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PP-100. The effect of the neonatal resuscitation program courses on the long-term neurodevelopmental outcome of newborn infants with perinatal asphyxia
Abstracts
Conclusions A dramatic improvement is noted with each two weeks of maturity. This information can be helpful when discussing management and prognosis of twins.
S57
PP-99. Relationship between oxygen saturation and umbilical cord pH immediately after birth Sinan Uslu, Ali Bulbul, Emrah Can, Umut Zubarioglu, Asiye Nuhoglu Sisli Etfal Children's Hospital, Turkey Aim
doi:10.1016/j.earlhumdev.2010.09.150
PP-98. The impact of corticosteroid treatment standard modification on prevalence and type of BPD in infants born before 29 gestational age (GA) Martyna Woynarowska, Magdalena Rutkowska Institute of Mother and Child, Neonatal Intensive Care Unit, Warsaw, Poland Aim Possible negative impact of postnatal corticosteroids on premature CNS development led to limitation of their use, decrease in dosage and shortening of BPD treatment. The aim of the study was to assess the influence of corticosteroid treatment standard modification in infants born < 29 GA on prevalence and form of BPD.
The recommendations of oxygen use in the delivery room are limited to clinical findings (respiratory effort, heart rate, and color) for newborns. Some clinicians reflect the pulse oximetry to be a vital sign and, umbilical cord arterial pH value is put forward as valuable in directing the neonatal resuscitation. The aim of this study is to determine the relationship between oxygen saturation levels and umbilical cord pH values in healthy newborns in the first 15 min of life in delivery room. Materials and methods The study was performed with healthy term, appropriate for gestational age newly born infants. Umbilical artery blood sample was collected and pulse oximetry sensors were placed to pre- and post-ductal region for oxygen saturation measurements. All data were recorded on to computer data forms. Infants have been divided in 2 groups as; babies' umbilical cord arterial blood pH value ≤7.19 (group 1) and > 7.19 (group 2), and SpO2 levels in first 15 min of life have been compared between groups. Results
Materials and methods We retrospectively analyzed medical records of infants born before 29 GA and treated between 1999 and 2004. All children who survived until 36 PCA were checked for BPD diagnosis. Children were divided according to the median of total dose of corticosteroids into groups: D0—no corticosteroids, DL—low dose and DH—high dose. Periods ≤ 2001 and ≥ 2002 were compared for corticosteroid treatment and BPD characteristics.
One hundred twenty nine neonates were analyzed in the study (33 babies in group 1 and 96 babies in group 2). A significant correlation was found between first measured pre-ductal and post-ductal SpO2 levels by pulse oximetry, and umbilical artery blood pH values ([r2: 0.72 (0.62– 0.79); p < 0.0001] and [r2: 0.32 (0.25–0.54); p < 0.0001] respectively). In group 1, infants had lower SpO2 levels at both pre-ductal and postductal measurements, in the first 11 min and time to reach ≥90% SpO2 level took longer time, in comparison to infants in group 2.
Results
Conclusions
166 infants were included (82 infants born ≤ 2001 and 84 ≥ 2002). Perinatal and postnatal factors did not differ in both periods. Group D0 consisted of 88 infants. The remaining 78 patients received 123 corticosteroid courses with total dexamethasone dose 0.16–12.55 mg (median 1.8 mg). DL group (1.09 ± 0.52 mg) consisted of 40 infants and DH group (4.85 ± 3.02 mg) 38 infants. In the period of ≤2001 average total dose of corticosteroids was two times higher than in the period ≥2002 (3.99 vs 1.67 mg, p < 0.001). D0 group in both periods was similar (49% vs 57%), but the ratio of infants in group DL and DH changed from 12%:38% in the period ≤2001 to 35%:8% in the period ≥2002 (p = 0.001). BPD was diagnosed in 126 infants: 84 (51%) mild, 19 (11%) moderate and 23 (14%) severe. No significant differences were noted in the prevalence of BPD (72% vs 76%) or its forms in both periods.
