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ACA and MCA blood flow in infants < 1500 g treated with ibuprofen for PDA
Abstracts
45%). Steroids prophilaxy was made in 37% of cases, yet RDS occurred in 98% of case. Premature membrane rupture occurred in 73% (over 18 h — 37%), antibiotics during delivery — 31.8%. Mechanical ventilation duration was maximum of 33 days. Conclusions Steroids and surfactant prophilaxy increased survival rate with 60%, which is also influenced by cesarian section (Pv = 0.02), gestational age (Pv = 0.001), birth weight (Pv = 0.002), infection (Pv = 0.0001), resuscitation (Pv = 0.001) and mechanical ventilation duration (Pv = 0.006). The incidence of intraventricular hemorrhage and porencephally were maximum in the first day of life under 1000 g, and during first week for subgroup 1000– 1250 g birth weight and was correlated with delivery mode (Pv = 0.003). Survival rate is: 25 weeks — 21%, 28 weeks — 58%, 30 weeks — 77%, 32 weeks — 93%.
S13
Conclusions Maternal demographic and environmental factors were not correlated with onset of PND whilst a statistically significant correlation with child's EG, duration of hospitalisation in NICU, clinical condition and diagnosis of CLD was revealed. doi:10.1016/j.earlhumdev.2008.09.032
Abstract UENPS.17 The value of transcutaneous method of bilirubin measurement in newborn population with the risk of AB0 hemolytic disease Dalia Stoniene, Jurate Buinauskiene Egle Markuniene⁎ Kaunas Medical University Hospital, Lithuania
doi:10.1016/j.earlhumdev.2008.09.031 Background and aim
Abstract UENPS.16 Postnatal depression in mothers of infants admitted to a neonatal intensive care unit at birth
To evaluate the correlation of total serum bilirubin (TSB) level and transcutaneous bilirubin (TcB) level in newborn infants with the risk of AB0 hemolytic disease. Materials and methods
Coni Elisabetta, De Magistris Anna, Puddu Melania⁎, Fanos Vassilios Neonatal Intensive Care Unit, Puericultura Institute and Neonatal Section, University of Cagliari, Italy Background and aim The birth of a child requiring hospitalisation in a Neonatal Intensive Care Unit (NICU) is an emotionally stressful situation for mothers, frequently continuing past their discharge from hospital. It is unsurprising therefore that the latter present a higher risk of postnatal depression (10–14% according to data reported in literature) compared to mothers of healthy full-term babies. 1. To implement a screening programme to assess the prevalence of Postnatal Depression (PND) in mothers of infants admitted at birth to the NICU in Cagliari and compare data obtained with a group of mothers of healthy full-term infants from the maternity ward of the same hospital. 2. To compare findings obtained for mothers of infants having a birth weight < 1500 g with those of mothers with infants weighing = 1500 g at birth. 3. To evaluate the correlation between PND and several risk factors associated to mothers' past history and to child's clinical condition. Materials and methods • 113 mothers of infants admitted to NICU, 44 of whom < 1500 g and 69 = 1500 g. • 101 mothers of healthy full-term infants. The Edinburgh Questionnaire (EQ) (cut-off 10) was applied in screening for PND. Following filling in of the questionnaire, a counselling interview was performed to collect information on potential risk factors. The survey was conducted at least one month after delivery. Mothers whose children were still hospitalised were assessed on the hospital ward (once the possibility of an unfavourable outcome for their child had been largely ruled out) or at time of first follow-up. Mothers whose children had been placed in the regular maternity ward were assessed at one-month postnatal check-up. Results The prevalence of PND was significantly higher in mothers of infants admitted to the NICU compared to those on the maternity ward (23% vs 8%; p < 0.001). Following exclusion of 4 cases affected by prenatal depression, PND was revealed as being almost double in the “<1500 g” group (32% vs 17% of the other group), although not reaching statistical significance.
