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Lipid infusions as part of total parenteral nutrition in newborn infants with congenital diaphragmatic hernia and pulmonary hypertension
Abstracts
Abstract UENPS.35 Lipid infusions as part of total parenteral nutrition in newborn infants with congenital diaphragmatic hernia and pulmonary hypertension Birgin Torer⁎,a, Aylin Tarcanb, Hande Gulcana, Serdar Ardab, Semire Ezera Baskent Univercity Faculty of Medicine, Adana, Turkey b Baskent Univercity Faculty of Medicine, Ankara, Turkey
a
Background and aim Congenital diaphragmatic hernia (CDH) is a disorder with high mortality rates.Pulmonary hypertension (PH) is associated with the outcome in newborns with CDH. The use of lipid emulsions is a frequent practice in the care of newborns in neonatal intensive care units.However, lipid infusions may influence pulmonary vascular resistance and deteriorate PH. The objective of this retrospective study was to investigate the practice of lipid infusions in newborns with CDH and PH.
S21
Materials and methods We concluded a historical cross over design study. Data was prospectively collected from all the VLBW infants admitted to the NICU at Assaf Harofeh medical center, Israel. All VLBW infants admitted from 1/1/97 till 30/6/01 were transfused with blood group match platelet concentrates at a dose of 10 ml/Kg (from one blood donor) within 3 h after birth during approximately 1 h (treatment group). VLBW infants admitted from 1/7/01 till 31/12/04 did not get any platelet transfusion (control group). Exclusion criteria included: Infants who did not survive initial resuscitation at delivery, major lethal congenital anomalies and thrombocytopenic infants requiring platelet transfusion (initial platelet count < 50 × 109 /L). Results During the study period 593 eligible very low birth infants were admitted to the NICU at Assaf Harofeh medical center, Israel. 312 infants were in the treatment group and 281 in the control group. Results are summarized in Table 1.
Materials and methods Conclusions A retrospective analysis was performed of the charts of newborn infants with CDH from our institution from 2003, January to 2008, May. Gender, birth weight, gestational age, associated anomalies, treatment modalities, timing of initiation of lipid infusion, total lipid infusion time, maximum lipid infusion rate were the data collected from the charts. Results A total of 35 infants (20 boys, 15 girls), with CDH were evaluated. The mean gestational age was 37.4 weeks (range 31–42 weeks) and mean birth weight was 2740 g (range 1490–3700 g). Nine patients (25.7%) were diagnosed antenatally. 22 patients (62.8%) required mechanical ventilation during 6 h of life. There were associated anomalies in 5 patients (14.2%).PH was observed in 23 patients (62.9%) and 11 patients received ilomedin and/or sildenafil treatment.Surgical repair of CDH was performed in 30 patients, 5 patients died before surgical treatment.Eleven patients died after surgical management and total mortality rate was 45.7%.Intravenous lipid infusions were given in 17 infants, started on days 1–12 (mean 4.50 ± 2.50 days). Thirteen of these 17 infants had PH. Lipid infusions were continued for 1– 35 days (10.22 ± 8.10 days).Maximum lipid infusion rates were between 0.5– 3.5 g/kg/day (mean: 1.68 ± 0.8 g/kg/day).Treatment for PH was analyzed as the only independent risk factor of prognosis. Conclusions Although the effects of lipid infusions in infants who have respiratory failure with PH is not evident, avoiding lipids is considered in infants who have evidence of increased pulmonary vascular resistance. Eighteen of 35 patients with CDH received lipid infusions and 11 of them received infusions above the dosage to prevent essential fatty acid deficiency; but not only time of lipid infusion but also the dosage did not affect the prognosis in our group of patients. doi:10.1016/j.earlhumdev.2008.09.051
In our opinion, the goal of better neurodevelopmental outcome, as measured by preventing high grade IVH, PVL and mortality, may not be reached with one treatment only. It must be a prolonged, team effort from all the NICU staff. Table 1 Incidence of intraventricular hemorrhage (grade III–IV), periventricular leukomalacia and mortality in the treatment and the control groups
