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PP-115. Thoracic congenital ectopic right kidney with diaphragmatic hernia: A rare developmental anomaly
Abstracts
plasma-SOD, 560.95 +/− 52.52 vs. 704.76 +/− 24.59 U/g protein, p < 0.001; RBCs-GSHPx, 663.43 +/− 41.74 vs. 748.80 +/− 25.50 U/g Hb, p < 0.001; plasma-GSHPx, 98.26 +/− 15.67 vs. 131.80 +/− 8.73 U/ g protein, p < 0.001). RBCs-CAT levels were not different between groups (131.68 +/− 12.89 vs. 133.00 +/− 13.29 k/g Hb, p = 0.811). Late-ARMD patients had significantly lower antioxidant enzyme levels and higher MDA levels when compared with SAP (for each, p < 0.001). In addition, plasma NO and MDA levels were negatively correlated with SOD and GSHPx activities.
S63
follow-up, lung protective strategies such as noninvasive delivery room management, lower concentration of supplemental oxygen, noninvasive ventilatory strategies and efficient PDA management. doi:10.1016/j.earlhumdev.2010.09.167
PP-114. Management of congenital diaphragmatic hernia (CDH) during the last 10 years in a tertiary referral neonatal and surgical center
Conclusions This study demonstrated for the first time that NO, the most abundant free-radical in the body, might be implicated in the pathophysiology of SAP in association with decreased antioxidant enzymes and increased lipid peroxidation status.
Jakub Behrendta, Magdalena Kwiatkowska-Grucaa, Klaudia Dąbrowskab, Dorota Kuhnya, Anna Króla, Wojciech Korlackib, Urszula Godula-Stuglika a NICU Zabrze, Department of Pediatrics, Poland b Department of Pediatric Surgery Zabrze, Silesian Medical University, Poland Aim
doi:10.1016/j.earlhumdev.2010.09.166
PP-113. Few new BPD on the eastern front: Dominance of old BPD in a developing country during the last decade Ayse Korkmaz, Sadik Yurttutan, Sule Yigit, Murat Yurdakok, Gulsevin Tekinalp Hacettepe University Ihsan Dogramacı Children's Hospital Neonatology Unit, Ankara, Turkey Aim In developed countries, the classic or “old” BPD which has been described 43 years ago has been replaced mostly by “new BPD” with the introduction of widespread use of antenatal steroids, postnatal surfactant and less aggressive mechanical ventilation in preterm infants. However in developing countries this “transition” is not completed yet as the above mentioned prenatal and postnatal measures for reducing the risk of or treating RDS which is a major risk factor for BPD, are not widely applied. In this study we aimed to analyze the “spectrum” and characteristics of BPD in our NICU in the last 10 years. Materials and methods The study was conducted retrospectively covering the period 1999–2008. The frequency of old and new BPD were defined in two consecutive five year periods, 1999–2003 and 2004–2008 respectively. Preterm infants who were diagnosed as BPD were divided into two groups as “old BPD” and “new BPD” according to the presence of typical demographic, clinical and radiologic findings.