130 full-term (= 37 weeks of gestation) newborn infants with a diagnosed AB0 blood group incompatibility were investigated. TSB level was measured at the age of 6 h; further measurements were performed in 24, 48 and 72 h following the first measurement. A blood sample was collected from peripheral vein. TcB level in a forehead was measured using non-invasive bilirubinometer BiliCheck within +/−30 min following blood sampling. Results 387 double tests were performed to measure TSB and TcB level. TSB level 114.83 (62.85) mcmol/L (mean (S.D.)) closely correlates TcB level 115.51 (61.31) mcmol/L (r = 0.92, p < 0.001). The strongest correlation was reported at the age of 54 h (r = 0.873, p < 0.001), the weakest — at the age of 6 h (r = 0.729, p < 0.001). TSB and TcB levels have high correlation, however, we found a significant difference between these values (95% CI [0.70; 5.93], p < 0.05). The highest difference between TSB and TcB was found at 6 h of age, 5.58 (17.46) mcmol/L (95% CI [2.55; 8.61], p < 0.001). No significant difference was reported at the age of 30, 54 and 78 h. Using a linear regressive curve it was established that correlation of TSB and TcB is described by equation y = 14.13 + 0.903x. Transcutaneously measured bilirubin level exceeded serum bilirubin level. The sensitivity of these values at the age of 6 and 54 h was 100% (area under the curve 0.95–0.97), at the age of 30 h — 87% (area under the curve 0.88). The specificity was 86–95%, positive prognostic value at the age of 6 and 30 h was 35% and 54% at the age of 54 h and negative prognostic value was 99–100%. Conclusions TSB and TcB levels have high correlation, however, we found a significant difference between these values. In order to evaluate bilirubin level transcutaneously according to nomograms of serum bilirubin level the results should be considered with care, especially for newborns with a risk of development of AB0 hemolytic disease. The hour-specific nomograms for transcutaneous bilirubin level are required to evaluate bilirubin level measured transcutaneously. doi:10.1016/j.earlhumdev.2008.09.033
Abstract UENPS.18 ACA and MCA blood flow in infants <1500 g treated with ibuprofen for PDA Witoslaw Beata⁎, Szymankiewicz Marta, Gadzinowski Janusz Department of Neonatology, Poznan, Poland
S14
Abstracts
Background and aim To evaluate the efficacy of IBU used for treatment of PDA, 2. to assess blood flow in ACA and MCA, 3. to investigate whether IBU affects ACA and MCA blood flow. Materials and methods 50 neonates. Group 0(G0)-neonates before the 1st dose of IBU. Before the 2nd dose: G1 neonates with closed PDA, G2 with PDA still present. Before the 3rd dose: G3-without PDA, G4 with PDA. IBU was given i.v. 10/5/5 mg/kg at 24 h intervals between 3rd and 7th day of life. INS now=" "; The inclusion criteria: BUN = 40 mg/dL, a serum creatinine level = 1.6 mg/dL, a platelet count = 60G/L, urine output = 1 ml/ kg/h. Measurements of ACA and MCA blood flow were obtained before and 30′, 60′, 120′ after IBU. The resitance index (RI) and pulsatility index (PI) were estimated.
NVD. Most of them were term newborns (73%). About half of the neonates were admitted in the age range of < 7 days. The mean hospital stay was 6.5 days. The common reasons of admission were: jaundice (44.5%), sepsis (30.5%), Hyaline membrane disease(5.9%), Congenital anomalies (3.4%) and others. Sixty eight percent were discharged successfully, 14 cases (2%) transferred to more equipped hospitals, 21% of neonates were discharged aganinst medical advice. The overall mortality rate was 9%. The main causes of mortality were congenital anomalies and hyaline membrane disease. Conclusions The recognition of neonatal illnesses is necessary for future health care planning and rational allocation of health resources. doi:10.1016/j.earlhumdev.2008.09.035
Results PDA closure occurred in 84% after three doses of IBU. Cerebral blood flow measurements: in G0 drop of RI in ACA 0′–120′(0.80–0.78), in MCA 0′–120′ (0.81–0.79), 30′–120′ (0.82–0.79), 60′–120′(0.80–0.79) (p < 0.05) and drop of PI in ACA 0′–120′ (1.68–1.57), 60′–120′ (1.71–1.57) (p < 0.05), in MCA drop of PI 0′–120′ (1.79–1.67) (NS). During the 2nd dose RI in ACA was higher after 120′ (0.76–0.80) in G1 (NS), but in G2 0′–120′ (0.75– 0.81), 30′–120′ (0.77–0.81), 60′–120′ (0.79–0.81) (p < 0.05). RI in MCA was higher after 120′ (0.77–0.81 G1), (0.77–0.80 G2) (NS). PI in ACA was higher after 120′ (1.55–1.63 G1), PI was also higher 0′–120′(1.37–1.70 G2)(NS), but only 30′–120′ (1.50–1.70) this difference was statistically significantly (p < 0.05). PI in MCA in both groups was higher after 120′ (1.51–1.80 G1), and (1.61–1.71 G2) (NS). During the 3rd dose we observed growth of RI in ACA 0′–120′ (0.74–0.77) in G3 and drop of RI after 120′ (0.79–0.78) (NS) in G4. In MCA growth of RI in G3 0′–120′ (0.74–0.79) (NS) and 0′–120′ (0.77– 0.79) (p < 0.05) in G4. PI in ACA in G3 was higher after 120′ (1.38–1.60) (NS), but PI in G4 was lower 0′–120′ (1.63–1.56) (NS). MCA: in G3 PI was higher after 120′ (1.43–1.79) (NS), in G4 PI was also higher and statistically significantly 0′–30′ (1.52–1.80), 0′–60′ (1.52–1.69) and 0′–120′ (1.52–1.70) (p < 0.05).
