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A4 Can lung ultrasound scan screen late preterm and near term neonates needing respiratory assistance?
S102
Selected abstracts / Early Human Development 88S2 (2012) S101–S115
Reference(s) Raimondi et al Ped Inf Dis J Mar 2010, 29(3) 288. A3 Bovine lactoferrin supplementation for prevention of necrotising enterocolitis in preterm very-low-birth-weight neonates: a randomised trial M. Rinaldi2 , P. Manzoni1 , M. Meyer3 , E. Della Casa4 , L. Pugni5 , F. Mosca5 , I. Stolfi6 , H. Messner7 , L. Memo8 , N. Laforgia9 , L. Decembrino10 , M. Betta Pasqua11 , F. Vagnarelli12 , M. Stronati10 , D. Farina1 . 1 Neonatology and NICU, S. Anna Hospital, Torino, Italy; 2 Neonatology and NICU, Ospedali Riuniti, Foggia, Italy; 3 Neonatology and NICU, Middlemore Hospital, Auckland, New Zealand; 4 Neonatology and NICU, University of Modena, Modena, Italy; 5 Neonatology and NICU, IRCCS Mangiagalli Hospital, Milano, Italy; 6 Neonatology and NICU, Policlinico Umberto I, Roma, Italy; 7 Neonatology and NICU, Ospedale Regionale, Bolzano, Italy; 8 Neonatology and NICU, Ca’ Foncello Hospital, Treviso, Italy; 9 Neonatology and NICU, Policlinico Universitario, Bari, Italy; 10 Neonatology and NICU, IRCCS San Matteo, Pavia, Italy; 11 Neonatology and NICU, Azienda Ospedaliera Universitaria Policlinico, Catania, Italy; 12 Neonatology and NICU, Arcispedale, Reggio Emilia, Italy Background: NEC is a common and severe complication in premature neonates, particularly those with very-low-birth-weight (VLBW, <1500 g at birth). Probiotics including Lactobacillus rhamnosus GG (LGG) proved effective in preventing NEC in preterm infants in RCTs. Lactoferrin, a mammalian milk glycoprotein involved in innate immune host defences, can reduce the incidence of NEC in animal models, and its action is enhanced by LGG. The effect on NEC of bovine lactoferrin (BLF), alone or with the probiotic LGG, has not yet been studied in human infants. Objective: To establish whether bovine lactoferrin alone or with LGG, reduces the incidence of NEC in VLBW neonates. Design and Methods: This was an international, multicentre, randomised, double-blind, placebo-controlled trial. Thirteen Italian and New Zealand tertiary neonatal intensive care units screened and enrolled preterm, VLBW infants from October 1, 2007 through October 31, 2010. Infants were randomly assigned to receive orally either bLF (100 mg/day) alone (group LF; n = 251) or with LGG (at 6 × 109 CFU/day; group LF+LGG; n = 242), or placebo (Control group; n = 259) from birth until day 30 of life (45 for neonates <1000 g at birth). The main outcome measures were NEC greater than stage 2, and NEC (any stage). Results: 825 VLBW neonates were enrolled and assessed until discharge for development of NEC.Demographics, clinical and management characteristics of the 3 groups were similar, including type of feeding and maternal milk intakes. NEC incidence was significantly lower in groups BLF and BLF+LGG [5/251 (2.0%) and 1/242 (0.4%), respectively] than in controls [14/259 (5.4%)] (R.R. 0.35; 95% C.I. 0.13–0.99; p = 0.04 for BLF vs. control; R.R 0.07; 95% C.I. 0.01–0.55; p = 0.001 for BLF+LGG vs.control). The decrease occurred both for surgical and low-stages NECs. No adverse effects or intolerances to treatment occurred. Conclusions: Compared with placebo, BLF supplementation alone or in combination with LGG reduces the incidence of NEC of any stage in VLBW neonates. A4 Can lung ultrasound scan screen late preterm and near term neonates needing respiratory assistance? F. Migliaro1 , A. Sodano1 , L. Capasso1 , R. Paludetto1 , G. Vallone1 , A. Romano1 , A. Umbaldo1 , F. Raimondi1 . 1 Division of Neonatology and Pediatric Radiology, Universit` a “Federico II”, Naples, Italy Background and Aim: At birth, fluid is replaced by air in the lungs and compared to full term neonates, less mature infants experience more difficulties in the process. N-CPAP and mechanical ventilation (MV) may be needed to support their respiration. In adult medicine, ultrasound scan is used to assess fluid content in the lung. We tested the hypothesis that lung ultrasound scan may screen neonates needing respiratory assistance. Patients and Methods: Within 4 hours from birth, consecutive newly born infants (GA 34+3 – 41+4 ) were screened applying a flat 5.8 MHz probe (MCMD02AA, Philips, Bothell, WA) on the chest in 3 different locations per side. An experienced neonatologist performed the scan and images were reviewed by a paediatric radiologist. Patients were allocated in 3 profiles: type 1, diffuse hyperechogenicity (white lung); type 2, vertical