CDH is a severe defect that occurs sporadically with incidence of 1:2500 live birth, unknown pathogenesis and high mortality (30–50%). Survival is dependent on availability of prenatal diagnosis, resuscitation, modes of respiratory assistance, NO, ECMO and definitive surgical intervention in referral center. Aim. Assessment of treatment results of CDH in neonates according to the their gestational age, birth asphyxia and day of life in which diagnosis was stated. Materials and methods Within 10 years (2000–9) 20 (13 males and 7 females) newborns with mean GA 38.6 weeks (13 full-term and 7 prematures), all with perinatal risk factors, 4 with severe birth asphyxia (Apgar ≤ 3) were born with CDH; 3: R-CDH, 11: typical L-CDH, 4 — defect of posterior part of diaphragm, and 2 — absent of lip of posterior part of diaphragm. Results Prenatal diagnosis of CDH only in 1 case was stated; in other cases between the 1st and 4th days of life: in 6 in first referral neonatal unit, in 7 in NICU without surgery, and in 6 in NICU with surgical center. PPNH in 6 (3 died) were diagnosed. Surgical repair was made on the first day of life in 1 neonate, in 3 — on second, in 12 — on third and in 4 — on 4–5th days of life. Mechanical ventilation (mean 24 days), dopamine and total parenteral nutrition (mean 21 days) were necessary in all babies. Hypoplastic lung in 4 (3 died) neonates was diagnosed. Five neonates died, among them 2 prematures and 2 SGA, all with birth asphyxia and vaginally born. Total survival of 55%, neurodevelopment disorders of 15% (hydrocephalus 1 and BPD — 1), and postoperative relaxation of diaphragm of 1 baby were noted. Conclusions
Results A total of 100 preterm infants with BPD were included in the study and of these 69 (69.0%) were “old BPD” while 31 (31.0%) were “new BPD”. In 1999–2003 period the frequency of old BPD was 66.7%, and nearly no change was noted in 2004–2008 period (70%). Although the mean gestational ages and birth weights were similar in old and new BPD groups, the mean duration of mechanical ventilation and supplemental oxygen, the frequencies of aggressive resuscitation at birth, hypotension in the first 12 h of life, pneumonia and patent ductus arteriosus (PDA) were statistically higher in the “old BPD” group. Conclusions Old BPD has been a big problem in developing countries in the last decade. This was mainly due to less availability of appropriate prenatal
Birth asphyxia, LBW, and lung hypoplasia connected with delayed diagnosis of CDH are factors of bad prognosis in the management of CDH in neonates. doi:10.1016/j.earlhumdev.2010.09.168
PP-115. Thoracic congenital ectopic right kidney with diaphragmatic hernia: A rare developmental anomaly Sonia Nouri-merchaouia, Nebiha Mahdhaouia, Jihene Methlouthia, Rafia Zakhamaa, Moez Adouania, Abdellatif Nourib, Hassen Sebouia a Neonatology Department Farhat Hached Maternity, Tunisia b Pediatric Surgery Department- F Bourguiba Hospital, Tunisia
S64
Abstracts
Aim
Materials and methods
Ectopic kidney is a very rare developmental anomaly estimated to be seen in 1/1000 births. It is extremely rare to detect intrathoracic kidney in the neonatal period. We present a female infant admitted for mild respiratory distress at birth in relation with materno fetal infection (MFI) in whom a right posterior opacity on chest X-ray was diagnosed as intrathoracic kidney by sonography and chest CT scan.
Intratracheal LPS was given to 48 adult rats, which were divided into 3 groups, on day 0. On the same day, rats from groups 1 and 3 received intraperitoneal saline, whereas group 2 received immunoglobulin. 24 hours later saline was given to groups 1 and 2 and immunoglobulin to group 3. At the 48th hour, blood samples and brochoalveolar lavage (BAL) fluids were obtained from 8 rats from each group and then sacrificed for pathological evaluation. The same procedure was repeated on day 30 for the rest of the rats.
Case presentation Results A female infant born at a 38 week gestational age was admitted in our NICU at birth with mild respiratory distress. Pregnancy was uneventful. Prenatal ultrasonography showed no anomalies. The birth weight was 2200 g. The infant presented with tachypnea. O2 Sa was 98%. Both cardiac and pulmonary auscultations were normal. Physical examination was otherwise unremarkable. Initial laboratory tests were within normal ranges. Chest X-ray revealed an opacity at the base of right lung. Suspected diagnoses at this stage were either MFI with pulmonary localization or pulmonary malformation. Intravenous antibiotics were started. MFI was confirmed by positive CRP at 48 h. Tachypnea resolved after MFI treatment. Chest X-ray showed the same findings. On abdominal sonography the right kidney was located in right thoracic space. Chest CT scan revealed an ectopic right kidney without visible diaphragmatic interruption. A routine chest X-ray at 2 months showed the same findings associated to air blebs at the base of right lung. The infant underwent surgery. A posterior right diaphragmatic defect was noted. Right kidney was intimately adherent to hernial sac. The kidney was reduced into the abdominal cavity. Postoperative course was uneventful and renal function was normal.