Intraventricular hemorrhage (grade III–IV) Periventricular leukomalacia Mortality All (1 or 2 or 3)
Treatment group
Control group
P
4.2% 4.8% 10.3% 16.4%
5.3% 2.8% 9.6% 14.2%
0.146 0.307 0.900 0.550
doi:10.1016/j.earlhumdev.2008.09.052
Abstract UENPS.37 Postnatal growth failure and neurodevelopmental outcomes in VLBW infants Bogumila Stoinska⁎,a, Magdalena Kosinskaa, Janusz Gadzinowskia Chair and Department of Neonatology, Poznan University of Medical Sciences, Poland b Institute of Anthropology, Department of Human Biological Development, Poland
a
Background and aim Aim to examine growth attainment and the neurosensory status of children < 1500 g including AGA/SGA and compare their growth and neurodevelopmental outcomes. Materials and methods
Abstract UENPS.36 Platelets transfusion to prevent intraventricular hemorrhage, periventricular leukomalacia or death in very low birth weight infants Bernard Barzilay⁎, Rimona Keidar, David Batash, Eli Heyman Assaf Harofeh Medical Center, Zerifin, Israel Background and aim During the initial NICU hospitalization, high grade IVH and PVL as detected by routine cranial ultra-sound, carry a worse prognosis for neurodevelopment delay. The multifactorial etiology of intraventricular hemorrhage in very low birth weight infants may involve coagulation disturbances. By giving to VLBW infants platelet we tried to prevent IVH, PVL and mortality.
450 infants born at ?35 week of g.a. with BW500–1500 g without major congenital malformations, from JAN1999–DEC2003.Infants were admitted to the NICU a tertiary level hospital. The mean birth weight was 1097.3 g (Me = 920.0 g); mean g.a.27.0 weeks (Me = 26). The criterion for SGA was estimated using the birth weight below the 10 percentile with reference to the data for the Wielkopolska Region. The association between SGA/AGA and neurologic status at1and 2years corrected age were examined. Development was evaluated with use of the Bayley Scales of Infant Development (MDI/PDI). Results Considering the percentile position 104 (23%) of infants were born SGA. No statistical difference by gender. At 1 year BW below the 10 percentile increased to 47% and at 2 year to 55%.We observed that at 2 year of corrected age BW below the 10 percentile had 52% of AGA children at birth and 64% of SGA at birth.
Abstract UENPS.35 Lipid infusions as part of total parenteral nutrition in newborn infants with congenital diaphragmatic hernia and pulmonary hypertension Birgin Torer⁎,a, Aylin Tarcanb, Hande Gulcana, Serdar Ardab, Semire Ezera Baskent Univercity Faculty of Medicine, Adana, Turkey b Baskent Univercity Faculty of Medicine, Ankara, Turkey
a
Background and aim Congenital diaphragmatic hernia (CDH) is a disorder with high mortality rates.Pulmonary hypertension (PH) is associated with the outcome in newborns with CDH. The use of lipid emulsions is a frequent practice in the care of newborns in neonatal intensive care units.However, lipid infusions may influence pulmonary vascular resistance and deteriorate PH. The objective of this retrospective study was to investigate the practice of lipid infusions in newborns with CDH and PH.
S21
Materials and methods We concluded a historical cross over design study. Data was prospectively collected from all the VLBW infants admitted to the NICU at Assaf Harofeh medical center, Israel. All VLBW infants admitted from 1/1/97 till 30/6/01 were transfused with blood group match platelet concentrates at a dose of 10 ml/Kg (from one blood donor) within 3 h after birth during approximately 1 h (treatment group). VLBW infants admitted from 1/7/01 till 31/12/04 did not get any platelet transfusion (control group). Exclusion criteria included: Infants who did not survive initial resuscitation at delivery, major lethal congenital anomalies and thrombocytopenic infants requiring platelet transfusion (initial platelet count < 50 × 109 /L). Results During the study period 593 eligible very low birth infants were admitted to the NICU at Assaf Harofeh medical center, Israel. 312 infants were in the treatment group and 281 in the control group. Results are summarized in Table 1.