Abstract UENPS.20 Biochemical markers of neonatal myocardial dysfunction Almeida Cristina⁎,a, Pinto Fernandob, Pinto Marianab, Ferreira Sofiab, Marinho Luisb, carrapato MRGa a Faculty of Health Sciences, Fernando Pessoa University, Oporto, Portugal b São Sebastião Hospital, Santa Maria da Feira, Portugal Background and aim Fetal and neonatal myocardial dysfunction may occur secondary to intrauterine and postnatal events. Cardiac ultrasounds (US) are not always available at the bedside of neonatal intensive care units (NICU). Cardiac Troponin I (cTnI), CK-MB and NT-proBNP may be an alternative or complementary to influence evaluation and treatment. OBJECTIVES: 1) To determine reference ranges of biochemical markers; 2) Their correlation to ultrasound findings Materials and methods
Conclusions Pharmacological treatment of PDA proved high efficacy in infants weighing = 1500 g. 2.1st dose of IBU significantly improved ACA and MCA blood flow. IBU statistically significantly increased RI and PI in cerebral arteries during the next doses, but within normal ranges.
Cord and blood samples were collected from Full Term (FT) Appropriate for Gestational Age (AGA) infants of healthy mothers with uneventful pregnancies, upon parental consent, if clinically indicated. NT-proBNP was determined by VIDAS NT-proBNP (bioMerieux), CK-MB and cTnI by chemoluminescence techniques.
doi:10.1016/j.earlhumdev.2008.09.034
Results
Mosayebi Ziba⁎, Hossein Movahedian Amir, Abbas Mousavi Gholam Kashan University of Medical Sciences, Iran
Median values for CK-MB declines from 64.0 to 44.0 U/L within the first 3 days of live, whilst cTnI gradually rises from 0.0055 to 0.0490 ng/mL during the same period. NT-proBNP peaks between the first and second day of live (4057.5 pg/mL), and gradual falls to 2420.0 pg/mL at the end of the third day to 1358.0 pg/mL at the end of the fourth day. US evaluations of these same patients were either normal or showed small VSD/PDA with no significant shunt.
Background and aim
Conclusions
To determine the admission and outcome patterns of neonatal diseases in a neonatal unit.
CK-MB, being mostly of skeletal muscle origin in the neonate, declines from birth reflecting the stress of delivery rather than myocardial injury per se. Conversely, the rise in cTnI may be explained by a degree of myocardial involvement albeit physiological or due to impaired plasmatic clearance. The initial rise and subsequent fall of NT-proBNP quite likely represents the physiological ventricular overload of transient birth adaptation. Intrauterine or postnatal events from hypoxia to sepsis, gestational diabetes, PDA, congenital heart disease, etc, may all lead to major biochemical changes helpful in the management of preterms and sick neonates.