Serum TGF-β1 levels showed no difference in all groups at any time points. BAL TGF-β1 levels of groups 2 and 3 on day 30, were lower compared to the levels of day 2 (p= 0.01, p = 0.01); and when BAL TGFβ1 levels were compared between the groups, BAL TGF-β1 levels of groups 2 and 3 were lower than the levels of group 1 on day 30 (p= 0.002, p = 0.001). Pathological examination revealed that the lung inflammation scores of groups 2 and 3 on day 30, were lower than the scores of day 2 (p= 0.02, p = 0.01) and inflammation scores of group 2 were lower than group 1 on day 30 (p= 0.02). Moderate fibrosis was seen in half of the rats from group 1 and one rat from group 2. Conclusions These data suggest that IVIG decreases lung inflammation scores by decreasing the levels of TGF-β1 and this therapy would give even better results if it is given earlier. doi:10.1016/j.earlhumdev.2010.09.170
Conclusion Intrathoracic ectopic kidney with protrusion above the level of diaphragm is the least common form of all ectopic kidneys found in less than 1 per 10 000 cases. This condition is rarely bilateral and occurs mostly on the left side with preponderance in males. It is asymptomatic in up to 90% of cases and most of them are discovered incidentally. Apart from very rare complications such as respiratory distress in newborns, ectopic kidney doesn't require any specific treatment unless it is associated to a diaphragmatic defect.
PP-117. Measurement of surfactant gene expression on bronchoalveolar lavage: A non-invasive assessment of lung maturity Donatella Pecaa, Chiara Marianib, Camilla Gizzib, Rocco Agostinob, Olivier Danhaivea a Bambino Gesù Children's Hospital, Italy b S. Giovanni Calibita - Fatebenefratelli Hospital, Italy Aim
doi:10.1016/j.earlhumdev.2010.09.169
PP-116. The effects of intravenous immunoglobulin on lipopolysaccharide induced lung inflammation Seyhan Erisir Oygucua, Irem Hicran Ozbudakb, Abdullah Barıs Akcana, Mesut Coskunc, Deniz Ozeld, Gulay Ozbilimb, Nihal Oygura a Akdeniz University School of Medicine, Department of Neonatology, Turkey b Akdeniz University School of Medicine, Department of Pathology, Turkey c Akdeniz University School of Medicine, Department of Immunology, Turkey d Akdeniz University School of Medicine, Department of Statistics, Turkey Aim Bronchopulmonary dysplasia is an important cause of morbidity in preterm infants and inflammation plays an important role in its pathogenesis. Intravenous immunoglobulin (IVIg) is currently used in a number of autoimmune and inflammatory diseases. In this study our purpose was to investigate the effects of IVIg on lipopolysaccharide (LPS) induced lung inflammation by determining TGF-β1 levels and histopathological changes.
Surfactant deficiency is a major cause of RDS and mortality in preterm infants. Surfactant synthesis, composition and function are difficult to assess in clinical settings. Our aim was to validate a semiquantitative measure of the expression of surfactant-related genes SFTP-B and ABCA3 on type II pneumocytes (TIIc) from bronchoalveolar lavage fluid (BALF). Materials and methods We collected BALF in intubated infants by deep tracheal suction after 1 cm3 saline instillation from 16 neonates with GA 24–40 weeks and isolated the cell pellet and supernatant fractions by centrifugation. Cell slides underwent cytology analysis and differential count after TIIc labelling with SP-B or ABCA3. SFTP-B and ABCA3 expression was measured by real-time RT-PCR on cell pellets in RNAlater buffer. In order to normalize RT-PCR results for variability of TIIc proportion in BALF cells, E-Cadherin, a TIIc-specific protein, was tested as alternative to the Actin housekeeping gene. Results E-Cadherin correlated significantly with the TIIc proportion in BALF pellet. Expression of ABCA3 gene was 10-fold higher in the 28–
plasma-SOD, 560.95 +/− 52.52 vs. 704.76 +/− 24.59 U/g protein, p < 0.001; RBCs-GSHPx, 663.43 +/− 41.74 vs. 748.80 +/− 25.50 U/g Hb, p < 0.001; plasma-GSHPx, 98.26 +/− 15.67 vs. 131.80 +/− 8.73 U/ g protein, p < 0.001). RBCs-CAT levels were not different between groups (131.68 +/− 12.89 vs. 133.00 +/− 13.29 k/g Hb, p = 0.811). Late-ARMD patients had significantly lower antioxidant enzyme levels and higher MDA levels when compared with SAP (for each, p < 0.001). In addition, plasma NO and MDA levels were negatively correlated with SOD and GSHPx activities.
