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251 Intrapartum Pulse Ommetry Predicts Neonatal Depression
SPO Abstracts
Volume 168 Number I, Pa rt 2
250
ANTEPARTUM VITAMIN K (VX) AND PHENOBARBITAL (PH) FOR PREVENTING INTRAVENTRICULAR HEMORRHAGE (IVH) IN THE PREMATURE NEWBORN: A RANDOMIZED DOUBLE BLINDED PLACEBO CONTROLLED TRIAL. III2m1A, Parriott" J, Ferrette-Smithx D, Holst" V, Meyer BA, Cohen GR, Yeast JD, Johnsonx J, Andersonx J. Univ of MO @ KC-St Luke'. Hospital; Kansas City, MO, 64111. OBJECTIVE: To determine if antepartum vitamin K and phenobatbital prevent IVH in the premature newborn STUDY DESIGN: Patients at imminent risk for spontaneous or indicated premature delivery between 24 and 34 weeks gestation were randomized to receive either placebo or VK and PH. All patients received betametbasone and antibiotics and were managed uniformly by a single perinatal group in one hospital. All newborns were managed uniformly in the same facility by one neonatal group. Data are reported as mean t SD. RESULTS There are no significaot differences (p > 0 I)
.
Gestation (weeks) Cord Art pH at birth Birth weight
Placebo N = 83 29.5 t 2.2 7.31 ± 0.09 1331 ± 422 51.0% 6.7 ± 6 .5 25.0 ± 25.4 44.6% 6.0% 50.6%
Treatment N = 83 29.4 ± 2.5 7.31 ± 0.08 1335 ± 393 49.4% 8 .9 ±13.2 21.0 ± 20.0 33.7% 3.6% 37.3%
CONCLUSIONS: There i. a non-significant reduction in both mild IVH (glade 1 &; 2) and severe IVH (grade 3 &; 4) in this randomized double blinded placebo controUed trial
251
INTRAPARTUM PULSE OXIMETRY PREDIcrs NEONATAL DEPRESSION.I<. Porter, M. Williams, W. O'Brien, C. Casanova', Dept. ObIGyn, Univ.of South FL.. Tampa. FL OBJECTIVE: Pregnant WOlDen have been reported to undergo intrapartum oxygen desaturation events (Sa02 <91%) although their clinical significance is not clear. The purpose of this study was to determine whether intrapartum maternal oxygen saturation status correlates with standard neonatal markers of hypoxia. STUDY DESIGN: All women entering in labor were eligible. Maternal and neonatal desaturation events (MOE and NDE, respectively) were monitored by pulse oximeter and defined as a SaO, value <91% and <65%, respectively. of more than 20 Umbilical cord arterial saturation was seconds duration. measured by standard blood gas analysis. and desaturation was defmed as Sa02 < 11 % based on institutional norms. RESULTS: 192 of 849 patients (22%) studied had MOE (median 6 events, range 1 to 60). although mean SaO, throughout labor MOE was was comparable for both groups of mothers. significantly associated with meconium (p='(J02) and Apgar (AP) score of <7 at 1 minute (min) (P=.OO5). No association was found between MOE and electronic fetal distress pattern. AP score at 5 min, cord gas pH <7.20, or base deficit (BD) values <7. MOE was significantly associated with intravenous analgesic use during labor (P= .OOOl). NDE correlated with Ap scores <7 at 1 (P=.OOO3) and 5 mins (P=.OO5). Neonatal cord SaO,
252
367
IS SURFACTANT (SURVANTA,TA) ASSOCIATED WITH IMPROVED SURVIVAL AT THE LIMITS OF VIABILITY (4~ GRAMS)? E-.Amon , -M. C. Malicdem. -A. Noguchi. -S . Wolske. H Winn. ·U. Devaskar. Divisions of Maternal-Fetal Medicine and Neonatal Medicine, St. Louis University School of Medicine. St. Louis, MO. OBJECTIVE: Caarean section for standard fetal indications is not infrequenUy considered for incredibly preterm infants with the asSlD1Iplion that survival is improved with surfactant therapy. We studied the effect of Survanta (rescue Rx) upon survival of infants weighing 450~g at birth. STUDY DESIGN: Inclusion criteria required successful initial resuscitation and admission to the NICU indicating potential viability. SW'Vivai was defined as "discharged home" . 83 consecutive infants were studied. Surfactant was readily used beginning in 01/90. RESULTS: Surfactant(n=3O) Non-SUlfacI8ot(n-53) ~ mean ± sd BWT(g) 542 ± 42 540 ± 43 NS range 475-600 45O-fflO mean ± sd GA (wk) 24.8±1.8 24.8±2 NS range 22 - 28 21 - 30 mean ± sd stay (d) 62 ± 58 65 ± 80 NS range 1 - 186 1 - 363 % survival 16 (53%) 23 (43%) NS % born < 1990 1 (3%) 42 (79%) <0.0001 % born .. 1990 29 (97%) 11 (21%) Of infants who died, 1lI14 ('79%) in the surfactant group and 24130 (80%) in the non-surfactant group died within 1 week of birth. CONCLUSION:Despite the fact that surfactant use Was highly associated with a more recent time frame. the administration of Survanta in infants weighing" 600 g did not improve survival; nor did surfactant use change the time interval from birth to death.