Umbilical artery blood pH values may predict the oxygen saturation level of the newly borns immediately after birth. Determination of umbilical arterial blood pH values in addition to clinical findings and oxygen saturation measurements, might be helpful to decide to give in oxygen concentration and to continue oxygen supplementation to newborn in delivery room. Further studies (in prematures, resuscitated and hypoxic newborns) are needed to confirm this assumptions. doi:10.1016/j.earlhumdev.2010.09.153
Conclusions
PP-100. The effect of the neonatal resuscitation program courses on the long-term neurodevelopmental outcome of newborn infants with perinatal asphyxia
1. Corticosteroid dose used ≥ 2002 significantly decreased, without an increase of BPD prevalence or severity. 2. The data suggest that decreasing the corticosteroid dose is safe and may be justified.
Ridvan Durana, Işık Görkerb, Yasemin Küçükuğurluoğlua, Nukhet Aladag Ciftdemira, Ulfet Vatansever Ozbeka, Betul Acunasa a Trakya University Faculty of Medicine, Department of Pediatrics, Turkey b Department of Pediatric Psychiatry, Turkey Aim
doi:10.1016/j.earlhumdev.2010.09.152
Neonatal resuscitation provided within the first few minutes of life plays a major role in the reduction of neonatal morbidity and mortality of
S58
Abstracts
rats. Although a few studies have shown that NRP courses reduce morbidity and mortality rates of the newborn infants with perinatal asphyxia, there has been no evidence to demonstrate the effect of NRP on long-term outcomes of perinatal asphyxia. The aim of this study was to determine the effect of the NRP courses on the long-term neurodevelopmental outcome of newborn infants with perinatal asphyxia. Materials and methods This prospective study included infants with perinatal asphyxia referred to our Neonatal Unit since 2003. Those patients who were referred before NRP courses (pretraining period) were designated as Group 1, those who were referred after the first NRP course (transition period) as Group 2, and those who were referred after the second NRP course (posttraining period) as Group 3. Neurodevelopmental outcomes of the surviving infants were assessed and compared at 4–6 years of age. Results The study comprised 40 patients; 23 in Group 1, 9 in Group 2 and 8 in Group 3. The number of cases who had been diagnosed as cerebral palsy was 13 in Group 1, 2 in Group 2, and 1 in Group 3 which decreased significantly. While 4 cases died in Group 1, there was no death in Groups 2 and 3 after the neonatal period. The number of cases with seizures and EEG abnormality was 12 and 14 in Group 1, 3 and 2 in Group 2, and 1 and 1 in Group 3 respectively which also decreased significantly.
recurrent bronchoconstriction. Others have found that a prevention strategy of RSV infection with the monoclonal antibody palivizumab may not only protect against acute disease but may also prevent recurrent wheezing episodes in later life. The risk of developing pulmonary sequelae after RSV bronchiolitis also depends on the magnitude of the specific IgE response. Airway remodeling during and after bronchiolitis seems to play an integral part in the development of pulmonary disease and eventually may cause restrictive lung disease. Conclusions The majority of studies show an association between early severe RSV disease and asthma during childhood and adolescence. However, the study results also reflect the multifactorial risk profile for the development of asthma. How RSV infection affects long-term pulmonary function in patients with asthma is still controversial. This may include interference of viral infection with the development of the lungs in early infancy as well as a genetic predisposition or various environmental pollutants. doi:10.1016/j.earlhumdev.2010.09.155
PP-102. The role of NT-proBNP in the pathogenesis of transient tachypnea of newborn
Conclusions
Semra Kara, Alparslan Tonbul, Müsemma Karabel, Halise Akca, Nurdan Uras, M. Mansur Tatlı Fatih University Medical Faculty NICU, Turkey
NRP courses have positive effects on long-term neurodevelopmental outcomes of infants with perinatal asphyxia. Further studies are required for longer-term effect of NRP courses.