S63
follow-up, lung protective strategies such as noninvasive delivery room management, lower concentration of supplemental oxygen, noninvasive ventilatory strategies and efficient PDA management. doi:10.1016/j.earlhumdev.2010.09.167
PP-114. Management of congenital diaphragmatic hernia (CDH) during the last 10 years in a tertiary referral neonatal and surgical center
Conclusions This study demonstrated for the first time that NO, the most abundant free-radical in the body, might be implicated in the pathophysiology of SAP in association with decreased antioxidant enzymes and increased lipid peroxidation status.
Jakub Behrendta, Magdalena Kwiatkowska-Grucaa, Klaudia Dąbrowskab, Dorota Kuhnya, Anna Króla, Wojciech Korlackib, Urszula Godula-Stuglika a NICU Zabrze, Department of Pediatrics, Poland b Department of Pediatric Surgery Zabrze, Silesian Medical University, Poland Aim
doi:10.1016/j.earlhumdev.2010.09.166
PP-113. Few new BPD on the eastern front: Dominance of old BPD in a developing country during the last decade Ayse Korkmaz, Sadik Yurttutan, Sule Yigit, Murat Yurdakok, Gulsevin Tekinalp Hacettepe University Ihsan Dogramacı Children's Hospital Neonatology Unit, Ankara, Turkey Aim In developed countries, the classic or “old” BPD which has been described 43 years ago has been replaced mostly by “new BPD” with the introduction of widespread use of antenatal steroids, postnatal surfactant and less aggressive mechanical ventilation in preterm infants. However in developing countries this “transition” is not completed yet as the above mentioned prenatal and postnatal measures for reducing the risk of or treating RDS which is a major risk factor for BPD, are not widely applied. In this study we aimed to analyze the “spectrum” and characteristics of BPD in our NICU in the last 10 years. Materials and methods The study was conducted retrospectively covering the period 1999–2008. The frequency of old and new BPD were defined in two consecutive five year periods, 1999–2003 and 2004–2008 respectively. Preterm infants who were diagnosed as BPD were divided into two groups as “old BPD” and “new BPD” according to the presence of typical demographic, clinical and radiologic findings.