Materials and methods Conclusions A retrospective analysis was performed of the charts of newborn infants with CDH from our institution from 2003, January to 2008, May. Gender, birth weight, gestational age, associated anomalies, treatment modalities, timing of initiation of lipid infusion, total lipid infusion time, maximum lipid infusion rate were the data collected from the charts. Results A total of 35 infants (20 boys, 15 girls), with CDH were evaluated. The mean gestational age was 37.4 weeks (range 31–42 weeks) and mean birth weight was 2740 g (range 1490–3700 g). Nine patients (25.7%) were diagnosed antenatally. 22 patients (62.8%) required mechanical ventilation during 6 h of life. There were associated anomalies in 5 patients (14.2%).PH was observed in 23 patients (62.9%) and 11 patients received ilomedin and/or sildenafil treatment.Surgical repair of CDH was performed in 30 patients, 5 patients died before surgical treatment.Eleven patients died after surgical management and total mortality rate was 45.7%.Intravenous lipid infusions were given in 17 infants, started on days 1–12 (mean 4.50 ± 2.50 days). Thirteen of these 17 infants had PH. Lipid infusions were continued for 1– 35 days (10.22 ± 8.10 days).Maximum lipid infusion rates were between 0.5– 3.5 g/kg/day (mean: 1.68 ± 0.8 g/kg/day).Treatment for PH was analyzed as the only independent risk factor of prognosis. Conclusions Although the effects of lipid infusions in infants who have respiratory failure with PH is not evident, avoiding lipids is considered in infants who have evidence of increased pulmonary vascular resistance. Eighteen of 35 patients with CDH received lipid infusions and 11 of them received infusions above the dosage to prevent essential fatty acid deficiency; but not only time of lipid infusion but also the dosage did not affect the prognosis in our group of patients. doi:10.1016/j.earlhumdev.2008.09.051
In our opinion, the goal of better neurodevelopmental outcome, as measured by preventing high grade IVH, PVL and mortality, may not be reached with one treatment only. It must be a prolonged, team effort from all the NICU staff. Table 1 Incidence of intraventricular hemorrhage (grade III–IV), periventricular leukomalacia and mortality in the treatment and the control groups
Intraventricular hemorrhage (grade III–IV) Periventricular leukomalacia Mortality All (1 or 2 or 3)
Treatment group
Control group
P
4.2% 4.8% 10.3% 16.4%
5.3% 2.8% 9.6% 14.2%
0.146 0.307 0.900 0.550
doi:10.1016/j.earlhumdev.2008.09.052
Abstract UENPS.37 Postnatal growth failure and neurodevelopmental outcomes in VLBW infants Bogumila Stoinska⁎,a, Magdalena Kosinskaa, Janusz Gadzinowskia Chair and Department of Neonatology, Poznan University of Medical Sciences, Poland b Institute of Anthropology, Department of Human Biological Development, Poland
a
Background and aim Aim to examine growth attainment and the neurosensory status of children < 1500 g including AGA/SGA and compare their growth and neurodevelopmental outcomes. Materials and methods
Abstract UENPS.36 Platelets transfusion to prevent intraventricular hemorrhage, periventricular leukomalacia or death in very low birth weight infants Bernard Barzilay⁎, Rimona Keidar, David Batash, Eli Heyman Assaf Harofeh Medical Center, Zerifin, Israel Background and aim During the initial NICU hospitalization, high grade IVH and PVL as detected by routine cranial ultra-sound, carry a worse prognosis for neurodevelopment delay. The multifactorial etiology of intraventricular hemorrhage in very low birth weight infants may involve coagulation disturbances. By giving to VLBW infants platelet we tried to prevent IVH, PVL and mortality.
450 infants born at ?35 week of g.a. with BW500–1500 g without major congenital malformations, from JAN1999–DEC2003.Infants were admitted to the NICU a tertiary level hospital. The mean birth weight was 1097.3 g (Me = 920.0 g); mean g.a.27.0 weeks (Me = 26). The criterion for SGA was estimated using the birth weight below the 10 percentile with reference to the data for the Wielkopolska Region. The association between SGA/AGA and neurologic status at1and 2years corrected age were examined. Development was evaluated with use of the Bayley Scales of Infant Development (MDI/PDI). Results Considering the percentile position 104 (23%) of infants were born SGA. No statistical difference by gender. At 1 year BW below the 10 percentile increased to 47% and at 2 year to 55%.We observed that at 2 year of corrected age BW below the 10 percentile had 52% of AGA children at birth and 64% of SGA at birth.