Aim
doi:10.1016/j.earlhumdev.2010.09.154
PP-101. Pulmonary sequelae of neonatal respiratory syncytial virus (RSV) infection Torsten Uhlig Klinik für Kinder- und Jugendmedizin, Romed Klinikum Rosenheim, Germany Aim There is increasing evidence for the correlation between respiratory syncytial virus (RSV) infection within the neonatal period or early infancy and the subsequent development of bronchial hyperresponsiveness and recurrent wheezing episodes. The abnormalities in lung function and clinical symptoms may persist during the following decades of life. Thus, RSV infection puts a substantial burden especially on the most vulnerable patients as premature infants. However, it is still controversial if RSV disease may cause asthma.
Transient tachypnea of the newborn (TTN) also known as wet lung disease, is a common cause of respiratory distress in the newborn. Although TTN is usually benign and self-limited, it sometimes causes some complications like mechanical ventilation requirement. Its exact etiology and pathogenesis still remain obscure. Brain natriuretic peptide (BNP) plays a major role in electrolyte and volume homeostasis through potent biological effects including natriuresis, diuresis, and vasorelaxation. Some studies showed that in type II alveolar epithelial cells of rat lung expressed natriuretic peptide receptors and atrial natriuretic peptide (ANP) decrease the amiloride sensitive Na+ transport in the lungs and inhibit Na+ reabsorption like in renal tubules with these receptors. BNP acts these receptors also and may play a role in absorption of lung fluid. In this study, we aimed to investigate the role of NT-proBNP in the pathogenesis of TTN. Materials and methods The serum NT-proBNP concentrations of 43 newborns diagnosed as TTN were studied and compared with 29 healthy controls. The gestational ages of two groups were similar (TTN group: 35.7 ± 1.7; control group: 35.7 ± 0.8). Results
Materials and methods This review summarizes the currently available experimental and clinical studies and focuses on the relationship between RSV infection, airway remodeling and atopy.
The serum NT-proBNP concentrations were 6.7 ng/ml (1.3–21.0) and 7.5 ng/ml (2.7–21.0) in TTN and control groups in respectively. There was no significant difference between the groups for NTproBNP level.
Results
Conclusions
Various recent studies have clearly demonstrated that a substantial proportion of neonates and infants with severe disease show signs of
In this study, we could not demonstrate any role of NT-proBNP in the pathogenesis of TTN although we believe that further studies
Conclusions A dramatic improvement is noted with each two weeks of maturity. This information can be helpful when discussing management and prognosis of twins.
S57
PP-99. Relationship between oxygen saturation and umbilical cord pH immediately after birth Sinan Uslu, Ali Bulbul, Emrah Can, Umut Zubarioglu, Asiye Nuhoglu Sisli Etfal Children's Hospital, Turkey Aim
doi:10.1016/j.earlhumdev.2010.09.150
PP-98. The impact of corticosteroid treatment standard modification on prevalence and type of BPD in infants born before 29 gestational age (GA) Martyna Woynarowska, Magdalena Rutkowska Institute of Mother and Child, Neonatal Intensive Care Unit, Warsaw, Poland Aim Possible negative impact of postnatal corticosteroids on premature CNS development led to limitation of their use, decrease in dosage and shortening of BPD treatment. The aim of the study was to assess the influence of corticosteroid treatment standard modification in infants born < 29 GA on prevalence and form of BPD.
The recommendations of oxygen use in the delivery room are limited to clinical findings (respiratory effort, heart rate, and color) for newborns. Some clinicians reflect the pulse oximetry to be a vital sign and, umbilical cord arterial pH value is put forward as valuable in directing the neonatal resuscitation. The aim of this study is to determine the relationship between oxygen saturation levels and umbilical cord pH values in healthy newborns in the first 15 min of life in delivery room. Materials and methods The study was performed with healthy term, appropriate for gestational age newly born infants. Umbilical artery blood sample was collected and pulse oximetry sensors were placed to pre- and post-ductal region for oxygen saturation measurements. All data were recorded on to computer data forms. Infants have been divided in 2 groups as; babies' umbilical cord arterial blood pH value ≤7.19 (group 1) and > 7.19 (group 2), and SpO2 levels in first 15 min of life have been compared between groups. Results
Materials and methods We retrospectively analyzed medical records of infants born before 29 GA and treated between 1999 and 2004. All children who survived until 36 PCA were checked for BPD diagnosis. Children were divided according to the median of total dose of corticosteroids into groups: D0—no corticosteroids, DL—low dose and DH—high dose. Periods ≤ 2001 and ≥ 2002 were compared for corticosteroid treatment and BPD characteristics.
