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PP-125. Early high-frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation in very low birth weight infants with omphalocele
Abstracts
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tidal volume no more than 4–6 ml/kg, PEEP (5 mm H2O) and breathing frequency 30–35 per minute.
PP-124. Thoracoamniotic shunt placement in fetal pleural effusions and neonatal outcome
Conclusions
Atalay Demirela, Asuman Cobana, Sukru Cekica, Zeynep Incea, Ibrahim Kalelioglub, Recep Hasb, Sükran Yıldırıma, Gulay Cana a Istanbul University, Istanbul Medical Faculty, Department of Pediatrics, Division of Neonatology, Turkey b Department of Obstetrics and Gynecology, Turkey
We squared neonate's lungs perioperatively optimizing oxygenation without using big respiratory volumes but by the way of recruitment maneuver.
Aim
doi:10.1016/j.earlhumdev.2010.09.176
To review our cases with antenatal thoracoamniotic shunt placement and neonatal outcome. PP-123. Infants' mechanical ventilation approach by means of lungs' mechanical characteristics variability analyses during surgical correction of viscera-abdominal disproportion a
b
b
Oleksandr Nazarchuk , Dmytro Dmytriiev , Konstantin Bertsun a Khmelnytskyi City Children's Hospital, Ukraine b Vinnitsa National Medical University, Ukraine
Materials and methods We examined retrospectively eight patients who had thoracoamniotic shunt placement for antenatal pleural effusion between 2007 and 2009. Results
Aim Objectives were the optimization of mechanical ventilation approach of newborns with gastroschisis and omphalocele in perioperative period by the way of studying their lung mechanical characteristics. Materials and methods In our research, 57 newborns were enrolled, 42 neonates (73.7%) had gastroschisis and 15 ones (26.3%) — omphalocele. This study was conducted during all steps of visceroabdominal disproportion surgical correction (by the way of multivectorial gradual distraction of all abdominal wall layers). We used volume control ventilation with PEEP — 5 mm H2O, PIP — 12–22 mm H2O breath frequency 30–35 per minute. Monitoring of dynamic compliance, pressure–volume loop, flow–volume loop, and capnography was essential.
Out of eight patients (4 male, 4 female) 3 were term, 5 were preterm; 5 babies were born by cesarean section. Polyhydramnios was seen in 5 cases. Three neonates needed intubation in the delivery room. Skin edema was the second most frequent finding. Six babies were hydropic. The etiologic diagnoses were: primary pulmonary effusion (1), congenital adenomatoid malformation (1), and non-immune hydrops fetalis (6). Five patients had unilateral, three patients had bilateral shunt placement. The time interval between shunt insertion and birth was between 1 day and 9 weeks. The external open site of the shunts was clamped after birth and replaced with a thoracic drainage tube postnatally. Two shunt complications were seen: 1. Displacement of the shunt into the thoracic cavity which was removed by thoracoscopy and 2. Displacement of the shunt into the amniotic fluid. This patient had four shunts inserted in which one of them was displaced. All but one of the babies needed mechanical ventilation. Two patients (%25) died in the first hours of life. Conclusions
Results Data are presented for both groups similar by sex-dimorphism, gestation terms, and middle age. We increased compliance, minute volume, decreased the lung resistance and medium airway pressure during stable preoperative period. The period of abdominal organs' plunging inside the abdominal cavity showed a progressive compliance decreasing (in 3.4 times), resistance (in 2.42 times) and medium airway pressure (till 14 cm H2O) increasing in both neonate groups. The reversion of lungs' mechanical characteristics to the very beginning could be achieved by the end of 72-d hour of distraction, by the way of protective volume-control ventilation (maximum volume 4–6 ml/kg with obligatory usage of PEEP not less than 5 mm H2O). Conclusions Recruitment maneuver and lung volume support by means of PEEP were easily implemented. We consider it may reduce frequency of ventilator associated lungs' injury, optimize insufflation of air– oxygen mixture in the lungs of babies who have viscera-abdominal disproportion.
