk value for shorter period (mean 55.4 hours/patients vs 74.6, p = 0.047). 43.9% GA-patients had thrombocytopenia, 21.9% hypocalcaemia, 4.9% hypomagnesaemia, 19.5% UC-related complications, and 9.8% adverse reactions during EXT. Two infants in GB developed NEC. Conclusions: High-dose IVIg in RHD patients reduced EXT need, UC need and permanence time, and risk of hyperbilirubinaemia-related neurological damage. Instead, IVIg-treated patients needed longer hospitalisation, longer phototherapy, and had increased need of RBC transfusions.
S113
Prognosis is good, with skin lesions improvement especially during the first two years of life and treatment is usually not required.
rapidly measurable, especially in neonates born by VD. A change in current clinical practice is therefore required.
A38 Lactobacillus paracasei ssp. paracasei F-19 and intestinal failure: use in stage 1 of necrotising enterocolitis (NEC)
A40 Preductal transcutaneous oxygen saturation at birth after elective caesarean section V. Dal Cengio1 , D. Trevisanuto1 , M. Parotto1 , N. Rizzo1 , M. Negro2 , V. Zanardo1 . 1 University of Padua, Padua, Italy; 2 University of Bergamo, Bergamo, Italy
N. Zampieri1 , F. Camoglio3 , G. Scire3 , F. Laconi3 , A. Pietrobelli2 . 1 Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Verona, Italy; 2 Pediatric Unit, Verona University Medical School, Verona, Italy; 3 Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Verona, Italy Necrotising enterocolitis (NEC) is one of the most important surgical disease in the first few days after birth in particular in preterm infants. Recently it was proposed the use of probiotics for NEC prevention due to positive effects on modulation of inflammatory response and mucosal barrier function. Aim: Aim of this study was to evaluate the role of Lactobacillus paracasei ssp. paracasei F-19 in Bell’s STAGE 1 in order to prevent the clinical progression to STAGE 2 and STAGE 3. Material and Methods: A prospective study was approved and started in December 2009; patients were infants weighing from 600 g to 1500 g at birth. The intervention group (24 patients) received standard therapy for and probiotic oral supplementation once a day for 10 days (L. paracasei ssp. paracasei F-19, 6×109 CFU/daily) and a control group (27 patients) received only medical standard treatment. Inclusion and exclusion criteria were created. Patients were selected consecutively after parents consent. The primary outcome was the progression to STAGE 2 and STAGE 3. Results: Two subjects in the study group developed STAGE 3 NEC; five patients of the study group developed STAGE 2 NEC; none of these patients died. Ten patients of the control group developed a STAGE 3 NEC and ten patients developed a STAGE 2 NEC. None of these patients died (p < 0.05). Development of STAGE 3 NEC was strictly correlated with gestational age at birth, low 1 min apgar score. Patients with advanced NEC showed longer time of meconium evacuation if compared to the others. Patients treated with probiotics showed a shorter time of meconium evacuation (p < 0.05). Discussion: Oral supplementation of Lactobacillus paracasei reduced the clinical progression of NEC. It was considered that an improvement in intestinal motility might have contributed to this result. The use of Lactobacillus paracasei is safe and effective. We may conclude that the reduction of the progression rate to advanced NEC could suggest the use in preterm infants as a prevention of any surgical procedures. Study with higher number of subjects will confirm our data. A39 Oxygen saturation monitoring at birth: feasibility of the 2010 neonatal resuscitation guidelines V. Dal Cengio1 , N. Rizzo1 , M. Parotto1 , D. Trevisanuto1 , M. Negro2 , V. Zanardo1 . 