One hundred twenty nine neonates were analyzed in the study (33 babies in group 1 and 96 babies in group 2). A significant correlation was found between first measured pre-ductal and post-ductal SpO2 levels by pulse oximetry, and umbilical artery blood pH values ([r2: 0.72 (0.62– 0.79); p < 0.0001] and [r2: 0.32 (0.25–0.54); p < 0.0001] respectively). In group 1, infants had lower SpO2 levels at both pre-ductal and postductal measurements, in the first 11 min and time to reach ≥90% SpO2 level took longer time, in comparison to infants in group 2.
Results
Conclusions
166 infants were included (82 infants born ≤ 2001 and 84 ≥ 2002). Perinatal and postnatal factors did not differ in both periods. Group D0 consisted of 88 infants. The remaining 78 patients received 123 corticosteroid courses with total dexamethasone dose 0.16–12.55 mg (median 1.8 mg). DL group (1.09 ± 0.52 mg) consisted of 40 infants and DH group (4.85 ± 3.02 mg) 38 infants. In the period of ≤2001 average total dose of corticosteroids was two times higher than in the period ≥2002 (3.99 vs 1.67 mg, p < 0.001). D0 group in both periods was similar (49% vs 57%), but the ratio of infants in group DL and DH changed from 12%:38% in the period ≤2001 to 35%:8% in the period ≥2002 (p = 0.001). BPD was diagnosed in 126 infants: 84 (51%) mild, 19 (11%) moderate and 23 (14%) severe. No significant differences were noted in the prevalence of BPD (72% vs 76%) or its forms in both periods.
Umbilical artery blood pH values may predict the oxygen saturation level of the newly borns immediately after birth. Determination of umbilical arterial blood pH values in addition to clinical findings and oxygen saturation measurements, might be helpful to decide to give in oxygen concentration and to continue oxygen supplementation to newborn in delivery room. Further studies (in prematures, resuscitated and hypoxic newborns) are needed to confirm this assumptions. doi:10.1016/j.earlhumdev.2010.09.153
Conclusions
PP-100. The effect of the neonatal resuscitation program courses on the long-term neurodevelopmental outcome of newborn infants with perinatal asphyxia
1. Corticosteroid dose used ≥ 2002 significantly decreased, without an increase of BPD prevalence or severity. 2. The data suggest that decreasing the corticosteroid dose is safe and may be justified.
Ridvan Durana, Işık Görkerb, Yasemin Küçükuğurluoğlua, Nukhet Aladag Ciftdemira, Ulfet Vatansever Ozbeka, Betul Acunasa a Trakya University Faculty of Medicine, Department of Pediatrics, Turkey b Department of Pediatric Psychiatry, Turkey Aim
doi:10.1016/j.earlhumdev.2010.09.152
Neonatal resuscitation provided within the first few minutes of life plays a major role in the reduction of neonatal morbidity and mortality of
S58
Abstracts
rats. Although a few studies have shown that NRP courses reduce morbidity and mortality rates of the newborn infants with perinatal asphyxia, there has been no evidence to demonstrate the effect of NRP on long-term outcomes of perinatal asphyxia. The aim of this study was to determine the effect of the NRP courses on the long-term neurodevelopmental outcome of newborn infants with perinatal asphyxia. Materials and methods This prospective study included infants with perinatal asphyxia referred to our Neonatal Unit since 2003. Those patients who were referred before NRP courses (pretraining period) were designated as Group 1, those who were referred after the first NRP course (transition period) as Group 2, and those who were referred after the second NRP course (posttraining period) as Group 3. Neurodevelopmental outcomes of the surviving infants were assessed and compared at 4–6 years of age. Results The study comprised 40 patients; 23 in Group 1, 9 in Group 2 and 8 in Group 3. The number of cases who had been diagnosed as cerebral palsy was 13 in Group 1, 2 in Group 2, and 1 in Group 3 which decreased significantly. While 4 cases died in Group 1, there was no death in Groups 2 and 3 after the neonatal period. The number of cases with seizures and EEG abnormality was 12 and 14 in Group 1, 3 and 2 in Group 2, and 1 and 1 in Group 3 respectively which also decreased significantly.