doi:10.1016/j.earlhumdev.2010.09.177
Pulmonary hypoplasia secondary to pleural effusion may lead to significant morbidity and mortality. Only 25% of our patients died. Antenatal thoracoamniotic shunt placement is a very useful therapeutic option in the prevention of pulmonary hypoplasia but the possibility of complications of the procedure must be kept in mind. doi:10.1016/j.earlhumdev.2010.09.178
PP-125. Early high-frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation in very low birth weight infants with omphalocele Oleksandr Nazarchuka, Konstantin Bertsunb, Dmytro Dmytriievb, Yriy Palamarchukb, Oleksandr Katilovb a Khmelnytskyi City Children's Hospital, Ukraine b Vinnitsa National Medical University, Ukraine Aim To evaluate the feasibility of conducting prospective randomized trial comparing early high-frequency oscillatory ventilation (HFOV) to synchronized intermittent mandatory ventilation (SIMV) in very low birth weight (VLBW) premature infants with omphalocele.
S68
Abstracts
Materials and methods 15 infants weighing 501 to 1000 g, less than 4 h of age, who had received one dose of surfactant and required ventilation with mean airway pressure > 4–6 cm H2O and FiO2 > 0.25, and had an anticipated duration of ventilation greater than 48 h. Newborns were stratified by birth weight and prenatal steroid status, and then randomized to either HFOV or SIMV with tidal volume monitoring. Ventilator management for patients in both study arms was strictly governed by protocols that included optimizing lung inflation and blood gases, weaning strategies and extubation criteria. Results Data are presented for 7 HFOV and 8 SIMV infants (two infants, twins, were withdrawn from the study at parent's request). 7 of the 7 HFOV infants and 7 of the 8 SIMV infants survived to 36 weeks corrected age. Age at final extubation for survivors was 6.2 ± 2.3 (mean ± SD) days for HFOV infants and 8.4 ± 2.1 days for SIMV infants. At 36 weeks corrected age, 7 of the 7 HFOV survivors were extubated and in room air, whereas 1 required supplemental oxygen. In comparison, 4 of the 8 SIMV survivors were extubated and in room air, whereas 4 required supplemental oxygen. Grade III/IVIVH and/or periventricular leukomalacia occurred in 1 HFOV and 4 SIMV patients. Conclusions The protocols for the early HFOV versus SIMV in VLBW infants ventilator management, both with HFOV and with SIMV were easily implemented and consistently followed, and data are presented here. doi:10.1016/j.earlhumdev.2010.09.179
PP-126. Efficacy of nasal flow-synchronized intermittent positive pressure ventilation (NFSIPPV) in treating apnea of prematurity (AOP): Preliminary results Camilla Gizzia, Chiara Castellanoa, Valentina Panettab, Chiara Mariania, Paola Papoffc, Corrado Morettic, Rocco Agostinoa a NICU, Fatebenefratelli Hospital, Isola Tiberina, Italy b Sesmıt, Afar, Fatebenefratelli Hospital, Isola Tiberina, Italy c Pediatric Icu, “Sapienza” University of Rome, Italy Aim AOP is a common problem of prematurity that represents a possible risk towards damage of the developing brain. Our aim was to assess the effect of three modes of nasal ventilation on the frequency and extent of apnea and bradycardia in preterm infants. Materials and methods Infants of <34 weeks gestation, in stable conditions and receiving caffeine, who were treated by Nasal Continuous Positive Airway Pressure (NCPAP) for AOP were enrolled in a randomized crossover study. During the study NCPAP, Nasal Intermittent Positive Pressure Ventilation (NIPPV, respiratory rate 20 bpm) and NFSIPPV (A/C mode) were applied in random order for 6 h each. Nasal ventilation was delivered by “Giulia” neonatal ventilator (Ginevri, Italy). Respiratory impedance, heart rate (HR), O2 saturation (SpO2), transcutaneous O2 and CO2, flow and airway pressure were simultaneously recorded through the study (Monitor Infinity Delta XL, Draeger, Germany). Apnea was defined as the absence of respiratory efforts for >20 s, or <20 s when associated with bradycardia (<100 bpm) or hypoxemia (SpO2 <85%).