hyperechoic stripes (B-lines) and horizontal lines (A-lines); type 3, A-lines only. Infants were monitored by lung ultrasound every 12 hours. An independent neonatologist was encharged of the clinical management of the newborns. Results: 138 neonates were enrolled in the study. 6 (4%) were assigned to type 1 (GA 35.4±0.3); 40 (29%) to type 2 (GA 37.2±0.6) and 92 (67%) to type 3 (GA 37.6±1.2). All babies with type 1 profile evolved to type 2 and later to type 3. Infants with type 2 evolved to type 3. Inter-observer variability was negligible. All neonates with type 1 profile had a negative chest X-ray while showing significant RD to require supplemental oxygen; two of these infants needed N-CPAP and one MV. Infants with initial type 2 or type 3 profile did not have RD. Conclusion: Neonatal ultrasound lung appearance after birth follows a recognizable pattern that can be used to screen infants needing respiratory assistance. A5 Catheter-related infections and the nurse. New strategies E. Boano1 , R. Guardione1 , A. Catarinella1 , C. Romano1 , P. Manzoni1 , D. Farina1 . 1 Neonatology and NICU, AO OIRM-S. Anna, Torino, Italy The preterm infant is a special guest in which there is a physiological immune deficiency related to prematurity making him particularly vulnerable to infections. The existence and importance of infectious and septic disease is remarkable in Neonatology, and it is clear that, even in developed countries, infections are the main obstacle to the viability of premature infants. Premature infants are immunocompromised hosts by definition: in such patients, proper management of all the devices needed to perform cares and assistance is mandatory to reduce the risk of infection and to ultimately improve the overall clinical course and to achieve a good long-term quality of life. In this context one of the key moments is the placement and management of Central Venous Catheter (CVC), since up to 60% of nosocomial infections are, in fact, catheter related. Prolonged intravenous treatments, need for parenteral nutrition, the difficulty of finding peripheral venous access and need of alternative vessel accesses in case of emergency make the placement of a CVC in premature infants a priority, at least for the first weeks of stay in NICU. Whenever catheter-related infections occur, the clinical worsening and the overall health threats for the neonate produce a consequent prolongation of hospitalisation thus translating into higher costs. A skilled, appropriate management of all intravenous accesses, therefore, reduces the times for care, antibiotic therapy and duration of stay. The management and maintenance of the CVC are a nurse’s responsibility. It is obvious that it is not possible to entirely avoid the risk of infection and eliminate catheter-related infections, thus the goal is to reduce to a minimum the presence of microorganisms able to develop in an infection in young patients, with the help of technology and care strategies. The key moments of such nursing management of CVCs are: Replacement of Administration Sets, administration of intravenous therapies and the dressing of the insertion site. The high rate of glucose typical of TPN favours the proliferation of pathogens. The lines of infusion may also be contaminated with microparticles from plastic syringes and needles, which are deposited in the catheter or into the bloodstream resulting in lung and intestinal infections. It also exists a correlation between microbial contamination and the frequency with whom infusion lines and taps are manipulated. According to the CDC guidelines, it is essential to minimise the access routes using catheters with a suitable number of lamps. A similar argument applies to the three-way taps that must not be greater than the number of infusions that the patient may have at one time. Therefore, other devices such as luer-lock caps might be helpful, as they allow the nurse to replace several times a day the infusions without opening the entire venous access. Noteworthy, it is recommended to repeatedly disinfect the site of entry of the syringe or the ramp with chlorexidine. The most appropriate frequency of infusion lines replacement is a debated issue. The latest CDC guidelines show that – in general – there is no proven additional benefit in performing replacement more frequently than one every 72 hours. The high concentrations of glucose in the TPN infusion and the presence of lipids, however, better suggest to replace