253 MECHANISMS OF SURFACTANT INACTIVATION. ~ Lawler x , G Enhorning, and BA Holm.
Dept. of Gyn/Ob, University at Buffalo and Children's Hospital of Buffalo, NY. Objective: To determine the mechanism(s) of surfactant inactivation by protein and non-protein agents. Study Design: puimonary surfactant activity was assessed using a Pulsating Bubble Surfactometer with a hypophase exchange device. Inhibitory agents from alveolar membrane damage, meconium aspiration, or bacterially secreted phospholipases were mixed with surfactant in suspension or injected beneath a dynamic pre-formed surfactant film. Results: Foreign protein and nonprotein agents cause severe surfactant inhibition. Proteins act by preventing surfactant adsorption to an air-water interface via competitive action. Lysolipids act by inhibiting adsorption and by intercalating into formed films. Conclusions: Surfactant inhibition by bacterially generated lysolipids, or by mixed component SUbstances like meconium, occurs by multiple mechanisms. This may effect the efficacy of exogenous surfactant. Supported by NIH HL02629, H136543.
Volume 168 Number I, Pa rt 2
250
ANTEPARTUM VITAMIN K (VX) AND PHENOBARBITAL (PH) FOR PREVENTING INTRAVENTRICULAR HEMORRHAGE (IVH) IN THE PREMATURE NEWBORN: A RANDOMIZED DOUBLE BLINDED PLACEBO CONTROLLED TRIAL. III2m1A, Parriott" J, Ferrette-Smithx D, Holst" V, Meyer BA, Cohen GR, Yeast JD, Johnsonx J, Andersonx J. Univ of MO @ KC-St Luke'. Hospital; Kansas City, MO, 64111. OBJECTIVE: To determine if antepartum vitamin K and phenobatbital prevent IVH in the premature newborn STUDY DESIGN: Patients at imminent risk for spontaneous or indicated premature delivery between 24 and 34 weeks gestation were randomized to receive either placebo or VK and PH. All patients received betametbasone and antibiotics and were managed uniformly by a single perinatal group in one hospital. All newborns were managed uniformly in the same facility by one neonatal group. Data are reported as mean t SD. RESULTS There are no significaot differences (p > 0 I)
.