Respiratory pauses >4 s not associated with bradycardia or hypoxemia were also considered. The frequency (number/h) and the extent of apnea, bradycardia and respiratory pauses >4 s were documented as well as SpO2, HR and transcutaneous blood gas values during the apneic episodes. Results To date 5 infants were enrolled (GA 27 ± 1.5 weeks, birth weight 920 ± 246 g). The median apneic spell rates during NCPAP, NIPPV and NFSIPPV were 2.3, 2.1 and 0.8 per hour respectively (p = 0.046). The longest apnea episodes were 26 ± 8, 20 ± 4 and 18 ± 12 s respectively (p = 0.042). The median frequencies of the respiratory pauses >4 s per hour were 15.4, 9.6 and 10.2 respectively (p = 0.0342). No significant differences were observed among the other parameters considered. Conclusions NFSIPPV may be more effective in treating AOP than NCPAP and NIPPV in preterm infants. Moreover both NIPPV and NFSIPPV may stimulate the respiratory drive by reducing the respiratory pauses >4 s. Support: grants from Chiesi Pharmaceuticals and Fatebenefratelli Association for Research. doi:10.1016/j.earlhumdev.2010.09.180
PP-127. Determination of serum mannan-binding lectin (MBL) levels and frequency of MBL gene polymorphism in cases with neonatal sepsis Hilal Ozkana, Nilgün Koksala, Merih Cetinkayaa, Sebnem Kılıcb, Solmaz Celebid, Barbaros Oralc, Ferah Budakc a Uludag University, Faculty of Medicine, Department of Neonatology, Turkey b Department of Pediatric Immunology, Turkey c Department of Immunology, Turkey d Department of Pediatric Infectious Disease, Turkey Aim Mannan-binding lectin (MBL) is a plasma protein that plays an important role in the innate immune response and circulating MBL concentrations are associated with the genetic variations in the structural and promoter regions. The aim of this study was to determine the serum MBL levels and the frequency of MBL gene polymorphism in infants with neonatal sepsis. Materials and methods Between January 2005 and January 2007, a total of 93 infants were included in this study and 53 of them had neonatal sepsis diagnosis as study group and 40 infants who had no sepsis according to clinical and laboratory findings as control group. Serum MBL levels and MBL gene polymorphisms of these infants were studied. Results Serum MBL levels were found to be low in 17 of 93 infants that were included in the study. Eleven of them were in the sepsis group and 6 of them were in the control group (p < 0.05). Serum MBL levels were significantly lower in infants with sepsis compared with the control group. In the study group, the mean serum MBL levels were found to be significantly lower in the premature infants compared
S67
tidal volume no more than 4–6 ml/kg, PEEP (5 mm H2O) and breathing frequency 30–35 per minute.
PP-124. Thoracoamniotic shunt placement in fetal pleural effusions and neonatal outcome
Conclusions
Atalay Demirela, Asuman Cobana, Sukru Cekica, Zeynep Incea, Ibrahim Kalelioglub, Recep Hasb, Sükran Yıldırıma, Gulay Cana a Istanbul University, Istanbul Medical Faculty, Department of Pediatrics, Division of Neonatology, Turkey b Department of Obstetrics and Gynecology, Turkey
We squared neonate's lungs perioperatively optimizing oxygenation without using big respiratory volumes but by the way of recruitment maneuver.
Aim
doi:10.1016/j.earlhumdev.2010.09.176
To review our cases with antenatal thoracoamniotic shunt placement and neonatal outcome. PP-123. Infants' mechanical ventilation approach by means of lungs' mechanical characteristics variability analyses during surgical correction of viscera-abdominal disproportion a
b
b
Oleksandr Nazarchuk , Dmytro Dmytriiev , Konstantin Bertsun a Khmelnytskyi City Children's Hospital, Ukraine b Vinnitsa National Medical University, Ukraine
Materials and methods We examined retrospectively eight patients who had thoracoamniotic shunt placement for antenatal pleural effusion between 2007 and 2009. Results
Aim Objectives were the optimization of mechanical ventilation approach of newborns with gastroschisis and omphalocele in perioperative period by the way of studying their lung mechanical characteristics. Materials and methods In our research, 57 newborns were enrolled, 42 neonates (73.7%) had gastroschisis and 15 ones (26.3%) — omphalocele. This study was conducted during all steps of visceroabdominal disproportion surgical correction (by the way of multivectorial gradual distraction of all abdominal wall layers). We used volume control ventilation with PEEP — 5 mm H2O, PIP — 12–22 mm H2O breath frequency 30–35 per minute. Monitoring of dynamic compliance, pressure–volume loop, flow–volume loop, and capnography was essential.