CDH is a severe defect that occurs sporadically with incidence of 1:2500 live birth, unknown pathogenesis and high mortality (30–50%). Survival is dependent on availability of prenatal diagnosis, resuscitation, modes of respiratory assistance, NO, ECMO and definitive surgical intervention in referral center. Aim. Assessment of treatment results of CDH in neonates according to the their gestational age, birth asphyxia and day of life in which diagnosis was stated. Materials and methods Within 10 years (2000–9) 20 (13 males and 7 females) newborns with mean GA 38.6 weeks (13 full-term and 7 prematures), all with perinatal risk factors, 4 with severe birth asphyxia (Apgar ≤ 3) were born with CDH; 3: R-CDH, 11: typical L-CDH, 4 — defect of posterior part of diaphragm, and 2 — absent of lip of posterior part of diaphragm. Results Prenatal diagnosis of CDH only in 1 case was stated; in other cases between the 1st and 4th days of life: in 6 in first referral neonatal unit, in 7 in NICU without surgery, and in 6 in NICU with surgical center. PPNH in 6 (3 died) were diagnosed. Surgical repair was made on the first day of life in 1 neonate, in 3 — on second, in 12 — on third and in 4 — on 4–5th days of life. Mechanical ventilation (mean 24 days), dopamine and total parenteral nutrition (mean 21 days) were necessary in all babies. Hypoplastic lung in 4 (3 died) neonates was diagnosed. Five neonates died, among them 2 prematures and 2 SGA, all with birth asphyxia and vaginally born. Total survival of 55%, neurodevelopment disorders of 15% (hydrocephalus 1 and BPD — 1), and postoperative relaxation of diaphragm of 1 baby were noted. Conclusions
Results A total of 100 preterm infants with BPD were included in the study and of these 69 (69.0%) were “old BPD” while 31 (31.0%) were “new BPD”. In 1999–2003 period the frequency of old BPD was 66.7%, and nearly no change was noted in 2004–2008 period (70%). Although the mean gestational ages and birth weights were similar in old and new BPD groups, the mean duration of mechanical ventilation and supplemental oxygen, the frequencies of aggressive resuscitation at birth, hypotension in the first 12 h of life, pneumonia and patent ductus arteriosus (PDA) were statistically higher in the “old BPD” group. Conclusions Old BPD has been a big problem in developing countries in the last decade. This was mainly due to less availability of appropriate prenatal
Birth asphyxia, LBW, and lung hypoplasia connected with delayed diagnosis of CDH are factors of bad prognosis in the management of CDH in neonates. doi:10.1016/j.earlhumdev.2010.09.168
PP-115. Thoracic congenital ectopic right kidney with diaphragmatic hernia: A rare developmental anomaly Sonia Nouri-merchaouia, Nebiha Mahdhaouia, Jihene Methlouthia, Rafia Zakhamaa, Moez Adouania, Abdellatif Nourib, Hassen Sebouia a Neonatology Department Farhat Hached Maternity, Tunisia b Pediatric Surgery Department- F Bourguiba Hospital, Tunisia
S64
Abstracts
Aim
Materials and methods
Ectopic kidney is a very rare developmental anomaly estimated to be seen in 1/1000 births. It is extremely rare to detect intrathoracic kidney in the neonatal period. We present a female infant admitted for mild respiratory distress at birth in relation with materno fetal infection (MFI) in whom a right posterior opacity on chest X-ray was diagnosed as intrathoracic kidney by sonography and chest CT scan.
Intratracheal LPS was given to 48 adult rats, which were divided into 3 groups, on day 0. On the same day, rats from groups 1 and 3 received intraperitoneal saline, whereas group 2 received immunoglobulin. 24 hours later saline was given to groups 1 and 2 and immunoglobulin to group 3. At the 48th hour, blood samples and brochoalveolar lavage (BAL) fluids were obtained from 8 rats from each group and then sacrificed for pathological evaluation. The same procedure was repeated on day 30 for the rest of the rats.
Case presentation Results A female infant born at a 38 week gestational age was admitted in our NICU at birth with mild respiratory distress. Pregnancy was uneventful. Prenatal ultrasonography showed no anomalies. The birth weight was 2200 g. The infant presented with tachypnea. O2 Sa was 98%. Both cardiac and pulmonary auscultations were normal. Physical examination was otherwise unremarkable. Initial laboratory tests were within normal ranges. Chest X-ray revealed an opacity at the base of right lung. Suspected diagnoses at this stage were either MFI with pulmonary localization or pulmonary malformation. Intravenous antibiotics were started. MFI was confirmed by positive CRP at 48 h. Tachypnea resolved after MFI treatment. Chest X-ray showed the same findings. On abdominal sonography the right kidney was located in right thoracic space. Chest CT scan revealed an ectopic right kidney without visible diaphragmatic interruption. A routine chest X-ray at 2 months showed the same findings associated to air blebs at the base of right lung. The infant underwent surgery. A posterior right diaphragmatic defect was noted. Right kidney was intimately adherent to hernial sac. The kidney was reduced into the abdominal cavity. Postoperative course was uneventful and renal function was normal.