Selected abstracts / Early Human Development 88S2 (2012) S101–S115
Reference(s) Raimondi et al Ped Inf Dis J Mar 2010, 29(3) 288. A3 Bovine lactoferrin supplementation for prevention of necrotising enterocolitis in preterm very-low-birth-weight neonates: a randomised trial M. Rinaldi2 , P. Manzoni1 , M. Meyer3 , E. Della Casa4 , L. Pugni5 , F. Mosca5 , I. Stolfi6 , H. Messner7 , L. Memo8 , N. Laforgia9 , L. Decembrino10 , M. Betta Pasqua11 , F. Vagnarelli12 , M. Stronati10 , D. Farina1 . 1 Neonatology and NICU, S. Anna Hospital, Torino, Italy; 2 Neonatology and NICU, Ospedali Riuniti, Foggia, Italy; 3 Neonatology and NICU, Middlemore Hospital, Auckland, New Zealand; 4 Neonatology and NICU, University of Modena, Modena, Italy; 5 Neonatology and NICU, IRCCS Mangiagalli Hospital, Milano, Italy; 6 Neonatology and NICU, Policlinico Umberto I, Roma, Italy; 7 Neonatology and NICU, Ospedale Regionale, Bolzano, Italy; 8 Neonatology and NICU, Ca’ Foncello Hospital, Treviso, Italy; 9 Neonatology and NICU, Policlinico Universitario, Bari, Italy; 10 Neonatology and NICU, IRCCS San Matteo, Pavia, Italy; 11 Neonatology and NICU, Azienda Ospedaliera Universitaria Policlinico, Catania, Italy; 12 Neonatology and NICU, Arcispedale, Reggio Emilia, Italy Background: NEC is a common and severe complication in premature neonates, particularly those with very-low-birth-weight (VLBW, <1500 g at birth). Probiotics including Lactobacillus rhamnosus GG (LGG) proved effective in preventing NEC in preterm infants in RCTs. Lactoferrin, a mammalian milk glycoprotein involved in innate immune host defences, can reduce the incidence of NEC in animal models, and its action is enhanced by LGG. The effect on NEC of bovine lactoferrin (BLF), alone or with the probiotic LGG, has not yet been studied in human infants. Objective: To establish whether bovine lactoferrin alone or with LGG, reduces the incidence of NEC in VLBW neonates. Design and Methods: This was an international, multicentre, randomised, double-blind, placebo-controlled trial. Thirteen Italian and New Zealand tertiary neonatal intensive care units screened and enrolled preterm, VLBW infants from October 1, 2007 through October 31, 2010. Infants were randomly assigned to receive orally either bLF (100 mg/day) alone (group LF; n = 251) or with LGG (at 6 × 109 CFU/day; group LF+LGG; n = 242), or placebo (Control group; n = 259) from birth until day 30 of life (45 for neonates <1000 g at birth). The main outcome measures were NEC greater than stage 2, and NEC (any stage). Results: 825 VLBW neonates were enrolled and assessed until discharge for development of NEC.Demographics, clinical and management characteristics of the 3 groups were similar, including type of feeding and maternal milk intakes. NEC incidence was significantly lower in groups BLF and BLF+LGG [5/251 (2.0%) and 1/242 (0.4%), respectively] than in controls [14/259 (5.4%)] (R.R. 0.35; 95% C.I. 0.13–0.99; p = 0.04 for BLF vs. control; R.R 0.07; 95% C.I. 0.01–0.55; p = 0.001 for BLF+LGG vs.control). The decrease occurred both for surgical and low-stages NECs. No adverse effects or intolerances to treatment occurred. Conclusions: Compared with placebo, BLF supplementation alone or in combination with LGG reduces the incidence of NEC of any stage in VLBW neonates. A4 Can lung ultrasound scan screen late preterm and near term neonates needing respiratory assistance? F. Migliaro1 , A. Sodano1 , L. Capasso1 , R. Paludetto1 , G. Vallone1 , A. Romano1 , A. Umbaldo1 , F. Raimondi1 . 1 Division of Neonatology and Pediatric Radiology, Universit` a “Federico II”, Naples, Italy Background and Aim: At birth, fluid is replaced by air in the lungs and compared to full term neonates, less mature infants experience more difficulties in the process. N-CPAP and mechanical ventilation (MV) may be needed to support their respiration. In adult medicine, ultrasound scan is used to assess fluid content in the lung. We tested the hypothesis that lung ultrasound scan may screen neonates needing respiratory assistance. Patients and Methods: Within 4 hours from birth, consecutive newly born infants (GA 34+3 – 41+4 ) were screened applying a flat 5.8 MHz probe (MCMD02AA, Philips, Bothell, WA) on the chest in 3 different locations per side. An experienced neonatologist performed the scan and images were reviewed by a paediatric radiologist. Patients were allocated in 3 profiles: type 1, diffuse hyperechogenicity (white lung); type 2, vertical