Out of eight patients (4 male, 4 female) 3 were term, 5 were preterm; 5 babies were born by cesarean section. Polyhydramnios was seen in 5 cases. Three neonates needed intubation in the delivery room. Skin edema was the second most frequent finding. Six babies were hydropic. The etiologic diagnoses were: primary pulmonary effusion (1), congenital adenomatoid malformation (1), and non-immune hydrops fetalis (6). Five patients had unilateral, three patients had bilateral shunt placement. The time interval between shunt insertion and birth was between 1 day and 9 weeks. The external open site of the shunts was clamped after birth and replaced with a thoracic drainage tube postnatally. Two shunt complications were seen: 1. Displacement of the shunt into the thoracic cavity which was removed by thoracoscopy and 2. Displacement of the shunt into the amniotic fluid. This patient had four shunts inserted in which one of them was displaced. All but one of the babies needed mechanical ventilation. Two patients (%25) died in the first hours of life. Conclusions
Results Data are presented for both groups similar by sex-dimorphism, gestation terms, and middle age. We increased compliance, minute volume, decreased the lung resistance and medium airway pressure during stable preoperative period. The period of abdominal organs' plunging inside the abdominal cavity showed a progressive compliance decreasing (in 3.4 times), resistance (in 2.42 times) and medium airway pressure (till 14 cm H2O) increasing in both neonate groups. The reversion of lungs' mechanical characteristics to the very beginning could be achieved by the end of 72-d hour of distraction, by the way of protective volume-control ventilation (maximum volume 4–6 ml/kg with obligatory usage of PEEP not less than 5 mm H2O). Conclusions Recruitment maneuver and lung volume support by means of PEEP were easily implemented. We consider it may reduce frequency of ventilator associated lungs' injury, optimize insufflation of air– oxygen mixture in the lungs of babies who have viscera-abdominal disproportion.
doi:10.1016/j.earlhumdev.2010.09.177
Pulmonary hypoplasia secondary to pleural effusion may lead to significant morbidity and mortality. Only 25% of our patients died. Antenatal thoracoamniotic shunt placement is a very useful therapeutic option in the prevention of pulmonary hypoplasia but the possibility of complications of the procedure must be kept in mind. doi:10.1016/j.earlhumdev.2010.09.178
PP-125. Early high-frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation in very low birth weight infants with omphalocele Oleksandr Nazarchuka, Konstantin Bertsunb, Dmytro Dmytriievb, Yriy Palamarchukb, Oleksandr Katilovb a Khmelnytskyi City Children's Hospital, Ukraine b Vinnitsa National Medical University, Ukraine Aim To evaluate the feasibility of conducting prospective randomized trial comparing early high-frequency oscillatory ventilation (HFOV) to synchronized intermittent mandatory ventilation (SIMV) in very low birth weight (VLBW) premature infants with omphalocele.
S68
Abstracts
Materials and methods 15 infants weighing 501 to 1000 g, less than 4 h of age, who had received one dose of surfactant and required ventilation with mean airway pressure > 4–6 cm H2O and FiO2 > 0.25, and had an anticipated duration of ventilation greater than 48 h. Newborns were stratified by birth weight and prenatal steroid status, and then randomized to either HFOV or SIMV with tidal volume monitoring. Ventilator management for patients in both study arms was strictly governed by protocols that included optimizing lung inflation and blood gases, weaning strategies and extubation criteria. Results Data are presented for 7 HFOV and 8 SIMV infants (two infants, twins, were withdrawn from the study at parent's request). 7 of the 7 HFOV infants and 7 of the 8 SIMV infants survived to 36 weeks corrected age. Age at final extubation for survivors was 6.2 ± 2.3 (mean ± SD) days for HFOV infants and 8.4 ± 2.1 days for SIMV infants. At 36 weeks corrected age, 7 of the 7 HFOV survivors were extubated and in room air, whereas 1 required supplemental oxygen. In comparison, 4 of the 8 SIMV survivors were extubated and in room air, whereas 4 required supplemental oxygen. Grade III/IVIVH and/or periventricular leukomalacia occurred in 1 HFOV and 4 SIMV patients. Conclusions The protocols for the early HFOV versus SIMV in VLBW infants ventilator management, both with HFOV and with SIMV were easily implemented and consistently followed, and data are presented here. doi:10.1016/j.earlhumdev.2010.09.179