Serum TGF-β1 levels showed no difference in all groups at any time points. BAL TGF-β1 levels of groups 2 and 3 on day 30, were lower compared to the levels of day 2 (p= 0.01, p = 0.01); and when BAL TGFβ1 levels were compared between the groups, BAL TGF-β1 levels of groups 2 and 3 were lower than the levels of group 1 on day 30 (p= 0.002, p = 0.001). Pathological examination revealed that the lung inflammation scores of groups 2 and 3 on day 30, were lower than the scores of day 2 (p= 0.02, p = 0.01) and inflammation scores of group 2 were lower than group 1 on day 30 (p= 0.02). Moderate fibrosis was seen in half of the rats from group 1 and one rat from group 2. Conclusions These data suggest that IVIG decreases lung inflammation scores by decreasing the levels of TGF-β1 and this therapy would give even better results if it is given earlier. doi:10.1016/j.earlhumdev.2010.09.170
Conclusion Intrathoracic ectopic kidney with protrusion above the level of diaphragm is the least common form of all ectopic kidneys found in less than 1 per 10 000 cases. This condition is rarely bilateral and occurs mostly on the left side with preponderance in males. It is asymptomatic in up to 90% of cases and most of them are discovered incidentally. Apart from very rare complications such as respiratory distress in newborns, ectopic kidney doesn't require any specific treatment unless it is associated to a diaphragmatic defect.
PP-117. Measurement of surfactant gene expression on bronchoalveolar lavage: A non-invasive assessment of lung maturity Donatella Pecaa, Chiara Marianib, Camilla Gizzib, Rocco Agostinob, Olivier Danhaivea a Bambino Gesù Children's Hospital, Italy b S. Giovanni Calibita - Fatebenefratelli Hospital, Italy Aim
doi:10.1016/j.earlhumdev.2010.09.169
PP-116. The effects of intravenous immunoglobulin on lipopolysaccharide induced lung inflammation Seyhan Erisir Oygucua, Irem Hicran Ozbudakb, Abdullah Barıs Akcana, Mesut Coskunc, Deniz Ozeld, Gulay Ozbilimb, Nihal Oygura a Akdeniz University School of Medicine, Department of Neonatology, Turkey b Akdeniz University School of Medicine, Department of Pathology, Turkey c Akdeniz University School of Medicine, Department of Immunology, Turkey d Akdeniz University School of Medicine, Department of Statistics, Turkey Aim Bronchopulmonary dysplasia is an important cause of morbidity in preterm infants and inflammation plays an important role in its pathogenesis. Intravenous immunoglobulin (IVIg) is currently used in a number of autoimmune and inflammatory diseases. In this study our purpose was to investigate the effects of IVIg on lipopolysaccharide (LPS) induced lung inflammation by determining TGF-β1 levels and histopathological changes.
Surfactant deficiency is a major cause of RDS and mortality in preterm infants. Surfactant synthesis, composition and function are difficult to assess in clinical settings. Our aim was to validate a semiquantitative measure of the expression of surfactant-related genes SFTP-B and ABCA3 on type II pneumocytes (TIIc) from bronchoalveolar lavage fluid (BALF). Materials and methods We collected BALF in intubated infants by deep tracheal suction after 1 cm3 saline instillation from 16 neonates with GA 24–40 weeks and isolated the cell pellet and supernatant fractions by centrifugation. Cell slides underwent cytology analysis and differential count after TIIc labelling with SP-B or ABCA3. SFTP-B and ABCA3 expression was measured by real-time RT-PCR on cell pellets in RNAlater buffer. In order to normalize RT-PCR results for variability of TIIc proportion in BALF cells, E-Cadherin, a TIIc-specific protein, was tested as alternative to the Actin housekeeping gene. Results E-Cadherin correlated significantly with the TIIc proportion in BALF pellet. Expression of ABCA3 gene was 10-fold higher in the 28–