hyperechoic stripes (B-lines) and horizontal lines (A-lines); type 3, A-lines only. Infants were monitored by lung ultrasound every 12 hours. An independent neonatologist was encharged of the clinical management of the newborns. Results: 138 neonates were enrolled in the study. 6 (4%) were assigned to type 1 (GA 35.4±0.3); 40 (29%) to type 2 (GA 37.2±0.6) and 92 (67%) to type 3 (GA 37.6±1.2). All babies with type 1 profile evolved to type 2 and later to type 3. Infants with type 2 evolved to type 3. Inter-observer variability was negligible. All neonates with type 1 profile had a negative chest X-ray while showing significant RD to require supplemental oxygen; two of these infants needed N-CPAP and one MV. Infants with initial type 2 or type 3 profile did not have RD. Conclusion: Neonatal ultrasound lung appearance after birth follows a recognizable pattern that can be used to screen infants needing respiratory assistance. A5 Catheter-related infections and the nurse. New strategies E. Boano1 , R. Guardione1 , A. Catarinella1 , C. Romano1 , P. Manzoni1 , D. Farina1 . 1 Neonatology and NICU, AO OIRM-S. Anna, Torino, Italy The preterm infant is a special guest in which there is a physiological immune deficiency related to prematurity making him particularly vulnerable to infections. The existence and importance of infectious and septic disease is remarkable in Neonatology, and it is clear that, even in developed countries, infections are the main obstacle to the viability of premature infants. Premature infants are immunocompromised hosts by definition: in such patients, proper management of all the devices needed to perform cares and assistance is mandatory to reduce the risk of infection and to ultimately improve the overall clinical course and to achieve a good long-term quality of life. In this context one of the key moments is the placement and management of Central Venous Catheter (CVC), since up to 60% of nosocomial infections are, in fact, catheter related. Prolonged intravenous treatments, need for parenteral nutrition, the difficulty of finding peripheral venous access and need of alternative vessel accesses in case of emergency make the placement of a CVC in premature infants a priority, at least for the first weeks of stay in NICU. Whenever catheter-related infections occur, the clinical worsening and the overall health threats for the neonate produce a consequent prolongation of hospitalisation thus translating into higher costs. A skilled, appropriate management of all intravenous accesses, therefore, reduces the times for care, antibiotic therapy and duration of stay. The management and maintenance of the CVC are a nurse’s responsibility. It is obvious that it is not possible to entirely avoid the risk of infection and eliminate catheter-related infections, thus the goal is to reduce to a minimum the presence of microorganisms able to develop in an infection in young patients, with the help of technology and care strategies. The key moments of such nursing management of CVCs are: Replacement of Administration Sets, administration of intravenous therapies and the dressing of the insertion site. The high rate of glucose typical of TPN favours the proliferation of pathogens. The lines of infusion may also be contaminated with microparticles from plastic syringes and needles, which are deposited in the catheter or into the bloodstream resulting in lung and intestinal infections. It also exists a correlation between microbial contamination and the frequency with whom infusion lines and taps are manipulated. According to the CDC guidelines, it is essential to minimise the access routes using catheters with a suitable number of lamps. A similar argument applies to the three-way taps that must not be greater than the number of infusions that the patient may have at one time. Therefore, other devices such as luer-lock caps might be helpful, as they allow the nurse to replace several times a day the infusions without opening the entire venous access. Noteworthy, it is recommended to repeatedly disinfect the site of entry of the syringe or the ramp with chlorexidine. The most appropriate frequency of infusion lines replacement is a debated issue. The latest CDC guidelines show that – in general – there is no proven additional benefit in performing replacement more frequently than one every 72 hours. The high concentrations of glucose in the TPN infusion and the presence of lipids, however, better suggest to replace