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Does peripartum infection increase the incidence of cerebral palsy in extremely low birth weight infants?
SMFM Abstracts S189 622 FEASIBILITY AND EFFICACY OF DIFFERENT TRACHEAL OCCLUSION METHODS IN A FETAL RAT MODEL LOURENC¸O SBRAGIA1, JAAN TOELEN1, RIK GIJSBERS1, PAUL LEWI2, DEBYSER ZEGER1, JAN DEPREST2, 1Catholic University Leuven, Molecular Virology and Gene Therapy, Leuven, Belgium, 2Catholic University Leuven, Woman and Child, Leuven, Belgium OBJECTIVE: Tracheal occlusion (TO) triggers lung growth and may therefore be considered in cases of severe lung hypoplasia associated to isolated congenital diaphragmatic hernia (CDH). Most experimental studies are done in sheep and rabbits with surgically induced CDH. Toxic murine models have the advantage that molecular and genetic studies are easier. However experience with TO in these smaller models is limited. We aimed to establish feasibility of TO in fetal rats in our hands. STUDY DESIGN: Time mated pregnant Wistar rat (term=21 days) underwent at E19 general anesthesia, laparotomy and hystertomomy in max 50% of fetuses, to carry out either ligation (n=20), coagulation (n=20), microclipping (n=20) or a sham (n=20) operation on the fetal trachea. These and unmanipulated fetuses (internal controls; n=20) were harvested at E21 to determine survival, lung weight (LW), body weight (BW) and lung to body weight ratio (LBWR). Adequate lung response was defined as lung weight C 2SD above that of controls. To assess the effects of anesthesia and surgery, 20 fetuses were also harvested in unmanipulated rats (external controls; n=20). (Table; *p!0.05 comparing to controls). RESULTS: Fetuses from non-operated mothers weighed more at birth (p!0.005). TO at E19 increases LW and LBWR, but response was best after clipping (efficacy =64%; p!0.005). Fetal surgery decreased BW and LW but not LBWR. TO increases LBWR independent of technique (p!0.005). CONCLUSION: In a fetal rat model, tracheal microclipping is well tolerated and was most effective in increasing lung weight. These experiments will now be repeated with nitrofen exposed fetuses.
chorioamnionitis and neonatal sepsis remained significantly different between the CP and no CP group after adjustment for gender. CONCLUSION: In extremely low birth weight infants, CP was strongly associated with chorioamnionitis and neonatal sepsis.
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.677
Results per study group Group
LBWR X 1000
Survival
Efficacy
External control Internal control Sham Ligation Coagulation Clip
29.2 29.5 28.6 42.7 36.4 43.7
100% 100% 100% 65%* 100% 100%
40% 41% 65%*
(G (G (G (G (G (G
3) 4) 5) 12)* 12)* 11)*
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.676
623 DOES PERIPARTUM INFECTION INCREASE THE INCIDENCE OF CEREBRAL PALSY IN EXTREMELY LOW BIRTH WEIGHT INFANTS? MAGED COSTANTINE1, HELEN HOW1, KRISTIN COPPAGE1, ROSE MAXWELL1, BAHA SIBAI1, 1University of Cincinnati, Obstetrics & Gynecology, Cincinnati, Ohio OBJECTIVE: To determine the perinatal predictors of cerebral palsy (CP) in extremely low birth weight infants (! 1000 gms). STUDY DESIGN: A case control study of infants with birth weight of ! 1000 gm (19 with CP and 38 controls) who survived beyond 18-22 months of corrected age was performed. Outcome variables included maternal demographics, obstetrical complications and neonatal outcome (gestational age at delivery, birth weight, Apgar scores, IUGR, RDS, IVH and neonatal sepsis). Data analysis consisted of t-tests, chi-square and ANOVA when appropriate. RESULTS: There were no differences with regard to demographics, magnesium sulfate use, steroid use, preeclampsia, anterpartum vaginal bleeding, mode of delivery among infants with CP vs. no CP. The mean gestational age at delivery (2547 ’b 1.4 wks vs. 2557 ’b 1.8 wks), mean birth weight (727.1 ’b 107 g vs. 807.9 ’b 138 g) and the rate of IUGR (5% vs. 8%) are similar between groups. Using univariate analysis, male gender (OR 3.70; 95% CI: 1.0-12.5), primigravid (OR 5.52; 95% CI:1.7-18.3), early neonatal sepsis (OR 12.9; 95% CI: 2.9-57.2), chorioamnionitis (OR 3.7; 95% CI:1.2-11.9) and PROM O 48 hrs OR 6.2; 95% CI:1.1-36.6) were significantly more frequent in children who later developed CP. Table below shows that neonatal sepsis, chorioamnionitis and PROM O 48 hours remained significantly different between the CP and no CP group after adjustment for primigravidity. However, only
624 RADIAL RAY DEFECTS: A CLINICAL ALGORITHM MAIREAD KENNELLY1, 1Royal Victoria Infirmary, Newcastle-upon-Tyne, Newcastle-upon-Tyne, United Kingdom OBJECTIVE: Radial ray defects comprise a large heterogenous group of disorders which can present a diagnostic dilemma. Conditions vary conditions requiring surgical input (VACTERL) to possible developmental delay (Cornelia de Lange, Fanconi Anemia) to lethal abnormalities (Trisomy 18, Roberts syndrome). The specific diagnosis requires familiarity with a complex algorithm of ultrasonographic features. Antenatal diagnosis has been furthered by advancements in 3D ultrasound and molecular genetics The aim of this population based study was to report the experience over a 5 year period of a tertiary referral fetal medicine unit. We set out a clinical algorithm to enable a comprehensive pathway of assessment and management of radial ray defects. STUDY DESIGN: The Northern Congenital Abnormality Survey (NorCAS) collects data on all major congenital abnormalities in the Northern Region. All cases of radial ray defects isolated or associated with other anomalies notified to NorCAS between 2000 and 2005 were identified. RESULTS: Thirty seven cases of radial ray defects were referred to the Fetal medicine unit over a five year period. An antenatal diagnosis of a skeletal dysplasia or a variant of normal was made in seventeen cases. The remaining 20 cases were reviewed: 3 cases of trisomy 18, 4 cases of VATERL association, 4 cases of an isolated limb reduction defect, 1 case of TAR, 1 case of Nager syndrome, 1 case of Roberts syndrome, 1 case of Cornelia de Lange, 1 case of Fanconi’s anaemia, 1 case of Goldenhar and a fetal Valproate syndrome and 2 cases of unknown diagnosis. CONCLUSION: We set out a clinical algorithm which enables a systematic approach in the assessment and management of radial ray defects which will include fetal medicine referral, fetal echo and 3D ultrasound and genetic counselling. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.678
chorioamnionitis and neonatal sepsis remained significantly different between the CP and no CP group after adjustment for gender. CONCLUSION: In extremely low birth weight infants, CP was strongly associated with chorioamnionitis and neonatal sepsis.