1 University of Padua, Padua, Italy; 2 University of Bergamo, Bergamo, Italy Background: The 2010 Neonatal Resuscitation Guidelines recommend preductal transcutaneous oxygen saturation (SpO2) monitoring at birth. Objective: To verify the feasibility of SpO2 monitoring at birth by determining the time to get the first SpO2 value using a pulse oximeter. Methods: The study included 100 healthy newborns at term by elective caesarean section (Elective CS, 50 neonates), vaginal delivery (VD, 32 neonates) and emergency caesarean section (Emergency CS, 18 neonates). A Masimo Radical-7 (Masimo, Irvine, CA) pulse oximeter sensor was applied on neonatal right hand noting the minute at which the first oximetry value was provided. For the comparison between the time to get the first oximetry value among the three groups, Chi Square and Fisher Exact Test were used. A p value <0.05 was considered statistically significant. Results: In the total study population, 52% of SpO2 values were obtained within the first minute of life; 28% in the second; 13% in the third; 3% in the fourth; 3% in the fifth; 1% in the sixth. However, the first SpO2 value was more frequently obtained within the first minute of life in newborns by Elective CS (74%) and by Emergency CS (61%) than in those by VD (12.5%), p < 0.05. Conclusions: The first minute after birth is critical for Apgar score and neonatal resuscitation. This study demonstrated that SpO2 is not always
Background: The 2010 Neonatal Resuscitation Guidelines recommend preductal transcutaneous oxygen saturation (SpO2) monitoring at birth. Previous studies have assessed SpO2 showing that SpO2 is lower in newborns by caesarean section (CS) vs. vaginal delivery (VD). This difference has never been investigated in newborns by Elective CS vs. Emergency CS. Objective: To compare SpO2 in newborns by Elective CS vs. Emergency CS. Methods: The study included healthy newborns at term or near term by Elective CS (50 neonates), by Emergency CS (12 neonates) and by VD (17 neonates) as a control group. Infants receiving supplemental oxygen or assisted ventilation were excluded. SpO2 was recorded using a Masimo Radical-7 pulse oximeter probe (Masimo, Irvine, CA) applied to the right hand. The groups were compared with Anova and Fisher test. For the SpO2 comparison, Anova was used. A p value <0.05 was considered statistically significant. Results: The SpO2 gradually improved during the first 10 minutes of life in all groups (p per trend <0,001). The average SpO2 in newborns by VD was significantly higher than in those by CS (p < 0.05 Emergency CS vs. VD at the fifth minute of life). In addition, the SpO2 in newborns by Elective CS was higher than in those by Emergency CS, although the difference was not statistically significant. Conclusions: SpO2 in newborns by VD in the first ten minutes of life is significantly higher than in those born by CS. Prenatal foetal distress may account for lower SpO2 in newborns by Emergency CS vs. Elective CS. A41 Rhesus haemolytic disease (RHD) after the introduction of high-dose intravenous immunoglobulin (IVIg) E. Legnani1 , E. Mariani1 , S. Martini1 , L. Corvaglia1 , G. Faldella1 . 1 University of Bologna, Bologna, Italy Background and Aims: RHD is characterised by haemolysis and hyperbilirubinaemia. New AAP guidelines recommended high-dose IVIg as an alternative of exchange transfusion (EXT). The aim of this study was to compare clinical outcomes of RHD patients before and after the introduction of IVIg. Methods: A chart-review of 88 Coombs-positive RHD patients (1999– 2009) was performed. Patients were divided into two groups, treated before (Group A [GA], n = 35) and after (Group B [GB], n = 53) the introduction of IVIg, respectively. Number of EXT and RBC transfusions, days of permanence of umbilical catheter (UC), duration of hospitalisation and phototherapy, maximum bilirubinaemia, changes in bilirubinaemia over time, and morbidity were compared in the two groups. Results: GB-patients had lower EXT need (13% vs 82% in GA, p = 0.000), UC need (58% vs 97%, p = 0.001) and UC days (mean 2.8/patient vs 4.6, p = 0.001), higher need of RBC transfusions (mean 0.9/patient vs 0.2, p = 0.000), longer hospitalisation (mean 12.1 days/patient vs 6.9, p = 0.000) and longer phototherapy (mean 7.6 days/patient vs 4.5, p = 0.000). No significant difference in maximum bilirubinaemia was found; in GB-patients bilirubinaemia overcame neurological-risk value for shorter period (mean 55.4 hours/patients vs 74.6, p = 0.047). 43.9% GA-patients had thrombocytopenia, 21.9% hypocalcaemia, 4.9% hypomagnesaemia, 19.5% UC-related complications, and 9.8% adverse reactions during EXT. Two infants in GB developed NEC. Conclusions: High-dose IVIg in RHD patients reduced EXT need, UC need and permanence time, and risk of hyperbilirubinaemia-related neurological damage. Instead, IVIg-treated patients needed longer hospitalisation, longer phototherapy, and had increased need of RBC transfusions.