Abstract UENPS.19 Admission patterns and outcomes in a neonatal unit in Kashan, Iran
Materials and methods All the neonates presented to neonatal unit during a one year period were enrolled in this study. All data were collected from medical records and analyzed carefully. Results During the study period 700 neonates were admitted, of whom 40% were female and 60% were male, 41% delivered by C/S and 59% by
doi:10.1016/j.earlhumdev.2008.09.036
45%). Steroids prophilaxy was made in 37% of cases, yet RDS occurred in 98% of case. Premature membrane rupture occurred in 73% (over 18 h — 37%), antibiotics during delivery — 31.8%. Mechanical ventilation duration was maximum of 33 days. Conclusions Steroids and surfactant prophilaxy increased survival rate with 60%, which is also influenced by cesarian section (Pv = 0.02), gestational age (Pv = 0.001), birth weight (Pv = 0.002), infection (Pv = 0.0001), resuscitation (Pv = 0.001) and mechanical ventilation duration (Pv = 0.006). The incidence of intraventricular hemorrhage and porencephally were maximum in the first day of life under 1000 g, and during first week for subgroup 1000– 1250 g birth weight and was correlated with delivery mode (Pv = 0.003). Survival rate is: 25 weeks — 21%, 28 weeks — 58%, 30 weeks — 77%, 32 weeks — 93%.
S13
Conclusions Maternal demographic and environmental factors were not correlated with onset of PND whilst a statistically significant correlation with child's EG, duration of hospitalisation in NICU, clinical condition and diagnosis of CLD was revealed. doi:10.1016/j.earlhumdev.2008.09.032
Abstract UENPS.17 The value of transcutaneous method of bilirubin measurement in newborn population with the risk of AB0 hemolytic disease Dalia Stoniene, Jurate Buinauskiene Egle Markuniene⁎ Kaunas Medical University Hospital, Lithuania
doi:10.1016/j.earlhumdev.2008.09.031 Background and aim
Abstract UENPS.16 Postnatal depression in mothers of infants admitted to a neonatal intensive care unit at birth
To evaluate the correlation of total serum bilirubin (TSB) level and transcutaneous bilirubin (TcB) level in newborn infants with the risk of AB0 hemolytic disease. Materials and methods
Coni Elisabetta, De Magistris Anna, Puddu Melania⁎, Fanos Vassilios Neonatal Intensive Care Unit, Puericultura Institute and Neonatal Section, University of Cagliari, Italy Background and aim The birth of a child requiring hospitalisation in a Neonatal Intensive Care Unit (NICU) is an emotionally stressful situation for mothers, frequently continuing past their discharge from hospital. It is unsurprising therefore that the latter present a higher risk of postnatal depression (10–14% according to data reported in literature) compared to mothers of healthy full-term babies. 1. To implement a screening programme to assess the prevalence of Postnatal Depression (PND) in mothers of infants admitted at birth to the NICU in Cagliari and compare data obtained with a group of mothers of healthy full-term infants from the maternity ward of the same hospital. 2. To compare findings obtained for mothers of infants having a birth weight < 1500 g with those of mothers with infants weighing = 1500 g at birth. 3. To evaluate the correlation between PND and several risk factors associated to mothers' past history and to child's clinical condition. Materials and methods • 113 mothers of infants admitted to NICU, 44 of whom < 1500 g and 69 = 1500 g. • 101 mothers of healthy full-term infants. The Edinburgh Questionnaire (EQ) (cut-off 10) was applied in screening for PND. Following filling in of the questionnaire, a counselling interview was performed to collect information on potential risk factors. The survey was conducted at least one month after delivery. Mothers whose children were still hospitalised were assessed on the hospital ward (once the possibility of an unfavourable outcome for their child had been largely ruled out) or at time of first follow-up. Mothers whose children had been placed in the regular maternity ward were assessed at one-month postnatal check-up. Results The prevalence of PND was significantly higher in mothers of infants admitted to the NICU compared to those on the maternity ward (23% vs 8%; p < 0.001). Following exclusion of 4 cases affected by prenatal depression, PND was revealed as being almost double in the “<1500 g” group (32% vs 17% of the other group), although not reaching statistical significance.