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.677
Results per study group Group
LBWR X 1000
Survival
Efficacy
External control Internal control Sham Ligation Coagulation Clip
29.2 29.5 28.6 42.7 36.4 43.7
100% 100% 100% 65%* 100% 100%
40% 41% 65%*
(G (G (G (G (G (G
3) 4) 5) 12)* 12)* 11)*
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.676
623 DOES PERIPARTUM INFECTION INCREASE THE INCIDENCE OF CEREBRAL PALSY IN EXTREMELY LOW BIRTH WEIGHT INFANTS? MAGED COSTANTINE1, HELEN HOW1, KRISTIN COPPAGE1, ROSE MAXWELL1, BAHA SIBAI1, 1University of Cincinnati, Obstetrics & Gynecology, Cincinnati, Ohio OBJECTIVE: To determine the perinatal predictors of cerebral palsy (CP) in extremely low birth weight infants (! 1000 gms). STUDY DESIGN: A case control study of infants with birth weight of ! 1000 gm (19 with CP and 38 controls) who survived beyond 18-22 months of corrected age was performed. Outcome variables included maternal demographics, obstetrical complications and neonatal outcome (gestational age at delivery, birth weight, Apgar scores, IUGR, RDS, IVH and neonatal sepsis). Data analysis consisted of t-tests, chi-square and ANOVA when appropriate. RESULTS: There were no differences with regard to demographics, magnesium sulfate use, steroid use, preeclampsia, anterpartum vaginal bleeding, mode of delivery among infants with CP vs. no CP. The mean gestational age at delivery (2547 ’b 1.4 wks vs. 2557 ’b 1.8 wks), mean birth weight (727.1 ’b 107 g vs. 807.9 ’b 138 g) and the rate of IUGR (5% vs. 8%) are similar between groups. Using univariate analysis, male gender (OR 3.70; 95% CI: 1.0-12.5), primigravid (OR 5.52; 95% CI:1.7-18.3), early neonatal sepsis (OR 12.9; 95% CI: 2.9-57.2), chorioamnionitis (OR 3.7; 95% CI:1.2-11.9) and PROM O 48 hrs OR 6.2; 95% CI:1.1-36.6) were significantly more frequent in children who later developed CP. Table below shows that neonatal sepsis, chorioamnionitis and PROM O 48 hours remained significantly different between the CP and no CP group after adjustment for primigravidity. However, only
624 RADIAL RAY DEFECTS: A CLINICAL ALGORITHM MAIREAD KENNELLY1, 1Royal Victoria Infirmary, Newcastle-upon-Tyne, Newcastle-upon-Tyne, United Kingdom OBJECTIVE: Radial ray defects comprise a large heterogenous group of disorders which can present a diagnostic dilemma. Conditions vary conditions requiring surgical input (VACTERL) to possible developmental delay (Cornelia de Lange, Fanconi Anemia) to lethal abnormalities (Trisomy 18, Roberts syndrome). The specific diagnosis requires familiarity with a complex algorithm of ultrasonographic features. Antenatal diagnosis has been furthered by advancements in 3D ultrasound and molecular genetics The aim of this population based study was to report the experience over a 5 year period of a tertiary referral fetal medicine unit. We set out a clinical algorithm to enable a comprehensive pathway of assessment and management of radial ray defects. STUDY DESIGN: The Northern Congenital Abnormality Survey (NorCAS) collects data on all major congenital abnormalities in the Northern Region. All cases of radial ray defects isolated or associated with other anomalies notified to NorCAS between 2000 and 2005 were identified. RESULTS: Thirty seven cases of radial ray defects were referred to the Fetal medicine unit over a five year period. An antenatal diagnosis of a skeletal dysplasia or a variant of normal was made in seventeen cases. The remaining 20 cases were reviewed: 3 cases of trisomy 18, 4 cases of VATERL association, 4 cases of an isolated limb reduction defect, 1 case of TAR, 1 case of Nager syndrome, 1 case of Roberts syndrome, 1 case of Cornelia de Lange, 1 case of Fanconi’s anaemia, 1 case of Goldenhar and a fetal Valproate syndrome and 2 cases of unknown diagnosis. CONCLUSION: We set out a clinical algorithm which enables a systematic approach in the assessment and management of radial ray defects which will include fetal medicine referral, fetal echo and 3D ultrasound and genetic counselling. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.678