Gestation (weeks) Cord Art pH at birth Birth weight
Placebo N = 83 29.5 t 2.2 7.31 ± 0.09 1331 ± 422 51.0% 6.7 ± 6 .5 25.0 ± 25.4 44.6% 6.0% 50.6%
Treatment N = 83 29.4 ± 2.5 7.31 ± 0.08 1335 ± 393 49.4% 8 .9 ±13.2 21.0 ± 20.0 33.7% 3.6% 37.3%
CONCLUSIONS: There i. a non-significant reduction in both mild IVH (glade 1 &; 2) and severe IVH (grade 3 &; 4) in this randomized double blinded placebo controUed trial
251
INTRAPARTUM PULSE OXIMETRY PREDIcrs NEONATAL DEPRESSION.I<. Porter, M. Williams, W. O'Brien, C. Casanova', Dept. ObIGyn, Univ.of South FL.. Tampa. FL OBJECTIVE: Pregnant WOlDen have been reported to undergo intrapartum oxygen desaturation events (Sa02 <91%) although their clinical significance is not clear. The purpose of this study was to determine whether intrapartum maternal oxygen saturation status correlates with standard neonatal markers of hypoxia. STUDY DESIGN: All women entering in labor were eligible. Maternal and neonatal desaturation events (MOE and NDE, respectively) were monitored by pulse oximeter and defined as a SaO, value <91% and <65%, respectively. of more than 20 Umbilical cord arterial saturation was seconds duration. measured by standard blood gas analysis. and desaturation was defmed as Sa02 < 11 % based on institutional norms. RESULTS: 192 of 849 patients (22%) studied had MOE (median 6 events, range 1 to 60). although mean SaO, throughout labor MOE was was comparable for both groups of mothers. significantly associated with meconium (p='(J02) and Apgar (AP) score of <7 at 1 minute (min) (P=.OO5). No association was found between MOE and electronic fetal distress pattern. AP score at 5 min, cord gas pH <7.20, or base deficit (BD) values <7. MOE was significantly associated with intravenous analgesic use during labor (P= .OOOl). NDE correlated with Ap scores <7 at 1 (P=.OOO3) and 5 mins (P=.OO5). Neonatal cord SaO,
252
367
IS SURFACTANT (SURVANTA,TA) ASSOCIATED WITH IMPROVED SURVIVAL AT THE LIMITS OF VIABILITY (4~ GRAMS)? E-.Amon , -M. C. Malicdem. -A. Noguchi. -S . Wolske. H Winn. ·U. Devaskar. Divisions of Maternal-Fetal Medicine and Neonatal Medicine, St. Louis University School of Medicine. St. Louis, MO. OBJECTIVE: Caarean section for standard fetal indications is not infrequenUy considered for incredibly preterm infants with the asSlD1Iplion that survival is improved with surfactant therapy. We studied the effect of Survanta (rescue Rx) upon survival of infants weighing 450~g at birth. STUDY DESIGN: Inclusion criteria required successful initial resuscitation and admission to the NICU indicating potential viability. SW'Vivai was defined as "discharged home" . 83 consecutive infants were studied. Surfactant was readily used beginning in 01/90. RESULTS: Surfactant(n=3O) Non-SUlfacI8ot(n-53) ~ mean ± sd BWT(g) 542 ± 42 540 ± 43 NS range 475-600 45O-fflO mean ± sd GA (wk) 24.8±1.8 24.8±2 NS range 22 - 28 21 - 30 mean ± sd stay (d) 62 ± 58 65 ± 80 NS range 1 - 186 1 - 363 % survival 16 (53%) 23 (43%) NS % born < 1990 1 (3%) 42 (79%) <0.0001 % born .. 1990 29 (97%) 11 (21%) Of infants who died, 1lI14 ('79%) in the surfactant group and 24130 (80%) in the non-surfactant group died within 1 week of birth. CONCLUSION:Despite the fact that surfactant use Was highly associated with a more recent time frame. the administration of Survanta in infants weighing" 600 g did not improve survival; nor did surfactant use change the time interval from birth to death.
253 MECHANISMS OF SURFACTANT INACTIVATION. ~ Lawler x , G Enhorning, and BA Holm.
Dept. of Gyn/Ob, University at Buffalo and Children's Hospital of Buffalo, NY. Objective: To determine the mechanism(s) of surfactant inactivation by protein and non-protein agents. Study Design: puimonary surfactant activity was assessed using a Pulsating Bubble Surfactometer with a hypophase exchange device. Inhibitory agents from alveolar membrane damage, meconium aspiration, or bacterially secreted phospholipases were mixed with surfactant in suspension or injected beneath a dynamic pre-formed surfactant film. Results: Foreign protein and nonprotein agents cause severe surfactant inhibition. Proteins act by preventing surfactant adsorption to an air-water interface via competitive action. Lysolipids act by inhibiting adsorption and by intercalating into formed films. Conclusions: Surfactant inhibition by bacterially generated lysolipids, or by mixed component SUbstances like meconium, occurs by multiple mechanisms. This may effect the efficacy of exogenous surfactant. Supported by NIH HL02629, H136543.