130 full-term (= 37 weeks of gestation) newborn infants with a diagnosed AB0 blood group incompatibility were investigated. TSB level was measured at the age of 6 h; further measurements were performed in 24, 48 and 72 h following the first measurement. A blood sample was collected from peripheral vein. TcB level in a forehead was measured using non-invasive bilirubinometer BiliCheck within +/−30 min following blood sampling. Results 387 double tests were performed to measure TSB and TcB level. TSB level 114.83 (62.85) mcmol/L (mean (S.D.)) closely correlates TcB level 115.51 (61.31) mcmol/L (r = 0.92, p < 0.001). The strongest correlation was reported at the age of 54 h (r = 0.873, p < 0.001), the weakest — at the age of 6 h (r = 0.729, p < 0.001). TSB and TcB levels have high correlation, however, we found a significant difference between these values (95% CI [0.70; 5.93], p < 0.05). The highest difference between TSB and TcB was found at 6 h of age, 5.58 (17.46) mcmol/L (95% CI [2.55; 8.61], p < 0.001). No significant difference was reported at the age of 30, 54 and 78 h. Using a linear regressive curve it was established that correlation of TSB and TcB is described by equation y = 14.13 + 0.903x. Transcutaneously measured bilirubin level exceeded serum bilirubin level. The sensitivity of these values at the age of 6 and 54 h was 100% (area under the curve 0.95–0.97), at the age of 30 h — 87% (area under the curve 0.88). The specificity was 86–95%, positive prognostic value at the age of 6 and 30 h was 35% and 54% at the age of 54 h and negative prognostic value was 99–100%. Conclusions TSB and TcB levels have high correlation, however, we found a significant difference between these values. In order to evaluate bilirubin level transcutaneously according to nomograms of serum bilirubin level the results should be considered with care, especially for newborns with a risk of development of AB0 hemolytic disease. The hour-specific nomograms for transcutaneous bilirubin level are required to evaluate bilirubin level measured transcutaneously. doi:10.1016/j.earlhumdev.2008.09.033
Abstract UENPS.18 ACA and MCA blood flow in infants <1500 g treated with ibuprofen for PDA Witoslaw Beata⁎, Szymankiewicz Marta, Gadzinowski Janusz Department of Neonatology, Poznan, Poland
S14
Abstracts
Background and aim To evaluate the efficacy of IBU used for treatment of PDA, 2. to assess blood flow in ACA and MCA, 3. to investigate whether IBU affects ACA and MCA blood flow. Materials and methods 50 neonates. Group 0(G0)-neonates before the 1st dose of IBU. Before the 2nd dose: G1 neonates with closed PDA, G2 with PDA still present. Before the 3rd dose: G3-without PDA, G4 with PDA. IBU was given i.v. 10/5/5 mg/kg at 24 h intervals between 3rd and 7th day of life. INS now=" "; The inclusion criteria: BUN = 40 mg/dL, a serum creatinine level = 1.6 mg/dL, a platelet count = 60G/L, urine output = 1 ml/ kg/h. Measurements of ACA and MCA blood flow were obtained before and 30′, 60′, 120′ after IBU. The resitance index (RI) and pulsatility index (PI) were estimated.
NVD. Most of them were term newborns (73%). About half of the neonates were admitted in the age range of < 7 days. The mean hospital stay was 6.5 days. The common reasons of admission were: jaundice (44.5%), sepsis (30.5%), Hyaline membrane disease(5.9%), Congenital anomalies (3.4%) and others. Sixty eight percent were discharged successfully, 14 cases (2%) transferred to more equipped hospitals, 21% of neonates were discharged aganinst medical advice. The overall mortality rate was 9%. The main causes of mortality were congenital anomalies and hyaline membrane disease. Conclusions The recognition of neonatal illnesses is necessary for future health care planning and rational allocation of health resources. doi:10.1016/j.earlhumdev.2008.09.035
Results PDA closure occurred in 84% after three doses of IBU. Cerebral blood flow measurements: in G0 drop of RI in ACA 0′–120′(0.80–0.78), in MCA 0′–120′ (0.81–0.79), 30′–120′ (0.82–0.79), 60′–120′(0.80–0.79) (p < 0.05) and drop of PI in ACA 0′–120′ (1.68–1.57), 60′–120′ (1.71–1.57) (p < 0.05), in MCA drop of PI 0′–120′ (1.79–1.67) (NS). During the 2nd dose RI in ACA was higher after 120′ (0.76–0.80) in G1 (NS), but in G2 0′–120′ (0.75– 0.81), 30′–120′ (0.77–0.81), 60′–120′ (0.79–0.81) (p < 0.05). RI in MCA was higher after 120′ (0.77–0.81 G1), (0.77–0.80 G2) (NS). PI in ACA was higher after 120′ (1.55–1.63 G1), PI was also higher 0′–120′(1.37–1.70 G2)(NS), but only 30′–120′ (1.50–1.70) this difference was statistically significantly (p < 0.05). PI in MCA in both groups was higher after 120′ (1.51–1.80 G1), and (1.61–1.71 G2) (NS). During the 3rd dose we observed growth of RI in ACA 0′–120′ (0.74–0.77) in G3 and drop of RI after 120′ (0.79–0.78) (NS) in G4. In MCA growth of RI in G3 0′–120′ (0.74–0.79) (NS) and 0′–120′ (0.77– 0.79) (p < 0.05) in G4. PI in ACA in G3 was higher after 120′ (1.38–1.60) (NS), but PI in G4 was lower 0′–120′ (1.63–1.56) (NS). MCA: in G3 PI was higher after 120′ (1.43–1.79) (NS), in G4 PI was also higher and statistically significantly 0′–30′ (1.52–1.80), 0′–60′ (1.52–1.69) and 0′–120′ (1.52–1.70) (p < 0.05).