PP-126. Efficacy of nasal flow-synchronized intermittent positive pressure ventilation (NFSIPPV) in treating apnea of prematurity (AOP): Preliminary results Camilla Gizzia, Chiara Castellanoa, Valentina Panettab, Chiara Mariania, Paola Papoffc, Corrado Morettic, Rocco Agostinoa a NICU, Fatebenefratelli Hospital, Isola Tiberina, Italy b Sesmıt, Afar, Fatebenefratelli Hospital, Isola Tiberina, Italy c Pediatric Icu, “Sapienza” University of Rome, Italy Aim AOP is a common problem of prematurity that represents a possible risk towards damage of the developing brain. Our aim was to assess the effect of three modes of nasal ventilation on the frequency and extent of apnea and bradycardia in preterm infants. Materials and methods Infants of <34 weeks gestation, in stable conditions and receiving caffeine, who were treated by Nasal Continuous Positive Airway Pressure (NCPAP) for AOP were enrolled in a randomized crossover study. During the study NCPAP, Nasal Intermittent Positive Pressure Ventilation (NIPPV, respiratory rate 20 bpm) and NFSIPPV (A/C mode) were applied in random order for 6 h each. Nasal ventilation was delivered by “Giulia” neonatal ventilator (Ginevri, Italy). Respiratory impedance, heart rate (HR), O2 saturation (SpO2), transcutaneous O2 and CO2, flow and airway pressure were simultaneously recorded through the study (Monitor Infinity Delta XL, Draeger, Germany). Apnea was defined as the absence of respiratory efforts for >20 s, or <20 s when associated with bradycardia (<100 bpm) or hypoxemia (SpO2 <85%).
Respiratory pauses >4 s not associated with bradycardia or hypoxemia were also considered. The frequency (number/h) and the extent of apnea, bradycardia and respiratory pauses >4 s were documented as well as SpO2, HR and transcutaneous blood gas values during the apneic episodes. Results To date 5 infants were enrolled (GA 27 ± 1.5 weeks, birth weight 920 ± 246 g). The median apneic spell rates during NCPAP, NIPPV and NFSIPPV were 2.3, 2.1 and 0.8 per hour respectively (p = 0.046). The longest apnea episodes were 26 ± 8, 20 ± 4 and 18 ± 12 s respectively (p = 0.042). The median frequencies of the respiratory pauses >4 s per hour were 15.4, 9.6 and 10.2 respectively (p = 0.0342). No significant differences were observed among the other parameters considered. Conclusions NFSIPPV may be more effective in treating AOP than NCPAP and NIPPV in preterm infants. Moreover both NIPPV and NFSIPPV may stimulate the respiratory drive by reducing the respiratory pauses >4 s. Support: grants from Chiesi Pharmaceuticals and Fatebenefratelli Association for Research. doi:10.1016/j.earlhumdev.2010.09.180
PP-127. Determination of serum mannan-binding lectin (MBL) levels and frequency of MBL gene polymorphism in cases with neonatal sepsis Hilal Ozkana, Nilgün Koksala, Merih Cetinkayaa, Sebnem Kılıcb, Solmaz Celebid, Barbaros Oralc, Ferah Budakc a Uludag University, Faculty of Medicine, Department of Neonatology, Turkey b Department of Pediatric Immunology, Turkey c Department of Immunology, Turkey d Department of Pediatric Infectious Disease, Turkey Aim Mannan-binding lectin (MBL) is a plasma protein that plays an important role in the innate immune response and circulating MBL concentrations are associated with the genetic variations in the structural and promoter regions. The aim of this study was to determine the serum MBL levels and the frequency of MBL gene polymorphism in infants with neonatal sepsis. Materials and methods Between January 2005 and January 2007, a total of 93 infants were included in this study and 53 of them had neonatal sepsis diagnosis as study group and 40 infants who had no sepsis according to clinical and laboratory findings as control group. Serum MBL levels and MBL gene polymorphisms of these infants were studied. Results Serum MBL levels were found to be low in 17 of 93 infants that were included in the study. Eleven of them were in the sepsis group and 6 of them were in the control group (p < 0.05). Serum MBL levels were significantly lower in infants with sepsis compared with the control group. In the study group, the mean serum MBL levels were found to be significantly lower in the premature infants compared