recurrent bronchoconstriction. Others have found that a prevention strategy of RSV infection with the monoclonal antibody palivizumab may not only protect against acute disease but may also prevent recurrent wheezing episodes in later life. The risk of developing pulmonary sequelae after RSV bronchiolitis also depends on the magnitude of the specific IgE response. Airway remodeling during and after bronchiolitis seems to play an integral part in the development of pulmonary disease and eventually may cause restrictive lung disease. Conclusions The majority of studies show an association between early severe RSV disease and asthma during childhood and adolescence. However, the study results also reflect the multifactorial risk profile for the development of asthma. How RSV infection affects long-term pulmonary function in patients with asthma is still controversial. This may include interference of viral infection with the development of the lungs in early infancy as well as a genetic predisposition or various environmental pollutants. doi:10.1016/j.earlhumdev.2010.09.155
PP-102. The role of NT-proBNP in the pathogenesis of transient tachypnea of newborn
Conclusions
Semra Kara, Alparslan Tonbul, Müsemma Karabel, Halise Akca, Nurdan Uras, M. Mansur Tatlı Fatih University Medical Faculty NICU, Turkey
NRP courses have positive effects on long-term neurodevelopmental outcomes of infants with perinatal asphyxia. Further studies are required for longer-term effect of NRP courses.
Aim
doi:10.1016/j.earlhumdev.2010.09.154
PP-101. Pulmonary sequelae of neonatal respiratory syncytial virus (RSV) infection Torsten Uhlig Klinik für Kinder- und Jugendmedizin, Romed Klinikum Rosenheim, Germany Aim There is increasing evidence for the correlation between respiratory syncytial virus (RSV) infection within the neonatal period or early infancy and the subsequent development of bronchial hyperresponsiveness and recurrent wheezing episodes. The abnormalities in lung function and clinical symptoms may persist during the following decades of life. Thus, RSV infection puts a substantial burden especially on the most vulnerable patients as premature infants. However, it is still controversial if RSV disease may cause asthma.
Transient tachypnea of the newborn (TTN) also known as wet lung disease, is a common cause of respiratory distress in the newborn. Although TTN is usually benign and self-limited, it sometimes causes some complications like mechanical ventilation requirement. Its exact etiology and pathogenesis still remain obscure. Brain natriuretic peptide (BNP) plays a major role in electrolyte and volume homeostasis through potent biological effects including natriuresis, diuresis, and vasorelaxation. Some studies showed that in type II alveolar epithelial cells of rat lung expressed natriuretic peptide receptors and atrial natriuretic peptide (ANP) decrease the amiloride sensitive Na+ transport in the lungs and inhibit Na+ reabsorption like in renal tubules with these receptors. BNP acts these receptors also and may play a role in absorption of lung fluid. In this study, we aimed to investigate the role of NT-proBNP in the pathogenesis of TTN. Materials and methods The serum NT-proBNP concentrations of 43 newborns diagnosed as TTN were studied and compared with 29 healthy controls. The gestational ages of two groups were similar (TTN group: 35.7 ± 1.7; control group: 35.7 ± 0.8). Results
Materials and methods This review summarizes the currently available experimental and clinical studies and focuses on the relationship between RSV infection, airway remodeling and atopy.
The serum NT-proBNP concentrations were 6.7 ng/ml (1.3–21.0) and 7.5 ng/ml (2.7–21.0) in TTN and control groups in respectively. There was no significant difference between the groups for NTproBNP level.
Results
Conclusions
Various recent studies have clearly demonstrated that a substantial proportion of neonates and infants with severe disease show signs of
In this study, we could not demonstrate any role of NT-proBNP in the pathogenesis of TTN although we believe that further studies