Abstract UENPS.20 Biochemical markers of neonatal myocardial dysfunction Almeida Cristina⁎,a, Pinto Fernandob, Pinto Marianab, Ferreira Sofiab, Marinho Luisb, carrapato MRGa a Faculty of Health Sciences, Fernando Pessoa University, Oporto, Portugal b São Sebastião Hospital, Santa Maria da Feira, Portugal Background and aim Fetal and neonatal myocardial dysfunction may occur secondary to intrauterine and postnatal events. Cardiac ultrasounds (US) are not always available at the bedside of neonatal intensive care units (NICU). Cardiac Troponin I (cTnI), CK-MB and NT-proBNP may be an alternative or complementary to influence evaluation and treatment. OBJECTIVES: 1) To determine reference ranges of biochemical markers; 2) Their correlation to ultrasound findings Materials and methods
Conclusions Pharmacological treatment of PDA proved high efficacy in infants weighing = 1500 g. 2.1st dose of IBU significantly improved ACA and MCA blood flow. IBU statistically significantly increased RI and PI in cerebral arteries during the next doses, but within normal ranges.
Cord and blood samples were collected from Full Term (FT) Appropriate for Gestational Age (AGA) infants of healthy mothers with uneventful pregnancies, upon parental consent, if clinically indicated. NT-proBNP was determined by VIDAS NT-proBNP (bioMerieux), CK-MB and cTnI by chemoluminescence techniques.
doi:10.1016/j.earlhumdev.2008.09.034
Results
Mosayebi Ziba⁎, Hossein Movahedian Amir, Abbas Mousavi Gholam Kashan University of Medical Sciences, Iran
Median values for CK-MB declines from 64.0 to 44.0 U/L within the first 3 days of live, whilst cTnI gradually rises from 0.0055 to 0.0490 ng/mL during the same period. NT-proBNP peaks between the first and second day of live (4057.5 pg/mL), and gradual falls to 2420.0 pg/mL at the end of the third day to 1358.0 pg/mL at the end of the fourth day. US evaluations of these same patients were either normal or showed small VSD/PDA with no significant shunt.
Background and aim
Conclusions
To determine the admission and outcome patterns of neonatal diseases in a neonatal unit.
CK-MB, being mostly of skeletal muscle origin in the neonate, declines from birth reflecting the stress of delivery rather than myocardial injury per se. Conversely, the rise in cTnI may be explained by a degree of myocardial involvement albeit physiological or due to impaired plasmatic clearance. The initial rise and subsequent fall of NT-proBNP quite likely represents the physiological ventricular overload of transient birth adaptation. Intrauterine or postnatal events from hypoxia to sepsis, gestational diabetes, PDA, congenital heart disease, etc, may all lead to major biochemical changes helpful in the management of preterms and sick neonates.
Abstract UENPS.19 Admission patterns and outcomes in a neonatal unit in Kashan, Iran
Materials and methods All the neonates presented to neonatal unit during a one year period were enrolled in this study. All data were collected from medical records and analyzed carefully. Results During the study period 700 neonates were admitted, of whom 40% were female and 60% were male, 41% delivered by C/S and 59% by
doi:10.1016/j.earlhumdev.2008.09.036